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Med Wars: From the Winner's Circle

After a world-ending cataclysmic event you find yourself amongst a group of survivors. Armed with minimal supplies, a plucky attitude, and several turkey sandwiches you begin to formulate a plan. Off in the distance group of marauders is rapidly approaching. You open a map with with directions to possibly the last haven left in a post-apocalyptic world. 3…2….1… Go.

After a year hiatus, these were the opening moments of Midwest Medwars 2021. A race that is part scavenger hunt, part amazing race, and all wilderness medicine. I recently participated in the daylong event with two of my co-residents, Dr Gregory Pontasch and Dr E Chin Mak. The race was held in the Pickney Recreation area, and had I done any research prior to the event the location would have been an excellent clue on the distance we would be covering that day. (The estimated distance was included in the orientation packet, but I neglected to read that part.) In teams of three you must cover the trail using the map provided, GPS was allowed if you could get your phone to work and perform the various wilderness medicine themed challenges you encounter along the way. Every team was given a list of supplies they should bring as well as topics that were considered fair game for any of the stations along the way. Wilderness Medicine is defined as “Medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources.” Think of treating anything from minor to life threatening pathology outside of a hospital with only what you’ve brought, and with a hospital or even safe medical evacuation potentially hours away. Medwars stuck to this theme with multiple challenges throughout the roughly 16-mile course.

Our first challenge began with diagnosing a series of fractures and ended with forming a splint around one of our team members with a lower extremity fracture. Fortunately, we had prepared for this by packing duct tape. Unfortunately, we had neglected to bring any splinting materials. We did have to pay a penalty at this station in the form of a very poor rendition of the “YMCA”. Once we were given our cardboard, we fashioned a lower extremity splint for Dr Mak’s injury. Next, we had to safely transport her across a large lake via a canoe in the park all without getting that splint wet. From our entry point in the water, we could see across the lake to where we thought was the exit point. We paddled for about 15 minutes to cross the lake to find the site deserted of any Medwars volunteers. After re-examining the map, we directed our canoe towards an area of the lake that initially had looked like a dead end. Upon reaching this area of reeds we found a passage just greater than the width of our canoe. After weaving through this for a short time we emerged with another beach in site, this one populated with Medwars volunteers. Once ashore we hopped out and noticed a mannequin was laying just ahead of us in the middle of a path. Noticeably, the mannequin’s right leg had been removed by the group of marauders previously mentioned. Alongside us was a friendly military man, who thanked us for arriving so quickly as the patient on the path had suffered life threatening injuries from the villainous marauders and required our immediate attention. We started forward beginning by checking the scene for safety. As we were checking the scene, the marauders jumped out of the bushes and began firing away at us. Our military friend returned fire as we dragged the fallen mannequin to safety to better assess its injuries. (Once the race had concluded we learned if a group did not check the scene for safety the team members had to perform the patient stabilization without use of an extremity after having it “shot off”. A good reminder to always check a scene for safety!) After going through our ATLS primary survery1 we had the patient intubated, as well as placing a chest tube, a tourniquet, and a pelvic binder. We brought the patient back to the canoe and began our journey back across the lake to transport the patient to safety.

Once back we unloaded the patient and began on the trail again. Dr Mak was especially eager to get going and ran up ahead of us. By the time Dr Pontasch and I had caught up to her she had regrettably suffered a venomous snake bite2. After heroically kicking away all the rubber snakes surrounding Dr Mak, we were able to stabilize her injuries. Dr Pontasch displayed his previously unknown love of herpetology and correctly was able to name the snake that bit Dr Mak. At this point we agreed never to let each other out of our sight again lest we suffer the wrath of additional venomous rubber toy creatures and began walking again. After several miles, and a few wrong turns, we found the next station which was a lesson on radioactivity3. A “dirty bomb” had been set off in the surrounding area. Unfortunately, Dr Mak’s eagerness again got the best of her, and she had gotten too close to the radioactive material. We “gowned” up and began the process of decontaminating her. (We did not bring radioactive decontamination material so this was more of a walkthrough station). We discussed proper decontamination techniques as well as the proper use of a Geiger counter. We were then given our next destination and set up the road yet again. After a short walk up the road we were given a makeshift satellite phone to try and alert any remaining authority to the location of the radioactive bomb so that people may avoid the contaminated area going forwards. While making the phone call we heard a large crash in the distance and shortly thereafter saw a large column of smoke.

