Recent hiking deaths spur focus of yearlong doctor training, teaching program
A string of recent heat-related deaths on hiking trails at state and national parks is bringing new urgency to a fellowship program in the Long School of Medicine at UT Health San Antonio aimed at preventing such tragedies.
The state’s first Wilderness and Survival Medicine Fellowship, in the school’s Department of Emergency Medicine, gives doctors practical training and experience practicing in harsh outdoor conditions, with limited resources. The yearlong fellowships even include two weeks or more in Big Bend National Park, site of two recent hiking deaths.
“With more people spending time outside, a changing climate and an increasing number of global medical missions, we thought it was time to start educating our students how to be safe in
austere environments,” said Steven Moore, MD, clinical associate professor of emergency medicine at UT Health San Antonio, and the fellowship’s director. “We first started with the wilderness medicine course for fourth-year medical students in 2020, and the fellowship for doctors was a natural progression of this.”
The department’s wilderness medicine section was created in 2019, inspired in part by another tragedy: the death of a North Texas doctor while hiking two years earlier in Grand Canyon National Park.
Just this summer, a 17-year-old boy died while hiking in Palo Duro Canyon State Park in the Texas Panhandle on June 21. Two days later, in Big Bend in far West Texas, a 14-year-old boy died hiking a rugged desert trail, and his 31-year-old stepfather died while seeking help. The boy’s 21-year-old brother survived. And on July 2, a 57-year-old woman died attempting an 8-mile hike in the Grand Canyon.
All of the recent victims were overcome by heat, in some of the hottest parts of the day with temperatures well more than 100 degrees – “tragic, and sadly, preventable,” Moore said.
“Combating heat illness is a passion of several physicians in our department,” he said.
Among those physicians is Bryan Everitt, MD, an EMS faculty member and an EMS medical director who works on treatments for heat stroke with local agencies, and is medical director of Texas Search and Rescue (TEXSAR), a nonprofit first responder organization. Lee Boyle, DO, is a second-year resident and former “smokejumper,” a wildland firefighter who parachuted into remote fires.
And currently, the program has two fellows – William Jones, MD, and Savannah Chavez, MD, who just began her fellowship. They say they were drawn to the fellowship by the opportunity to combine love of the outdoors with medicine – and to make a difference.
“If you’re unfortunate enough to have known somebody who has been a victim of an environmental accident, whether it’s injury or death, there’s a recurrent impetus to get people to understand the risks involved in these sorts of things,” Chavez said. “What it comes down to is people underestimate the risks. Getting lay people to understand those risks and training medical providers to treat these very specific disorders … the need is there, year after year.
“A lot of these things are very preventable,” she said. “And if there are people who can help prevent it, that’s what we should be doing.”
Clinical practice, and teaching
The fellowship offers a wide variety of exposures to austere environments, and is designed to have a consistent component of self-survival and outdoor skill-building, while still geared to the fellow’s goals and future practice. There are opportunities both nationally and internationally, with clinical practice and teaching.
The 12-month curriculum is based on the comprehensive core curriculum published in Academic Emergency Medicine to provide a well-rounded and robust experience in wilderness medicine while maintaining roots in emergency medicine practice in the emergency department at University Hospital in San Antonio.
As described in the AEM journal, wilderness medicine is “focused on the prevention of injuries as well as the evaluation, initial treatment and evacuation of acutely injured or ill patients. It also encompasses the unique knowledge of circumstances and medical events encountered in wilderness settings.”
Further, the field “shares many of the qualities and characteristics inherent (in) emergency medicine. These include a large breadth of knowledge and improvisational skills, the ability to provide emergent interventions and stabilization, and proficiency in teamwork, often integrating personnel from varied health care backgrounds.”
“Prevention strategies are very important,” said Everitt, acknowledging that his medical experience started on a wilderness expedition as a Boy Scout, when his scoutmaster fell from a waterfall, requiring an urgent airlift. “Ever since the pandemic, more and more people are going out to the wilderness. So, how do we prevent those parties from having devastating injuries?”
The two-plus weeks in a wilderness setting like Big Bend are spent both in clinical practice and teaching. Fellows now teach the month-long course in wilderness and survival medicine to fourth-year medical students, part of which takes place in Big Bend.
This coming year at the park, Moore said, two groups of students will rotate over eight days. Teams also will be part of the overall medical team for the Big Bend Ultra trail race in January, and work with area fire and EMS agencies, participating in training and going on calls.
And there are opportunities available for other external teaching, travel and niche experiences. For example, Danielle Brining, MD, who completed her fellowship June 30, provided medical support for a staged ultramarathon in the Gobi Desert of Mongolia, and was a researcher on a clinical trial there.
Fellows are required to complete at least one high-quality research project for publication, with the assistance of dedicated research staff and faculty. Along the way, there is adequate time built in for both the curriculum and practice in the emergency department.
The goal at the end: becoming a Fellow of the Academy of Wilderness Medicine (FAWM).
“The education, the prevention and the translation are all very important,” Everitt said. “That’s what we want the fellows to get out of this. How to translate that into day-to-day operations.”