TREK Doctor: 2018-19 After Action
Summary
Trek 2018-19 was quite different than 4
years ago. Trek 2014-15 was cold and dry while Trek 2018-19 was
warmer and wet. Taking into consideration both Trek 2018-19 and Trek
2014-15, we can be well prepared for any future winter activities at
Fort Gordon.
Trek Medical List:
1. Hot/Cold/Wet: Trek being in the
winter is not overly hot during the day, but can be very cold in the
AM. It is still possible to overheat and dehydrate. The carts are
heavy and a muddy trail can be a slog. It is important to keep feet,
and bedding dry. I agree with the use of modern camping tents for
Trek 2018-19 because of wet conditions. Bedding would have likely
gotten wet and even soaked if tarp tents were used in wet conditions.
2. Hydration: We encouraged individuals
and families to drink plenty of water water. All individuals are
given a tin drinking cup and all carts are outfitted with a water
jug, but many carts are guilty of placing their water jug in an
inaccessible position. We should also have scheduled rest and
hydration stops. Wagon engineers objected to water jugs lashed to
the tailgate, but we have never had a tailgate failure. Therefore,
the evidence supports that water jugs can be secured to the tailgate
without worry of tailgate failure.
3. Feet: Children should be encouraged
to double sock. Inner sock should be thin/shear nylon, acrylic, or
silk. The outer sock should be a thicker boot sock made of
synthetics or wool. Broken-in cross-trainers, light hikers are
preferred in dry weather. More waterproof boots are needed in wet
conditions. Heavy hiking or steel-toed boots are discouraged. Boots/shoes should be broken in before Trek. Children and adults should be encouraged to keep feet dry and apply
mole skin or duct tape over hot spots before they become blisters.
Blisters were much more prevalent in wet conditions than 4 years ago.
4. Meds: Adult advisers should manage
their children’s daily meds. Refrigerated meds can be kept in the
refrigerator at the Leitner Lake Lodge (basecamp).
5. Insects: Mosquitoes were not an
issue this year or 4 years ago. Bug spray is not necessary. However,
fire ants were a major issue during Trek 2018-19 while they were not
active at 4 years ago because of colder weather. A benedryl stick
was very effective for fire ant stings. Main activity areas should
be treated for fire ants prior to Trek.
6. OTC Meds: My rule of thumb was that
if a child had a condition that was simply treated with an OTC med
on-trail, I didn't feel like I need to contact parents or get
permission.
Motrin- headaches, aches (prefer)
Tylenol- headaches
Emetrol- nausea (usually exertion
related => rest, shade, water)
Robitussin- cold and cough
Boudreaux’s Butt Paste- chaffing
Gold Bond Medicated Powder- chaffing
Neosporin- scrapes, minor cuts
Benadryl- allergy, hives
Zyrtec- allergy, nondrowsy
Chlorhexadine- surgical disinfectant
Imodium- mild diarrhea
Pepcid Complete- acid stomach
Pepto-bismol- upset stomach, diarrhea
Hall's Cough Drops- sore throat, cough
Benedryl Stick- fire ant stings,
contact dermatitis
Dermaplast Spray- burns
Burn wipes (lidocaine, aloe)- burns
Alcohol Wipes- disinfection, cleaning
OTC Meds were individually dispensed
using Ziplock baggies, mini dixie cups, and plastic spoons.
7. Ortho: the physical demands of Trek
and moving heavy handcarts sometimes through mud and up hills
resulted in several minor orthopedic issues.
ACE Bandage- very popular, and
reusable.
4X4 Gauze- works well with ACE or Coban
Band-aids (varous sizes)
Cold Packs- very popular 4 years ago
Knee Sleeves- used several
Ankle Sleeve- used several
Wrist Sleeves-used several
Coban- I prefer ACE Bandages
Mole Skin- blisters on foot and ankles
(used 8 packs)
Lambs Wool- used to spread blistered
toes
SAM Splints
Silk Tape
Hinged Knee Brace
Velcro Wrist Brace
In-shoe Ankle Brace
8. Female: A female adult adviser was
designated to carry female hygiene products (tampons, pads).
9. Lodge: A few children will become
homesick or dislike the cold, or walking, or sleeping arrangements
and will present with nonspecific, vague symptoms. These can
usually sleep on a cot in the lodge and be transported to camp for
activities and meals. The Leitner Lake Lodge was fitted with 5 cots
for children's use.
10. Non-Walkers: Children who are
exhausted, dehydrated or have developed severe blisters, feet or knee
pain which visibly impacts their ability to walk (limp), should
discontinue walking and be transported to activity and meal
locations. Non-walkers can wait at lodge if there is a long period
between activities or meal locations. In rare cases non-walkers can
ride on the cart (last stretch to finish).
