SYMPOSIUM SCHEDULE

3rd International Mountain Medicine Symposium Schedule

September 25th – 29th, 2019

2019-09-25
2019-09-25
Kendall Mountain Recreation Center
2019-09-26
2019-09-26
Kendall Mountain Recreation Center
2019-09-27
2019-09-27
Kendall Mountain Recreation Center
2019-09-28
2019-09-28
Kendall Mountain Recreation Center
2019-09-29
2019-09-29
Kendall Mountain Recreation Center
Kendall Mountain Recreation Center
Kendall Mountain Recreation Center
Kendall Mountain Recreation Center
Kendall Mountain Recreation Center
Kendall Mountain Recreation Center
Pre-Symposium Technical Rope Rescue Workshop image
08:00 - 17:00
Pre-Symposium Technical Rope Rescue Workshop

This 2-day hands-on workshop is structured for mountain rescue personnel committed to developing and reinforcing their technical rope rescue skills in a variety of challenging terrain settings. Our primary emphasis in this team-oriented overview will be exploring select rigging options and techniques that are safe, timely, efficient, and most importantly gentle on the patient and rescuers. In addition, a critical thinking hands-on approach in introducing the “whys” behind safe, timely and efficient rope rescue rigging and systems analysis based on the rules of physics will be the hallmark of this workshop.

Much of our time will be spent in realistic, practical, and challenging terrain settings in and around the Silverton area. Workshop size is limited to 16 students. Sign up early as this workshop will fill up quickly! Learn More

Pre-Symposium Technical Rope Rescue Workshop image
Leo Lloyd RN, NRP, Seminar Planning Committee Member
EMS Captain at Durango Fire and Rescue / Technical Rescue Instructor
Pre-Symposium Technical Rope Rescue Workshop image
Ian Ellis, EMT
Pre-Symposium Technical Rope Rescue Workshop image
08:00 - 17:00
Pre-Symposium Technical Rope Rescue Workshop

This 2-day hands-on workshop is structured for mountain rescue personnel committed to developing and reinforcing their technical rope rescue skills in a variety of challenging terrain settings. Our primary emphasis in this team-oriented overview will be exploring select rigging options and techniques that are safe, timely, efficient, and most importantly gentle on the patient and rescuers. In addition, a critical thinking hands-on approach in introducing the “whys” behind safe, timely and efficient rope rescue rigging and systems analysis based on the rules of physics will be the hallmark of this workshop.

Much of our time will be spent in realistic, practical, and challenging terrain settings in and around the Silverton area. Workshop size is limited to 16 students. Sign up early as this workshop will fill up quickly! Learn More

Pre-Symposium Technical Rope Rescue Workshop image
Leo Lloyd RN, NRP, Seminar Planning Committee Member
EMS Captain at Durango Fire and Rescue / Technical Rescue Instructor
Pre-Symposium Technical Rope Rescue Workshop image
Ian Ellis, EMT
07:00
Registration Desk Opens
08:00 - 08:15
Welcome
Welcome image
Kimmet Holland NRP AIARE II, Seminar Planning Committee Member
Director, Silverton EMS
Welcome image
Jay Mathers, DO FAWM c-ISTM Conference Planning Committee Member
DO, Seminar Planning Committee Member
08:30 - 09:30
General Session: The Five Top Research Papers in Mountain Medicine 2019
General Session: The Five Top Research Papers in Mountain Medicine 2019 image
Darryl Macias MD, FACEP, FAWM, DiMM
Darryl Macias MD, FACEP, FAWM, DiMM
09:45 - 10:45
General Session: Nutrition in Extreme Environments – Eat, Drink, AND Survive!

This discussion, in lecture and interactive format, will discuss the latest strategies with regard to the best evidence in improving human performance and minimizing exhaustion in high altitude, cold, and hot environments. Nutritional and hydration myths will first be covered, with the presentation of evidence that is behind such nutritional strategies including ketogenic diets, intermittent fasting, carbohydrate loading, use of branched chain amino acids, carnivore diets, and vegan versus vegetarian diets. Hydration strategies for extreme sports in extreme environments will also be discussed, with case based studies from the Badwater 135 ultramarathon, the recent self-supported conquest of the Antarctic, as well as strategies used by top high altitude climbers.

