Concussion Education… here, there, everywhere! (pt 2)

Last weekend, I spoke at the 3rd Mountain Medicine Symposium in Silverton. This is a really unique conference as its focus is on rural and backcountry trauma and medical care, located in San Juan County Colorado – one of the more rugged and remote areas of Colorado, and a prime outdoor recreation destination. It was a real honor to share the podium with some of the other faculty including some of the big names in Colorado trauma care, wilderness medical education nationally, as well as prolific Swiss avalanche researcher Manuel Genswein.

My talk “Brain Injury – From the Sidelines to the Summits” was an attempt to distill much of the sideline concussion knowledge and best practices which are common in the sports medicine world, but less so among EMS professionals and even hospital-based emergency physicians.

Never miss an opportunity to throw in a sports metaphor.


The talk began with a review of care for the critically injured head trauma patient, and then transitioned to discussion about less obvious cases and how to screen for more serious brain injury that may not yet be fully obvious. With life-threatening trauma evaluation completed, we then went on to discuss the evaluation of potential concussion, and how to manage it. The talk concluded with a basic structure for decision making when dealing with a concussed patient in the backcountry.

My talk was scheduled after a fun and interactive demonstration by the UNM wilderness medicine team in care for the hypothermic patient. They provided such a patient by putting one of their physicians in the (very cold) river! I was fortunate to have an engaged audience who had just been through such an exciting and interactive presentation.

I also got to attend two on-snow (still plenty left from last season) avalanche search and rescue workshops with Manuel Genswein. While I had taken an excellent Level 2 avalanche program this past winter with AEW-Guides Tico Allulee and Jack Klim, this program really took my knowledge as an organized or partner rescuer to the next level. Manuel is a precise and polished instructor who developed through painstaking research and simulation a set of excellent techniques and protocols for optimizing the search, excavation and resuscitation of avalanche victims. If you work or recreate on or near avalanche terrain, this program will exponentially increase your avalanche response knowledge. It’s not an exaggeration to say he is a luminary in the field, and if you have the opportunity to learn from him, you should take it.

dropping the Swiss knowledge.
Manuel instructs on digging, the most time consuming aspect of avalanche rescue.

Sunday morning kicked off with an outstanding lecture on stabilization of the trauma patient outside of the setting of a major trauma center, delivered by Dr Charles Mains. Dr Mains is a trauma surgeon and director of the trauma program at Centura, a hospital system operating dozens of hospitals in multiple states. His talk began with a great foundational review of the physiology of trauma BLS concepts like temperature management and field hemostasis and then continued through progressively more advanced concepts like permissive hypotension, limiting crystalloid, TXA, whole blood use, junctional hemostasis strategies, tourniquet considerations, airway strategies associated with lower scene times and increased survival, REBOA, thoracotomy and experimental/future therapies such as peritoneal hemostatic foam. It was a real tour de force and one of the best talks I have heard at a medical conference.

The conference concluded with a sobering talk from UNM faculty member and fellow Einstein EM graduate Dr Aaron Reilly. Dr Reilly shared his reflections from both a personal and professional standpoint from his experiences as a member of a backcountry ski group that was caught in a shocking and unexpected avalanche last season where one of his group perished despite a well executed and heroic rescue and resuscitation attempt.

This conference was a fantastic and unique educational opportunity. The low student – faculty ratios, relevant, up-to-date content for professionals treating critical patients in the backcountry, and venue all make for a fantastic educational opportunity.

Fall in the San Juans.

I have talked with some of the folks involved with putting on this event and they are excited for an even better event in 2020. September 18-20… I hope to see you there!

Bring the 4Runner or the A-star…. just get here.
This conference may have more air operations than your conference.

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