TREK 2018-19

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):

1. Band-aids: regular size, larger size (most used)
2. Gauze: 4x4, 2x2
3. Coban
4. ACE Wraps (most used)
5. Mole Skin (most used)
6. Alcohol Wipes
7. folding snips/scissors (most used)
8. Silk/Fabric/Duct Tape
9. Motrin, Tylenol, Benedryl Stick (most used)
10. Cough Drops (most used)
11. 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.