General Session: Nutrition in Extreme Environments – Eat, Drink, AND Survive! image
Jamie Newberry, MD
09:45 - 10:45
Hemorrhage Control in Austere Environments

This session will cover:
• Interactive lecture, discussion, with demonstrations involving attendees will discuss the importance of hemorrhage control and how you CAN cave a life.
• Different strategies of hemorrhage control will be discussed, debated, and demonstrated
• Learn whether or not you should carry a commercial tourniquet
• Explore techniques that can be attempted prior to tourniquet application
• Just as important, when should you go straight to a tourniquet
• Once I place a tourniquet does it have to remain indefinitely?
• Do improvised tourniquets actually work or can they make an already bad situation worse?
• What’s the deal with TXA? Should I carry it?  When is it useful?  Show me the data!
• What about topical agents?  What’s out there, what’s the difference, does it really work?
• There is good literature showing that one of the main things we can do to save lives in a pre-hospital setting involves minimizing blood loss. This interactive lecture will cover the literature and attendees will leave with a much better understanding of not only why hemorrhage control is so important but will leave with new found knowledge and skills that they can immediately apply.

Hemorrhage Control in Austere Environments image
Risa Garcia, MD
Risa Garcia, MD
11:30 - 15:30
Manuel Genswein Afternoon Field Class

In the field with Manuel from 11:30-3:30. *Sack lunch in field/en route

Manuel Genswein Afternoon Field Class image
Manuel Genswein, Planning Committee
11:30 - 13:00
Lunch (on your own)
13:00 - 14:00
Breakout Session: Wound Care and Pain Management in the Austere Environment

This session will discuss guidelines and mostly evidenced based approach to austere wound care and pain management.

Breakout Session: Wound Care and Pain Management in the Austere Environment image
Jay Mathers, DO FAWM c-ISTM Conference Planning Committee Member
DO, Seminar Planning Committee Member
13:00 - 14:00
Breakout Session: Helicopter Mountain Operations

Helicopter capabilities: performance, pick up personnel and equipment, external load/body recovery, find backcountry access for ground SAR, search in areas that can’t be viewed by ground or fixed wing
-Learn what ground SAR can do when they are picked up, to help with aerial assist
-Become conversational about search patterns, arm signals, your role as ground SAR involved in aerial searches.
-Students should be able to understand helicopter performance, when to use a helicopter, what goals the helicopter pilot has during a SAR, public use utilization, what is expected of them as a helicopter crew member.

Breakout Session: Helicopter Mountain Operations image
Brandon Laird, Chief Pilot, Certified Flight Instructor, BS
Chief Pilot for Colorado Highland Helicopters Search and Rescue
Breakout Session: Helicopter Mountain Operations image
Dayle Morningstar Laird, MS, FP-C
Dayle Morningstar Laird, MS, FP-C
14:15 - 15:15
Chest Tubes and Rapid Sequence Intubation in The Field: Preparing for Transport 

In this presentation by Flight For Life Colorado, crew members will review the indications for  and the procedures involved when preparing for and performing Rapid Sequence Intubation (RSI) and Chest Tubes. This lecture will address how to best prepare for RSI and chest tubes in the field and the procedures involved by advanced providers. Case reviews of Flight for Life calls involving SAR and EMS services will highlight the importance of field personnel and preparation for RSI and chest tubes as well as the transitional care provided by flight crew. Time will be allotted for hands on intubation practice and chest tube placement.

Chest Tubes and Rapid Sequence Intubation in The Field: Preparing for Transport  image
Heather Lauritzen RN, BSN, CCRN
Chest Tubes and Rapid Sequence Intubation in The Field: Preparing for Transport  image
Maggie Sullivan, RN, BSN, CCRN, CFRN
14:15 - 15:15
Breakout Session: Critical Thinking – Urban to Austere

This session explores how education has been shifting toward the application of information (critical thinking) then discusses ways in which the austere setting complicates the application of knowledge and skills with the need to adapt to various challenges. Intended outcome is the increased awareness of the complexities of the austere environment in wilderness medicine, better preparation for successful management of a medical patient in the absence of normal resources

