You’re standing in the swamp, rescuing a man that has been bitten in the leg by an alligator. All of a sudden—WHAM! The alligator is attacking you, too.
“The lesson here is pay attention to your surroundings and think before you act,” says Michael Caudell, an emergency room physician and director of the MedWAR Challenge. MedWAR is a bizarre adventure race in East Georgia that blends trekking, canoeing, and mountain biking with wilderness medicine. Over the last decade, the adventure race has grown from Caudell’s pet project into a cult phenomenon amongst doctors and med students, drawn to the race for the chance to test their medical chops in the wild.
Beyond the sheer joy of spending a day running, paddling, and biking in the woods, the MedWAR Challenge is designed to underscore a single fundamental truth: most of us are clueless when it comes to handling emergency situations in the woods. Surprisingly, that rule applies to most doctors too.
Fort Gordon is a U.S. Army base just west of Augusta, Ga., with 56,000 acres of undeveloped wildlands used for training soldiers. The terrain is a brutal combination of sand, dirt canyons, swamp, and creeks—the signature terrain of MedWAR Southeast. Half the teams that start the challenge don’t finish the full course, and the competitors that do cross the finish line usually come out cussing Caudell’s name.
“I’m into all that bored-white-guy high adventure stuff,” says Luke Smith, a second year medical student at the Georgia College of Medicine and two-time MedWAR racer. “MedWAR is exhausting. I’m already training for next year.”
It’s not so much the sand that slows racers down, or the canyons, or the heat, which can be brutal in this corner of Georgia. It’s the swamp. Trekking through waist-deep muck for miles can kill even the fastest runner’s momentum.
“When you first enter the swamp, you try to daintily jump from log to log. But that takes too long, so eventually, you have to jump in and slog through waist deep mud,” Smith says. “It’s awesome. It’s like you’re in Predator, or one of those other Arnold movies I grew up watching.”
And right in the middle of this swamp leg of MedWAR, you and your team of four have to figure out how to stop an alligator attack victim from bleeding to death while not getting bitten yourself. Caudell has six medical scenarios scattered throughout the 15-mile course, along with half a dozen checkpoints with multiple choice questions stapled to a tree. The questions are taken straight out of a wilderness medicine handbook, but they tend to be really obscure. There might be pictures of five plants presented, for example, and you have to choose which one is poisonous. Finding the checkpoint with the questions alone will get you a five-minute time bonus. Answer the question right and you get an additional five-minute time bonus.
Most racers carry a copy of a wilderness medicine handbook, which may help them with some of the questions, but the book typically becomes useless during the medical scenarios. When you have to figure out how to treat a collapsed lung on the edge of a cliff, there’s no time to check the manual.
“You come up on a guy lying in a field with blood all over and you’ve got to figure out how to treat him? Man, I don’t know what to do in that situation,” Luke Smith says. “Most of the time, with our team, the victim ends up dying.”
If you fail to treat a victim properly, there’s a punishment involved, ranging from a round of pushups to a surprisingly difficult victim evacuation simulation, where you have to carry the guy you killed out of the woods.
Hillary Irons is a former MedWAR racer who’s become the mastermind behind the race’s national expansion, coordinating with individual race directors all over the country. She says it’s not uncommon for race teams to kill their victims through poor decision making. Even teams of doctors become flustered when presented with a dramatic scenario in the middle of a forest.
“The principles of emergency room medicine and wilderness medicine are the same, but it’s a completely different ball game in the field,” she says. “You have limited resources and you’re in an unusual environment, so you need creative answers to the problem at hand. Doctors have been trained for so long to treat a situation with ‘XYZ,’ and now they’re in a situation where they don’t have any of those tools at hand. They can have a hard time adjusting.”
The scenarios that racers are presented with range from the mundane (snake bite or diabetic coma) to the surreal (a logger who’s severed his leg with a chainsaw, or a girl lying paralyzed on the side of a trail).
“One year, I was eviscerated on a mountain bike, my guts hanging out of my stomach. My team handled it well,” says Dr. Terry Hashey, a family practice physician and Army in-flight surgeon. “The most important thing you can do in that situation is get the victim out of the trail so he doesn’t get hit by more bikers. Then you begin to address the immediate life threatening issues by securing the victim’s neck and checking his airway. Then rinse the wound, cover it, and call for help.”
