Phase One: Pre-environmental Training
Author: Brad Kinney MD. March 12, 2018.
Today began the Mountain Medicine Course hosted at the Marine Corps Mountain Warfare Training Center (MCMWTC) near Bridgeport, CA. Yesterday, the class flew into Reno-Tahoe Airport where a few instructors and staff waited with buses and a box truck to transport us and our gear the two hours south through the mountains to the remote schoolhouse. After arriving late in the evening, we were given a short brief and shown to our spartan living quarters. The “squad bays” – what we would call home for the next eighteen days – were open bay barracks with bunk beds and lockers and open showers. There were a few electrical outlets, spotty cell signal, and dysfunctional WiFi – a perfect place to learn the mountain medicine craft away from the outside world.
We were a diverse class of 24 composed of medical doctors, corpsmen attached to Marine units, a Marine infantryman and a demolitions expert, two Navy SEAL medics, and three German medical officers. All were males except for one student, a Reserve Lieutenant Commander Family Medicine doctor who was assigned as class leader due to her seniority. The class gelled quickly and each offered a unique perspective and skillset that proved valuable to the entire class throughout the remainder of the course.
After breakfast, we met in a classroom in our uniforms for the typical DOD course introductory briefs and paperwork. The command leadership introduced themselves and gave an environmental lecture detailing the forested mountains surrounding the schoolhouse. While the 650 acre schoolhouse complex is owned by the Marine Corps, the land surrounding the base where the various classes train is the Humboldt-Toiyabe National Forest – federal land managed by the national Forest Service. The classes are held to the same standards as any other hiker or camper adhering to the mantra of “leave no trace.” No fires without a permit, no digging, no cutting branches or trees, no leaving trash, no harassing or killing animals, etc. We became intimately familiar with this concept later during our field exercises when we were required to pack out our trash and use “wag bags” for collecting our waste.
The MWTC currently offers multiple formal courses including the Mountain Medicine Course, a Cold Weather Medicine Course, a Summer and Winter Mountain Leaders Course, an Animal Packers Course, a High-Angle Sniper’s Course, and also hosts many Marine Corps unit exercises throughout the year. Interestingly, due to the similar latitude, mountainous environment, weather, and compartmentalized terrain, the MWTC was originally created in the 1950s Korean War Era as a training site preparing troops for the cold weather and mountain warfare prevalent on the Korean peninsula. Recently, with evolving world events, there has been a resurgence of interest and focus on mountainous and cold weather training at the MCMWTC.
Following the morning briefs, we donned our PT gear and performed a Navy Physical Readiness Test. After max pushups and situps, we marched in columns down to State Route 108 where we ran 1.5 miles for time. The rigors of the course require that as a baseline level of fitness you must be able to do at least fifty pushups and fifty situps and run 1.5 miles in fourteen minutes. This sounds pretty easy, but the MWTC is at 6500 feet, and we were living at sea level the day before. Most were already feeling the effects of the elevation change: increased urination, increased respiratory rate and heart rate, etc. The run sucked, most lost thirty to sixty seconds on their run times, but only one of the 24 in the class failed the run, and one crushed the run at 9:07.
That afternoon we returned to the classroom and learned about nutrition in extreme environments, specifically at high altitude and in the cold. Interestingly, your caloric requirement nearly doubles in extreme environments due to the metabolic demands. After a lecture on mountain safety and leadership, we headed outside to the “rope corral,” a small area behind the squad bays cordoned off by rope and metal poles with a center area for the instructors and the perimeter for the students. We were each issued a Petzl rock climbing helmet, two locking carabiners, a length of climbing rope, two lengths of cordage, and two lengths of water tape. We then learned about “rope corral attire” – remove watches and rings to prevent “degloving,” tuck blouses and roll sleeves to prevent snagging, and unblouse trousers. Once we learned the requirements of the rope corral, we were taught five climbing knots required for advancement in the course – the square knot with two locking overhands, double fisherman’s knot, roundturn and two half-hitches, roundturn and a bowline, water tape knot, and a six finger prusic. The rest of the afternoon we practiced tying these knots with the guidance of the instructors.
On day two, we were issued all of our mountaineering gear: main packs (“rucks”), assault packs, sleeping systems, tarps and sleeping mats, clothing base layers and warming layers, Goretex, dry bags, Nalgenes and CamelBak bladders. We then returned to the rope corral where we learned the remaining required knots: midline figure eight, alpine butterfly, clovehitch, munter hitch, munter mule, slip figure eight, retrace figure eight, end of the line prusic with a bowline, around the body bowline with a figure eight just out of reach, and the Swiss seat – now referred to as the “military rappel harness.” To pass the course, each student must tie these knots within a specific time with specific standards for each knot. Thankfully, the test was still a week away, so we had time to practice. That afternoon we returned to the classroom for more lectures on initial stabilization and evacuation of casualties in mountainous environments, heat illness and hydration, and wilderness wound management.
We were also introduced to the SKED, a flexible lightweight litter system that would be implemented throughout the remainder of the course. The instructors demonstrated how to properly secure a patient in the SKED and rig it up ready for transport. Passing the “SKED exam” was a also requirement to continue the course, and we quickly learned that this would be a difficult task requiring hours of study and practice over the next weeks to become proficient. There were dozens of failure points, and the nitpicking of the instructors was purposeful, since any failure of the system could mean death for the patient.
Day three started with a 5K road ruck with all of our gear – approximately fifty pounds. The instructor cadre were beta-testing the ruck as an alternate fitness test in place of the Navy PRT since moving a heavy load at altitude over distance within a set time would better represent the course fitness requirements than the standard navy pushups, situps and run. The drop dead time was 45 minutes, which we all made, with some of the heroes crushing the time in under thirty minutes.
We then returned to the classroom for more lectures. This became the pattern for the first week with a few variations. Lectures in the morning followed by the rope corral and SKED in the afternoon. The pre-environmental training phase was designed to acclimatize our bodies to the altitude and environment and to cram as much mountain medicine into our brains as possible for the following practical exercises.
After the first week, we were given a day off to recuperate and prepare for the next phase. Most of us spent our time doing laundry, practicing knot tying, working the SKED, packing our gear, working out, and then going out on the town for dinner. “Out on the town” at Mountain Medicine meant going to a sports bar and grill in Bridgeport thirty minutes away. The schoolhouse is pretty far removed from most of civilization, with the closest “big” town and Walmart over an hour away. But getting away temporarily after the intensity of the previous week was just the mental break we needed before getting back to work.