Breakout Session: Critical Thinking – Urban to Austere image
Scott Sholes, BA, EMT-P
EMS Chief at Durango Fire Protection District
15:30 - 16:30
Breakout Session: Ice Climbing Fall Multisystem Trauma Case Study

In January 2018 I was the care provider for a 40 foot ice climbing fall victim. This course is a detailed case study focused on the assessment, treatments, and difficulties faced with a critical multi-system traumatically injured patient at the bottom of a canyon in winter. This lecture is developed for physician, ALS and BLS care providers that whether professionally or recreationally find themselves caring for patients in the rural or backcountry setting. Through interaction in the classroom and student input the learner will come away with new perspectives and outlooks when faced with the multi system traumatically injured patient. While there will not be a formal test learners will be expected to integrate assessments and treatments obtained from the presentation into practical scenarios the learners participate in throughout the symposium. 

Breakout Session: Ice Climbing Fall Multisystem Trauma Case Study image
Nate McGrath, NRP
15:30 - 16:30
Breakout Session: Lightning

What are the chances I’ll be struck by lightning in my life? (higher odds than winning the lottery)
· How is it that lighting causes injury to a person?  What body systems/organs are affected?
· Are there different types of lightning strikes?
· What does the term “Reverse Triage” mean, and why should I care?
· Learn this and more through an up to date and comprehensive discussion regarding the pathophysiology of lightning strikes, injury patterns, and appropriate treatment for lightning strike victims. Up to date guidelines including mechanisms of lighting injury, review of potential injuries/organ systems involved, appropriate treatment for lightning injuries including reverse triage in mass casualty scenarios, and means to reduce risk of lightning strikes will be discussed.

Breakout Session: Lightning image
Jake Jensen, MD
Jake Jensen, MD
16:45 - 18:00
General Session: Avalanche Medicine and Rescue
General Session: Avalanche Medicine and Rescue image
Scott McIntosh MD, MPH, FAWM, DiMM
Director, Wilderness Medicine Fellowship
18:00 - 19:30
Dinner (on your own)
19:30 - 21:00
Evening Event Around Town
07:30
Registration Desk Opens
08:00 - 09:00
General Session: Hypothermia – From Bubble Wrap to ECMO

This General Session will cover:
• Interactive lecture, discussion, and demonstrations regarding hypothermia and its treatment
• Attendees will learn about the pathogenesis, etiology, and those most at risk for hypothermia
• Cases will be presented as we go through the various levels of hypothermia
• Live demo will safely get one of the co-presenters mildly hypothermic just prior to and during the early portion of the lecture
• As we move through and discuss rewarming techniques we will begin to treat our “patient”
• Multiple treatment techniques will be discussed along with what does/doesn’t work, we will also attempt to dispel myths surrounding the treatment of hypothermia
• Attendees will then not only listen and look at proper treatment techniques but will see them put into action
• Special circumstances such as intermittent CPR, when to terminate efforts, extended care scenarios, preferred destinations (ie capability of hospital) based on degree of hypothermia will also be discussed
• Special attention will also be given regarding data/outcomes in patients that have successfully undergone ECMO (thank you friendly Europeans)
• Questions and experiences will be encouraged from the audience
• Learners will be those in the healthcare field with varying levels of experience (EMT, NP, MD, etc) who have either an interest in treating patients in a pre-hospital/wilderness setting or currently already do so.
• Up to date guidelines, current research will be used to teach proper care for patients suffering from various levels of hypothermia. This will entail pre-hospital care, extended care scenarios, preferred destinations (ie capability of hospital) based on degree of hypothermia.
• End goal will be for attendees to understand the pathophysiology of hypothermia, distinguish the different levels of hypothermia, and to know the appropriate treatment and special considerations regarding hypothermic patients.