By this point in the race, we had realized we were in first place. With the realization of being in first place also came the paranoia of losing our first place standing. To this point in the race, we had alternated walking with jogging to keep our hold on the top spot. Even though we had not seen a competing team since docking the canoe on the return trip across the lake we were still convinced that every small noise coming from the surrounding woods was coming from the opposing teams, about to emerge from just around the corner at a full sprint coming for the first-place finish. This led to many small jogs over the course of the afternoon. Somehow, we were lucky enough to arrive to every station during one of these jogging periods. No doubt making it look much more impressive than our legs felt at the point in the race we arrived at the site of the rising smoke column. This turned out to be a commercial plane crash resulting in a mass casualty incident. Our job at this station was to quickly assess each patient and triage them into an order they should be treated in. In all there were 10 patients spread out amongst this clearing in the woods with injuries ranging from minor to life threatening to some that had already succumbed to their injuries. Dr Pontasch and I first assessed each patient using a color designation of red, yellow, green, and black designations4 . Red designates the patients with the most immediate threat to life that we could successfully treat out in the wilderness. Yellow and green refer to progressively less threatening injuries that can wait for treatment, whereas black refers to patients that have already succumbed to their injuries. While Dr Pontasch and I were finishing up triaging our patients, Dr Mak’s sense of adventure and exploration again got the best of her. We were informed she had climbed onto a pile of rubble and fallen, sustaining injuries. Unfortunately, this time we were unable to save Dr Mak and she passed away due to a head injury. She was given an extra life an allowed to continue. The learning point being how limited we could sometimes be with our resources in the wilderness. Our triage list was discussed as well as our attempted stabilization of Dr Mak and we did pass the station, receiving 3 penalty points. Had we gotten 5 penalty points, we were informed our penalty would have been for Dr Mak and Dr Pontasch to maintain spinal precautions while placing a diaper on me that I would have to wear until the next station. Initially this sounded funny, however the next station proved to be about 4 miles away and it began raining so I was thankful this did not take place. Just as we were about to leave, we heard a cry and discovered a baby that was with one of the deceased passengers. We were instructed to take the baby with us for the rest of the race, and just like that our race team had increased to 4.

Four miles and some refreshing rain later we arrived at our penultimate station. Here we went through a simulation of acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema5. Happily, none of our team members became inflicted by illness or injury here, a true testament to the experience we had gained throughout the race about the importance of preventative care. After going through these altitude related pathologies, we also built a shelter that would have sustained us for the night had our legs not been able to carry us the rest of the way home. We also discussed non-medical survival skills like building a fire and acquiring clean water for us to drink. At this point in the race, it was beginning to get dark, and so prior to heading up the trail again we “cracked” our glow sticks so volunteers would be able to identify us. After a short walk up the road we arrived at our last station, where we had a short talk about morse code and how to signal “SOS”. After this station the only thing that remained was getting to our safe haven, located at the finish line of the race. Emerging from the woods approximately 30 minutes after dark had fallen, we found ourselves at the finish line. Finally, our journey had come to an end, approximately 5.5 hours after it had begun. We reached the finish line and were given a new challenge. If we were up for it, we could head back out on the trail for the “orienteering challenge”. We would be given a topographical map with 8 different checkpoints on it. At each of these checkpoints there would be a glowstick to mark the area and we would find both a password and medically related trivia questions. Each password we obtained or question we answered correctly would deduct 5 minutes off of our official race time. The catch was, if we returned even a single minute after 9 pm we would instantly be disqualified from the race. (This had happened to a first-place team once in the past who went out searching for these checkpoints and returned at exactly 9:04 PM.) We had been the first team to finish, however our paranoia struck again and drove us back out into the night to ensure our victory. With 16 miles on our legs, we limped back out into the darkness of the woods in search of these checkpoints. We had searched for the first one for almost half an hour and were about to give up when Dr Pontasch (and what I assume to be his body’s surplus of vitamin A) was somehow able to locate a faint glow a few hundred feet off the main trail. Dr Mak remained on the trail as to mark our way back as we ventured to the checkpoint. We were successfully able to locate this and an additional checkpoint for a total of 2 out of the 8 possible stations. Mindful of the time we began to head back to the finish line, and we made it back with about half an hour to spare. For our troubles we had more than an entire hour deducted off our race time and secured a first-place finish.

We would like to thank all the Medwars volunteers for their hard work in putting together this race. The amount of effort they put in to mapping the course and making the stations as realistic as possible paid off in a fantastic experience for all of the teams that competed in the race. To anyone reading this I would absolutely recommend competing in the event next year, you will not be disappointed!

Written by: Dan Strbich, DO, PGY-2

Edited by: Alex Dzurik, MD, Faculty Editor

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