Hashey’s team passed the mountain bike evisceration scenario by following this step-by-step approach that, according to Caudell, is typically ignored by doctors and laymen alike.
“Each situation presents a learning opportunity for the med students and doctors involved,” says Caudell. “You’ll learn how to splint in the field. You’ll learn how hard it is to carry somebody out of the woods.”
Most racers lack any true wilderness medicine training, so Caudell encourages them to start thinking about how they’re going to handle various scenarios before they even set foot at the starting line by requiring each racer to pack an emergency medical kit filled with items they think they’ll need in the field.
Hashey packs only the bare necessities: triangle bandages, a pocket mask and oral airway, pliable aluminum splints, an epinephrine pen, and a few common medications like benadryl and aspirin.
“You can always spot the new racers because they have giant bags with heavy items they’ll never use,” Hashey says. “What I love about wilderness medicine is you have limited resources in a hostile environment. You only have so much in your bag. Your job is to get the person back into the expedition as quickly as possible.”
Luke Smith had several common medications in his medical kit along with a cereal box just in case he had to splint someone. But he regrets not packing a pocket knife.
“One of our teammates got a pretend fish hook in his eye,” Smith says. “If we had had a pocket knife, we could have cut one end of the hook off, then fed it through his eye and patched him up. But we didn’t have a knife, so the guy had to keep the hook in there for the rest of the race.”
Charles Mock is a paramedic who’s competed in—and won—a variety of MedWAR challenges since 2004. He says Caudell’s MedWAR scenarios are as close as you can come to experiencing real life wilderness trauma without putting yourself in danger.
“I worked in Virginia for a while and had to do a lot of wilderness medicine on rescue calls. You can’t imagine how difficult it is to treat someone in a cave until you’ve had to do it. In that situation, you can only carry with you what will fit through a hole. You have to figure out the rest,” Mock says, reminiscing about a 16-hour-long cave rescue. “How do you get a person with a broken leg through a tight hole that you have to contort yourself through under the best circumstances? Lots of patience.”
Regardless of a team’s wilderness medicine training, there’s one scenario that inevitably trips teams up. Deep in the backcountry of Fort Gordon, there’s an army helicopter lying on its side. During the race, the downed chopper sets the scene for a multi-victim helicopter crash, with fake bodies strewn on the ground and a few survivors straggling about. This is where Caudell likes to plant a crazy person.
“Everybody knows what they’re supposed to do in treating the injuries,” says Caudell. “But what do you do when one of the victim’s best friends has died in the crash, and he’s out of his mind trying to get you to save his dead buddy?”
Caudell tells the volunteer acting out the role of demented victim to disrupt everything, all of the time.
“It’s interesting to watch the actors really get into it. One team had to tackle the actor and hold him down. Another team tied the frantic victim to a tree to keep him from hurting himself or someone else.”
It may sound sadistic, but it’s all part of Caudell’s plan to build more prepared doctors.
“Whatever he puts us through makes us better at our jobs,” Hashey says. “Even if you never find yourself in an ‘Everest rescue’ type situation, it’s good to know this stuff. Let’s say you witness a car crash. If you’ve been through MedWAR, you could very well save someone’s life.”
Think you’ve got what it takes to tackle MedWAR? The majority of MedWAR racers are in the medical field. Hillary Irons says medical knowledge is obviously key, but physical prowess goes a long way as well. Charles Mock agrees. The fastest team he ever competed on was a team of firemen who blew by the rest of the competitors simply because they were in superior shape.
Here are the MedWAR Challenges in our region:
MedWAR Pennsylvania(August) Snake bites, kayak carries, and navigating the Susquehanna River.
MedWAR Tennessee(November) Orienteering, ropes courses, rabid bears, and big elevation gain around Cumberland Gap.
Mid Atlantic MedWAR, Virginia(March) A beginner course and advanced course with a mid-lake canoe rescue that loops through Newport News Park.
Southeast MedWAR, Georgia (April) The original and still classic. Sand, swamp, and insanity on Fort Gordon military base.
With a plethora of wilderness medicine courses aimed at laymen, there’s no reason any of us should venture into the woods without some basic emergency medicine training. Classes for non-medical folks begin with a two-day Wilderness First Aid primer and advance to a Wilderness First Responder course, an 80-hour curriculum that includes realigning fractures. Check out the Appalachian Center for Wilderness Medicine for classes near you.
Watch This: See video of the Pennsylvania MedWAR race.