General Session: Hypothermia – From Bubble Wrap to ECMO image
Jake Jensen, MD
Jake Jensen, MD
General Session: Hypothermia – From Bubble Wrap to ECMO image
Risa Garcia, MD
Risa Garcia, MD
09:15 - 10:15
General Session: Brain Injury – From the Sidelines to the Summits

Head injury is a common and concerning problem in outdoor recreation, backcountry rescue, and sports at all levels. SAR medical director and sports physician Dr. Tim Durkin will review the latest science and standards in brain injury from the highest levels of sport, and apply them to backcountry context. At the conclusion of this activity, participants will be able to:

  • Define concussion, and discuss its signs, symptoms, natural history and importance of recognition.
  • Evaluate a patient with unclear findings to determine the presence or absence of a concussion.
  • Appropriately manage and disposition a patient with brain injury in a backcountry setting, regardless of severity.
  • Identify resources to learn more about brain injury evaluation, management and legal obligations.
General Session: Brain Injury – From the Sidelines to the Summits image
Timothy Durkin, DO, FAAEM, CAQSM
Timothy Durkin, DO, FAAEM, CAQSM
10:30 - 11:30
General Session: Transient Neurological Deficits at Altitude
General Session: Transient Neurological Deficits at Altitude image
David Hughes, MD
11:30 - 16:30
Manuel Genswein Afternoon Field Class

In the field with Manuel from 11:30-3:30. *Sack lunch in field/en route

Manuel Genswein Afternoon Field Class image
Manuel Genswein, Planning Committee
11:30 - 13:00
Lunch (on your own)
13:00 - 14:30
Breakout Session: The Five Lethal Chest Pains

Although rare, true medical emergencies can and will occur in the backcountry. The 5 lethal chest pains (myocardial infarction, tension pneumothorax, esophageal rupture, aortic dissection and pulmonary embolis) are a true life threat and require immediate assessment, treatment and transport to an appropriate hospital. Recognizing through various assessments, symptoms and signs the care provider can appropriately treat a patient and prompt appropriate transport to the appropriate hospital. This lecture is developed for physician, ALS and BLS care providers that whether professionally or recreationally find themselves caring for patients in the rural or backcountry setting. This lecture will provide a detailed focus on the 5 lethal chest pains. Focus will be on the assessments, differences in presentation and appropriate treatments when faced with the chest pain patient in the backcountry setting. The learner will be expected to participate and interact throughout the lecture. While there will not be a formal test it is expected that the learner utilize the knowledge gained from the lecture in the practical scenarios throughout the symposium.

Breakout Session: The Five Lethal Chest Pains image
Nate McGrath, NRP
13:00 - 14:30
Breakout Session: Group Cognition in Austere Mountain Environments

We assume that two (or three, or four) heads are better than one when performing complex tasks in complex, high-risk environments. While this is generally true, much of the benefit we can gain from groups is highly dependent on how the group is organized, and how communication flows within the group. This workshop will develop students’ ability to perform complex tasks in groups, focusing on tasks that are time-sensitive and involve some degree of risk. Drawing from expertise and theory in cognitive science and outdoor education and leadership, this workshop will utilize hands-on, experiential activities as well as reflection and discussion about communication and group dynamics in austere environments.

Breakout Session: Group Cognition in Austere Mountain Environments image
Russ Costa, Ph.D
14:45 - 15:45
Breakout Session: “MacGyver” in the Mountains – Improvised Medical Skills

· If you enjoyed the show, 80’s, and mullets then you will enjoy this interactive lecture, discussion, and demonstrations of improvised medical skills

· What do you carry in your bag?  Does it have more than one use?

· How can I use my hydration bladder as a splint?  What about dehydration if a person is unable to keep things down by mouth, is their another way I can hydrate them with the hydration bladder?

· Learn the “Epi-pen” hack and how to get 2-3 doses out of a single epi-pen

· Can I use a foley catheter as a chest tube?  Is it possible to improvise a water seal system for pneumothorax out of Gatorade bottles?

· Multiple topics such as wound care, hemorrhage control, fracture care/splint, dehydration, anaphylaxis, airway/respiratory issues will be discussed.  

· Up to date literature including case reports, research articles, and up to date practice guidelines will be discussed to help attendees provide the best care possible in a wilderness/austere setting, often with limited resources

· End goal will be for attendees to be better able to provide care for a variety of conditions with the limited supplies that may be available in a wilderness/austere setting. 

Breakout Session: “MacGyver” in the Mountains – Improvised Medical Skills image
Jake Jensen, MD
Jake Jensen, MD
14:45 - 15:45
Breakout Session: PIT CREW Approach to Cardiac Arrest

This session provides knowledge of how to get rural EMS services organized to provide the best care for cardiac patients that are remote and have long transport times and/or need to be flown to the appropriate facility for definitive care.

