MEGACODE!

One of my favorite parts of the course was Frank's set of Megacodes. Once or twice each day, Frank ran the medics outside and had them quickly treat a variety of emergency traumas. As with all procedures, repetition and practice are key, and the megacodes served as the best way for the medics to memorize the basics and familiarize themselves with treatments.

Day Five -- Saving the best for last

What a day: hands down the best day of the course! We did so much, and the medics got a chance to show us and, most importantly, themselves how much they have learned throughout the week.

The day commenced with perhaps the most memorable part of the course: actual surgery (though of course not on humans). The medics practiced throat and chest tube insertions, suturing, fasciotomies, and amputations. Several of the instructors then demonstrated several more advanced procedures, in addition to giving detailed anatomy lessons.

Here, our devoted instructors prepare the medics for the first procedures

After lunch, Jess and Monica gave a lesson on splinting, followed by a review of anesthetics and nerve blocks by Jaime.

More Thoughts:
The medics were very attentive all week. The final day was a highlight: medics practicing in the animal lab the procedures on pigs. We started early in the morning while cool and finished before the flies arrived. The medics practiced surgical airways (crichothyrotomies and tracheostomies), chest tubes, fasciotomies, venous countdowns, and finally amputations. Each table had at 4-5 medics, at least one senior medic as the senior trainers, and one of our volunteer teachers. It was exciting to see their skills in action.

The teachers then did thoracotomies, pericardotomies, and laparotomies on their pigs.
While the animal lab was a bit sad for the pigs, it was the best way to teach these skills that the medics will be using to save lives. And the medics and staff were thrilled to have all of the tasty pork.

Then we did more hands on training with plaster splints with Jess and Monica. Then anesthetic dosing and regional blocks with Jaime.

The medics then did their final test and all passed!

Then back in the evening for closing ceremonies, with heartfelt speeches by the coordinating trainer, Larry and Frank, and presentation of their certificates and pins. The medics were rightfully proud. The medics then hosted us to a grand pork feast!

The next morning half of us left at 4am for the airport. It was a long week with little sleep.

Mixed feelings now: Pleased and proud of the medics and the training. Sad to miss the medics, our fellow volunteers, and the profound feeling of being useful and appreciated.
-- Loren

Links:
aai.org.au
ghap.org/programs/landmine



Prior picture from the GHAP website of a trauma medic performing a jungle amputation after landmine injury using a Leatherman Multitool:

Day Four: It all comes together

Today was another huge day: Chest Trauma by Monica with clips from Three Kings (with George Clooney), Abdominal Trauma and Drug Dosing by Jaime (tough lectures to give and well done), Head, Neck, and Spine by Aaron, Nutrition for the Trauma Patient by Meredith, and Multiple Patient Incidents/Disasters by Frank. Loren and Jess did Ortho: Fractures and Dislocations with innovative models. Everyone helped out with Trauma megacodes.
Tomorrow is our last day: surgical lab and splinting with plaster, use of Ketamine and Lidocaine, a post test and then a final ceremony.
Seth has been a huge help as chief blogger, photographer, model maker, patient, and team international human rights attorney.
The medics are doing great and are highly motivated. They are quite engaged in the training and improving their skills with each passing day.
Larry

Day Three Afternoon -- Larry takes charge (awesome fasciotomy and amputation lessons)

Larry, with help from Loren and Jaime, spent the afternoon teaching the basics of fasciotomies and amputations, and then walked each medic through a simulated procedure using our self-made limb models (sugarcane for bone; diaper for muscle; plastic bags for fascia and skin). The students were incredibly engaged, and each had an opportunity to perform a simulated fasciotomy and amputation on their own model.

Who is this savage?

Is he really a doctor?

Yes, and a very good one. We swear. Really. We promise.

Day 2 -- Evening

After a succesful day of teaching trauma assessment in simulation codes, we returned after dinner for advanced surgical cricothyrotomy training. In true international medicine fashion, we constructed trachea "Cric" models out airway tubing, gloves, toilet paper, and tape. Each medic was able to successfully perform a Surgical Cric airway on these home made models.

Some interesting facts about our heroic medics:- longest trip for a medic to get to the training was 5 days including walking miles over mountainous terrain, a boat, and finally a car ride. (And I thought my 24 hours of travel on a cramped economy flight was rough ;-.) In 2011, the 19 medic teams treated 106 major trauma victims with 8 amputations and 17 fasciotomies. Over 31 medics have made it to this year's trauma training with 14 of those being first timers.

Day 2 Afternoon -- IVs, Complicated Surveys, Body Temperature

The afternoon was a whirlwind of short lectures and demonstrations on a variety of subjects. Aaron and Sophie ran through installing an IV line, and taught the more complicated venus cutdown for difficult IV access cases

Later, Loren expanded on the morning's lessons by going through a detailed primary and secondary survey, while Frank ran everyone outside for a Megacode --- an emergency review in which each medic performed a primary survey on one of their colleagues. Frank then ended the day's instruction with tricks on how to work on a patient while maintaining their core body temperature.