Pre-hospital Urban and Wilderness Rescue and Recovery
I am a wilderness emergency medical technician (W-EMT) in California, where I am the president of Stanford’s Emergency Medical Service (StEMS) and I volunteer with the Bay Area Mountain Rescue Unit (BAMRU). I am particularly interested in bringing high quality medical care to the pre-hospital environment, even in severe or resources limited conditions. BAMRU specializes in missing person search in any environment and in high-angle high-altitude technical rescue. Medical resources are very limited in these kinds of environments, and transport times to the hospital can be very long, so I put a lot of energy into learning in-the-field patient stabilization and treatment techniques.
I am currently preparing for medical school with the hope of possibly becoming an emergency physician. I am interested in emergency medicine in part because I feel that it is a field uniquely positioned to serve an extremely diverse population of patients, with the perhaps the most diverse array of maladies in medicine. This is particularly true in the United States where the emergency department is one of the few havens for the uninsured and the under-insured, in addition to being a frequent admission route to the hospital for the insured. Furthermore, the sick from all ethnicities, cultures and orientations come through the emergency department when they are at their sickest. In other areas of medicine this is often not the case, people tend to segregate themselves and choose providers by whichever identity matters to them this most. This exposure to patients from every background, when they are the sickest and most in need of help, combined with the sheer diversity of maladies served by emergency providers, is what draws me the most to emergency medicine.
I believe strongly in Paul Farmer’s concept of “Physicians as advocates for the poor”. While the poor of the United States have unjustifiably limited access to care (often being limited entirely to the emergency department if they have any access at all), the poor in the majority of this world have virtually no access to even rudimentary care. This limited access is made substantially worse by equally limited access to money, clean water, sufficient food, adequate policing, and to the education required to effect the greater political environment. This confluence of hardships is perhaps one of the most difficult to manage or improve, particularly for someone hailing from a former colonial power; there are just so many interconnected problems. However, I believe it is possible to not just temporarily fix the symptoms of abject poverty, but to actually effect permanent change, it will just take time and dedication.
Physicians are uniquely positioned to contribute substantially to improving the conditions that lead to abject poverty. A population beset by illness and malnourishment is not in a position to innovate, to effect political change, or to substantially change its own reality. Ill-health and nutrition can lead to real development defects as well as a general malaise. While improvements in access to healthcare and food alone are not enough to permanently change a community, they are essential components enabling that change.
I love the wilderness, particularly wild mountains. These places are necessarily isolated, and so they should remain, but this isolation creates a unique medical need: how do you provide adequate healthcare in an environment hours, days, or even weeks away from advanced medical resources? This problem is compounded by the nature of the wilderness itself, and by the activities people undertake in these places. The wilderness brings harsh weather and difficult terrain, and the people in these environments tend to do things that make severe trauma much more likely. Thankfully there is a suite of skills available that makes managing risk in the back-country much more feasible. The skills involved in the practice of wilderness medicine are what drew me to medicine initially, before everything else. I am already a certified Wilderness EMT, and I intend to continue to develop and extend my wilderness medical skills throughout my medical training.