Breakout Session: PIT CREW Approach to Cardiac Arrest image
Greg Childress, NRP
Volunteer Coordinator for Durango Fire & Rescue
16:00 - 16:45
“MacGyver” hands-on scenario-based group activity
“MacGyver” hands-on scenario-based group activity image
Darryl Macias MD, FACEP, FAWM, DiMM
Darryl Macias MD, FACEP, FAWM, DiMM
16:00 - 16:45
The Pediatric Assessment Triangle (PAT)

Most people in emergency medicine have been taught the pediatric assessment triangle. It is presented as a memory aid for the initial assessment of the pediatric patients. To simply use it as a memory aid is to not get the full benefit out of this tool. We will be looking at how to use the PAT as a driver of initial treatments as well as determining transport modality in the austere environment.

This lecture will expound on the popular memory aid, the pediatric assessment triangle. We will discuss how to use this as a tool to drive initial treatment and transport decisions in critically ill pediatric patients. In the austere environment many times best care comes down to best transport modality. The PAT can be used to help determine risk/benefit of our various transport options.

17:00 - 18:00
General Session: Traumatic Cervical Spine Injuries – Pearls and Pitfalls

Understanding different levels of cervical spine injury, understanding decision making guidelines for Trauma. Spine Surgery, Understanding the Subaxial Injury and Severity Scale (SLICS), being able to perform a basic neck exam in the field.

Participants will leave having a basic understanding of guidelines and decision making steps for the surgical treatment of traumatic cervical spine injuries through interactive case studies and slide presentations. Talk is geared towards first responder to accident or emergency rescue operation, EMT, nurses, residents, midlevel providers, physicians.

 

General Session: Traumatic Cervical Spine Injuries – Pearls and Pitfalls image
Dr. Jens-Peter Witt
Associate Professor Director, Neurosurgery Spine University of Colorado
18:00 - 19:00
Social Hour at Kendall Lodge

Appetizers and beer/wine/soda

19:00 - 20:00
Dinner (on your own)
07:00
Registration Desk Opens
08:00 - 09:30
General Session: Trauma Update
General Session: Trauma Update image
Charles W Mains, MD, FACS
Director of Trauma at Centura Health Trauma System
09:45 - 10:20
General Session: Khumbu Sherpa Training

This session will discuss personal experiences had by UNM IMMC Faculty (myself and others) while teaching medicine to 175+ Nepalese guides/porters in the Khumbu Valley of Nepal at the Khumbu Climbing Center.  Will discuss the need for this teaching and provide tips on how others can prepare to teach necessary medical skills to others along with lessons learned so that attendees have a better understanding how to teach others. Will discuss special considerations such as preparation beforehand including curriculum development, gathering supplies, logistics, language barrier, etc.  

General Session: Khumbu Sherpa Training image
Jake Jensen, MD
Jake Jensen, MD
10:30 - 11:15
General Session: Avalanche Rescue Updates

This session provides knowledge on the specific approach to avalanche victim burial by European specialists in the field with use of HEMS, resuscitation guidelines, extrication guidelines and transfer to definitive care in the European model set forth by experts in the field.

General Session: Avalanche Rescue Updates image
Manuel Genswein, Planning Committee
11:30 - 00:15
General Session: Skier #2 – Decision Making and Risk Acceptance in the Mountains

This session will discuss the basics of how humans make decisions and assess risk in the mountains, why they accept risk, and discuss frequent mistakes in decision making real time. The goals are to provide better understanding of the unconscious processes of risk assessment and decision making to be able to make more informed and better decisions during mountain recreation.

This lecture will be suitable for all learner levels, anyone participating in mountain recreation. The learners should be able to define risk, define decision making, list several well know “heuristic traps”. The gap exists in the difference between the subconscious process that occurs during decision making, and raising the baseline to make it a more conscious process, with the outcome being learning and change in behavior. 

General Session: Skier #2 – Decision Making and Risk Acceptance in the Mountains image
Aaron Reilly, MD, DO, DiMM
Aaron Reilly, MD, DO, DiMM
Select date to see events.
Please be aware that the schedule is subject to change.

Click here to download the Schedule in PDF format.