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Welcome to the newest column in Wilderness Medicine Magazine. In this column we’ll be exploring topics surrounding the systematic and formal delivery of wilderness medicine via an EMS system. While this is one of the most professionally-oriented and least recreationally-oriented of the magazine’s columns, for both of us, it is also deeply personal. In the installments to come we’ll not only explore the technical elements of delivering wilderness EMS (WEMS) care, but also some of the deeper and richer reasons why this niche of wilderness medicine is so important to us. In this, our first installment, we’ll begin the column by sharing this story from Tyler Prince and our thoughts about it.

When I was twenty-three, I helplessly watched a close friend die. Rob and I had both moved out to Colorado after graduating from college the year prior, and, connected by mutual friends, wound up “peak bagging” Colorado’s fourteeners (mountains with an elevation of at least 14,000 feet) together. As we grew more comfortable in the mountains, our objectives—while modest by alpine standards—became longer, faster, and more harrowing. We narrowly skirted disaster more times than I care to admit. Weeks before his death we had descended Capitol Peak in dense fog, only to be caught in a torrential downpour as we broke camp at the lake. One member of our climbing party contracted not insignificant hypothermia on the hike out to the car. A week to the day before Rob’s death, I had fallen fifty feet down a snowfield while on a solo traverse of the Wilson Group, and had somehow managed to summit Wilson Peak and hike out, only to shrug it off as a learning experience. Rob was always the most cautious of the group. He seldom hesitated to turn back, almost as happy to have simply spent a great day in the mountains as he was to have reached a summit.

On August 25th, 2012, five of us set out to climb Snowmass Mountain via the “S Ridge,” followed by a traverse over to North Snowmass, and then back across to Centennial thirteener Hagerman Peak. Anyone who’s spent much time in Colorado’s Elk Range knows how draining climbing here can be. The route was low class five (on the climbing rating system) at its worst, but mostly consisted of class three slabs the size of VW Beetles that teetered when you stepped on them. Rob had memorized enough beta to know which side of the Beetles to walk on to avoid their toppling. We’d have to be aggressive enough to hit the final summit by noon, but graceful enough not to set off a rockslide. Caution aside, somewhere not far below what was supposed to be the final summit of the day, the mountain collapsed underneath Rob’s feet. He fell over fifty feet, and within an hour, succumbed—we would eventually learn—to chest trauma and a ruptured spleen.

I had been just below Rob when the ridgeline gave way, and, with my ankle shattered by the rockfall, was unable to descend the technical terrain to get to him. Our friend Greg, fortunately, downclimbed and was with him when he died. A Black Hawk helicopter would pull us off the mountain four hours later, leaving Rob’s body to be recovered by Mountain Rescue Aspen the next day. Part of me, however impractical, will always wonder if his fate might have been different had I magically at that moment been endowed with the medical training I’ve been pursuing since.

For some reason, it has become taboo to talk about personal tragedies, however formative. In the years since our accident, I’ve worked as an urban paramedic, finished climbing all of Colorado’s fourteeners, and completed the brunt of med school. Like so many medical folks interested in wilderness medicine, I’m drawn to the philosophy of “anything, anywhere, anytime.” The wilderness and medical mindset overlap considerably. The requisites for a good shift—focus, endurance, skill—are similar to those for a hard day in the mountains. Risk analysis based off of little information is vital and can change at any second. Nonetheless, more than any more logical reason, this one incident in the mountains drove me toward wilderness medicine, and the chance to have the medical training I imagined might have been helpful. That day was the worst of my life. But the calm that washed over me as I was winched off the mountain, dangling thousands of feet over Lead King Basin, was the closest experience to a spiritual awakening I may ever have. From that vantage, tragedy made the world no less beautiful.

Academic medicine’s push for humanism directs us to share our trauma; its push for professionalism demands we repress it. Now more than ever, we’re reminded how uncomfortable we are with that cognitive dissonance. In medicine, we are obsessed with certainty. We order myriad tests to confirm what we already know, and countless others to rule out what we barely suspect. And, when things go wrong, we try and find a reason. But in out-of-hospital medicine—and in the wilderness, perhaps the fiercest and furthest “out” of the out-of-hospital environments—there’s just no way we can fully tame the chaos. We will always be outside our comfort zones, simply trying to make sense of it all. The fact is that this disaster has few learning points or admonitions for others. Rather than an embodiment of the consequences of an error, it merely represents a pre-existent and always present fixed risk of wilderness adventure. What may be more important than technical lessons, or some assignment of blame, is the reality that a thin and emotionally powerful space can open at the intersection of the wilderness and the formal delivery of rescue care within it. We hope to share technical information and lessons, but sometimes, as in this story, it is equally important to share the passion and transcendence that our work can bring. We hope this column brings readers to that space frequently as well.

Further reading on this topic from Wilderness Medicine Magazine:
Hawkins SC. Table rock rescue (revised). Wilderness Medicine 2009; 26(1):16-18.

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