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Extreme medics

Madigan's austere and wilderness medicine fellowship trains military physicians for the fight

Dr. Tracy Trujillo, a pediatrician and wilderness medicine expert, center, is loaded onto a makeshift gurney during the Military Mountain Medicine Course. Photo credit: Sgt. Zachary Gardner

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Editor's Note: The following is the first in a series profiling Madigan Army Medical Center.

Imagine you're alone and injured on a trail near the base of Mount Rainier. You've already called for help, but you're still scared, immobile and in need of medical assistance as soon as possible. Chances are medical professionals will rescue you, and they'll do so with expert training from Madigan Army Medical Center's Austere and Wilderness Medicine Fellowship.

"The fellows work with the rangers on Mount Rainier and provide training to multiple operational units within DoD and other government agencies," said Dr. (Col.) Ian S. Wedmore, director of the Austere Wilderness Medicine Fellowship at Madigan. "This training benefits the DoD by providing (austere wilderness medicine) expertise to a spectrum of medical providers ... The fellowship also provides its expertise to the national park service backcountry rangers and homeland defense medical personnel who work in austere settings."

The one-year fellowship began in July 2010 as a Department of Defense (DoD) pilot program at Madigan and is designed to train physicians to become subject matter experts on "austere operational care," or care provided in resource-limited environments where advanced technology is unavailable. Remote wilderness settings, combat zones, disaster situations or in-flight emergency care are all examples of austere environments.

"Madigan was chosen as the (first) DoD location (to host the fellowship), as we have the individuals with subject matter expertise in wilderness medicine, as well as the ideal mountain, ocean and operational unit combination for training in wilderness medicine," Wedmore said. "The goal of the fellowship is to train medical professionals in all aspects of austere and wilderness medicine so that on completion of the fellowship, they can fill an operational role ... and bring their expertise to those units that operate in the austere setting."

Initially, the fellowship only allowed for one participating fellow per year, but it has since grown to allow for two. It is open to all military emergency medicine, family medicine and internal medicine physicians. To date, 10 fellows have graduated from the program.

"The training provides knowledge in the medical conditions that are encountered across the full spectrum of an operational setting, including altitude illness, hypothermia, heat injury and trauma care in the austere setting, as some examples," Wedmore said. "The fellows also learn improvised patient care, patient rescue and extrication in a variety of austere environments."

With more than 20 years of wilderness medicine experience, an extensive background in emergency medicine, eight deployments to combat zones and operational experience with U.S. Special Operations Command (USSOCOM), Wedmore is uniquely qualified to lead the Austere and Wilderness Medicine Fellowship. He's also an avid climber who has climbed Aconcagua, Denali, Kilimanjaro and Elbrus mountain peaks.

Maj. Owen McGrane serves as the assistant program director of the Austere Wilderness Medicine Fellowship. He and Wedmore are the primary instructors of the program, but, "when we run wilderness and mountain medicine short courses, we have a large cadre of instructors we can utilize," Wedmore said.

Fellowship training is conducted at Madigan and other areas on Joint Base Lewis-McChord; Mt. Rainier; Crystal Mountain; San Antonio; The Army Mountain Warfare School in Jericho, Vermont; and other locations. By the end of the fellowship, fellows will become certified Austere Wilderness Life Support (AWLS) instructors and receive an International Diploma of Mountain Medicine. They'll also have provided training to Special Forces, Ranger regiment and Homeland Defense units and taught the Military Mountain Medicine Course (M3C) to other DoD medical providers.

"The training ... also teaches medical providers to improvise, evaluate and treat patients in the austere, ‘outside the military treatment facility' setting. This can be challenging for many providers," explained Wedmore. "The training helps to develop the ‘austere mindset' that a fully deployable, operationally trained medical provider desires."

Since its inception, Madigan's Austere Wilderness Medicine Fellowship has garnered recognition from the U.S. Army Medical Command (MEDCOM). The fellowship's training and funding is currently being evaluated for expansion.  

Next in the series: "Madigan's new facilities," Jan. 4.

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