BY KAREN BOSSICK

Addressing the 10 essential tools for wilderness survival and substituting compressions for blowing into mouths during CPR were among the focal points when the first Ski & Mountain Trauma Conference was held in Sun Valley 12 years ago.

This past weekend 500 firefighters, ski patrol, smoke jumpers, paramedics and other first responders learned things that weren’t even on their radar five years ago.

Things like how to treat mass casualties. And how to incorporate new know-how coming from battlefields in Afghanistan and Iraq.

Addressing something like mass casualties was something those practicing in rural Idaho hope they never have to use. But the information was timely, given the recent mass shootings at a Baptist church in Texas and a country music festival in Las Vegas.

“Active shooter response is something rarely talked about even a year ago,” Dr. Will Smith told them. “Now some schools are staging drills in which they teach kids to throw things like scissors and pencils at a shooter who enters the classroom.”

Smith, who practices emergency medicine in Jackson Hole, helped rescue 17 climbers struck by lightning near the summit of the Grand Teton seven years ago. He just completed his third Middle East deployment as a lieutenant colonel in the U.S. Army Reserve Medical Corps.

Smith, who earned an award from the Street Medicine Society for his role in bringing combat medicine to American streets, described how the advancement of pre-hospital care in Iraq and Afghanistan is prompting new approaches for EMS, or emergency medical services.

“We used to apply what we learned in EMS to combat. Now we’re applying what we’re learning on fields of combat to EMS,” he said. “And one of the things we’re learning is that the correct medical procedure performed at the wrong time may harm, rather than help.”

One of the biggest things being touted is the value of tourniquets to stop bleeding. One in four of every soldier who died in the Afghanistan and Iraq wars could have been saved. And 85 percent of those died from hemorrhaging.

Tourniquets, previously discouraged to avoid limb loss, are now strongly recommended by the Trauma Combat Casualty Care.

“Years ago, it was thought that tourniquets were a last resort. Now, we know that more than 30,000 lives could be saved each year with effective bleeding control,” said Smith. “It’s worthwhile adding a tourniquet to your backpack since it’s hard to improvise a good one in the field.”

Smith got no argument from Couer d’Alene Dr. Marcus Torgenson, who showed graphic pictures taken of himself amputating the leg of a trucker inside the cab of his semi-truck on Fourth of July Pass in North Idaho. The driver was trapped by 100,000 pounds of logs that pushed him to the back of his sleeper cab during an icy pile-up on Jan. 19, 2017. He wouldn’t have survived if the amputation had not been performed, Torgenson told attendees.

First responders are beginning to use fresh blood full of clotting agents in the field, employing  “walking blood banks,” essentially drawing blood from one guy and pumping it into the injured on the spot, Smith said.

They’re using plasma knives—laser-powered cutting tools that seal wounds to prevent infection and blood loss. And they’re using point-of-care ultrasound to diagnose internal bleeding outside hospitals.

They’re experimenting with Resqfoam, which resembles packing material, to stop torso hemorrhage. The foam is injected inside the abdomen, molding to the anatomy. Surgeons pull it out when it’s no longer needed.

Researchers are also investigating the practice of temporarily halting breathing, heart function and brain activity to thwart blood loss.

First responders are moving away from things they used since the Civil War, such as morphine which has been shown to be the worst thing you can use for pain management in the field, said Smith. They’re replacing it with pain management lollipops, intranasal fentanyl and ketamine and the immediate administration of a combat pill pack containing Tylenol and antibiotic pills.

And conference attendees got the opportunity to pump up vacuum splints that mold to a person’s body. The big splint or body cast is replacing backboards and neck splints for transporting people.

The Saint Alphonsus Ski & Mountain Trauma Conference was founded by Dr. Richard Moore, an orthopedic surgeon, with the help of others like mountain climber Lou Whittaker after former Smith Sport Optics consumer services manager Teresa Hukari was paralyzed in a ski accident.

The conference is unique, drawing participants from throughout Idaho, as well as places like Park City, Utah, Jackson, Wyo., Bozeman, Mont., and even Colorado and Oregon.

“First responders always want to know: How can we do things better?” said Dr. Bill Morgan, medical director of the Trauma Service at Saint Alphonsus Regional Medical Center. “We recognize that survival is dependent on what happens in the golden hour following an accident.”

Participants have used what they’ve learned to make a difference in outcomes from a water rescue on Bear Lake to ski injuries, said Dr. Richard Moore.

“I’m reminded every day what tremendous value comes from this conference,” he added. “It’s incredible how many lives have been touched and we know only a small portion of them. But we know it’s those in this room who see the victims first and their efforts to stabilize them that have as much to do with the outcome as anything we do at the hospital.”