11. Call Parents: If I am tempted to
give the child anything more than OTC meds, or do any procedure,
apart from an absolute emergency, I’ll call and get permission from
parents. This mainly would apply to using dermabond, staples,
sutures or giving Zofran. I would seriously avoid doing anything more
than dermabond. However, simple finger cuts are actually best
treated with cleaning, splinting and no closure.
12. Return Home: Anyone with severe
gastroenteritis should not continue. Noro viruses are very
contagious. Individuals with other highly infectious diseases like
mononucleosis and chicken pox, whooping cough, measles, mumps,
rubella should also be discouraged from participating. Children with
mild headache but no fever should be hydrated can try to sleep it
off, but should return home if headache persists in the morning.
13. Emergency Treatment: Generally
speaking, any condition that should visit the ED, that child should
stop the Trek, have their parents called, and they should go to the
ED. We will have children from the Greenville Stake which is a
3+-hour drive for parents.
14: Trek Doctor Emergency Supplies:
Nasal Airway/Trumpets
Fabric Litter/Stretcher
Cervical Collar
SAM Splints
Epi Pen
Benadryl
Dexamethasone
Hydroxyzine
Suture Kit
Staple Gun
Dermabond
Lidocaine
Albuterol Inhaler + Spacer
Small O2 tank with mask.
BP Cuff
Finger Pulse Ox
Otoscope
Prescription Pad and Stamp
15. Radio/911: We are in continual
radio/phone contact with the lodge at Lake Leitner and Fort Gordon
has its own EMS, ER, and full-service hospital.
16. Camp Rounds: Each night I clip on
a blinking bicycle light (camp visibility) and visit all the
carts/families.
17. Walking/Riding: 4 years ago, I
walked the Trek. However, inevitably there were needs at the front of
the caravan, middle, back, and then at the front again. This was way
too much walking. A trail minibike worked well for running back to
camp for supplies and catching up with the wagon train. The minibike
is loud, so I would shut the engine down when in the vicinity of the
Trek caravan as not not detract from the experience. I recommend
that the trail doctor ride on some form of light ATV (4-wheeler or
trail minibike).
18. Adults: Adult volunteers and
advisers also require treatment for various simple ailments.
19. Prescriptions: I may write an
antibiotic like a Z-pack and a medrol dose pack. I don’t write
opioid pain meds or benzodiazepines. I might do Motrin 800mg and
Robaxin 750mg.
20. Cart First Aid Kits: Cart first
aid kits were poorly put together both this year and 4 years ago and
did not contain items needed items. Most things I treated were
routine and could have been treated by the families if their first
aid kits were properly provisioned.
Cart First Aid Kit Contents (most items
available at $ Store):
Band-aids: regular size, larger
size (most used)
Gauze: 4x4, 2x2
Coban
ACE Wraps (most used)
Mole Skin (most used)
Alcohol Wipes
folding snips/scissors (most used)
Silk/Fabric/Duct Tape
Motrin, Tylenol, Benedryl Stick
(most used)
Cough Drops (most used)
Antibiotic Ointment (most used)
21. Migraines: several kids developed
migraines and had to return home. Giving benedryl and tylenol can
help a child sleep and sleep can break a migraine. However, reglan
is a common nausea medicine that is routinely used in the ER to break
migraines. Therefore, oral reglan might be considered to treat
migraines with parental approval.
22. Polaris RZR: was used to drive the
trail to verify trail condition before handcarts are taken on trail.
The ATV was used to transport tired/sore children and adults from the
caravan to meal and activity sites or base-camp lodge when needed.
23: Basecamp: I think it was
logistically much easier to operate from a single base-camp than
moving tents, lights, port-o-johns, etc from camp to camp.
24. 3-day Trek was preferable to a
4-day Trek
25: Women's Pull: this is the most
potentially dangerous part of Trek. It is also off-trail in violation
of Fort Gordon regulations. Boys climbing down the ridge to line the
course are prone to injury as much as the girls pulling the handcarts
up the ridge. Care should be taken to select the safest passage. I
selected a switch-backed course along a firm rocky outcrop. Leaders
were positioned at strategic points to direct the girls along the
safest route.
26. Sweetwater River Crossing: Boys
with waterproof boots should be selected to pull carts across.
27. Walmart is not far away, and trips
can be made to get needed supplies.
28. Adult advisers/volunteers who are
also medically trained nurses and medics have been very useful in
treating minor issues (blisters, fire ants) and directing more
serious issues to the trail and lodge doctors.
