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Mclarenmp
05-01-2018, 20:08
Hey all, thanks for having me.
I'm a Family Practice Resident in Virginia, I've been involved in wilderness medicine and wilderness activities for years now. I'm coming up on the last few weeks of my residency and I have a block of time from Mid-May until the end of June. I was thinking about setting up a local "Trail Clinic," for some of this time.
However, before I just jumped into it, I wanted people's thoughts on if this would be a useful thing. My intention is to set it up as a free service, but I would need to keep records of the visit (for legal purposes). Other than just general opinion, I was hoping for feedback on the following:

1) What level of care do you think would be best? i.e. - band-aid station, general health/exams, STI treatments, IV hydration.
As a fully licensed physician in VA, I'd be able to write prescriptions for things, but wouldn't be able to carry much in the way of prescription meds with me.
2) What, if any, over the counter medications/basic medical supplies are most needed?
3) Would having local info in a handout (food, hotels, taxi #, etc..) be useful?
4) Would handouts or quick, 5 minute talks, like hemmorhage control/splinting/hypo&hyperthermia be useful?

I realize most folks that do this type of hiking are pretty healthy and I'm not hitting ideal through hiker season here, but it's what I got to work with.
Also, something I have to investigate more is the legalities of just setting up on the trail and doing this, would appreciate any input on that if anyone is knowledgeable.

Thanks in advance! :banana

MuddyWaters
05-01-2018, 20:26
Id say people that need care...tend to REALLY need it. Often finding ERs . Infected blisters are not uncommon. As is needing a round of antibiotic for Lyme disease from attached tick, and things such as norovirus or other wicked gastrointestinal problems. Much of the rest are light sprains, sore knees, bumps and bruises. And of course blisters.

And understand nobody is going to want to stop and rest an injury, or stop and heal , or quit walking. Unless you tell them they're going to die or be crippled for life they're going to keep walking if possible. Sprains, stress fractures, you name it they're going to keep walking.
If you actually want to teach people stuff, Trail days or kickoff events will probably be better place. If you give people a hand out of some kind they're just going to throw it away they're not going to want to carry it with them.

The average person really doesn't need anything. Possibly some Advanced blister care might be nice. If its something more durable and better than the hiker has already. But treating blisters for athletic performance is a specialty task that is not something a physician does. It's what the people that work on feet at Ultra marathons do. The object is not to rest up and heal, it's for them to keep going.

The ATC can give you their opinion of doing this kind of work on the trail. Personally I'd rather see you at a trail head, you really don't have any business setting up on the trail.

But this is more of a form of Trail magic that I could support personally. For whatever that's worth.

If you find somebody you need to write a prescription for, you you should probably plan on giving them a ride to the pharmacy also. It's not like they got those on the trail.

rocketsocks
05-01-2018, 20:32
Monkey butt is a big problem

BuckeyeBill
05-01-2018, 20:58
Well Doc to answer your questions,

1. Have it more than a Band-aid station. General health sounds good as does IV hydration. STI treatments is something to consider I guess, never had one, but I don't sleep around. Are you talking about Trail Side or just a free clinic for hikers? If trail side I would setup in a place where hikers could take the prescription to a drug store to get filled. If you are going for a office type setup, then make sure once you are up and running, you get in contact with the Appalachian Trail Conservanc (http://appalachiantrail.org/)y, The Appalachian Long Distance Hikers Association (https://aldha.org/), and David Miller (https://www.theatguide.com/) to get a listing in their trail guides. I am sure there are other but these are the ones that people purchase most of the time. You can offer to check for ticks if you can setup some thing for privacy.

2. Ibuprofen by the case. Hikers call it vitamin I and use it almost daily. Some type of anti-diarrhea medication as this is a common occurrence on the trail. Maybe Ace bandages? But if you can show the hiker how to tape an ankle for support kind of like when an athlete that twist or sprains an ankle or other body part. Toss in the remaining tape roll so they can redo the wrap after a shower.

3. Short answer yes. Long answer get listed in the guide books and web sites.

4.Yes, have water handy and hikers will normally stop for a short talk if they get cold water they don't have to treat/filter.

hope this helped and good luck.

windlion
05-02-2018, 08:08
Great idea! But yes, best to walk it by ATC for legal concerns. Also perhaps some talk with local emergency rescue crews to choose

What kind of hours are you thinking of? Once the word gets out, there might be folk who should get to urgent care but head for your location instead (it's just a flesh wound, &c). Cautious thoughts about prescribing on the Trail, as overuse and sharing meds are almost certain. Especially painkillers.

You might find that a lot of people who stop by are only looking for professional medical advice on whether they should push through or should get off trail to recover.

Bandaging up ankles, caring for septic blisters, treating dehydration, all surely needed. Instead of pamphlets that will wind up littering the Trail, how about a couple of laptops set up with videos reviewing topics like bandaging, nutrition, diarrhea?



Virginia is Not Flat

trailmercury
05-02-2018, 09:23
Did you run it by your program director?
Seems like your faculty should be involved, as you are not quite yet an "attending" level physician and would likely need/want oversight/supervision.
There is still the issue of malpractice; i.e. is your residency malpractice going to cover this "free" care you will be providing, or will you have to buy your own?
Where will you keep the encounter notes? Will you be using your residency program EMR? If so the patients don't magically appear in the EMR and the process of adding them is not usually done by the provider. (I am an FP and we use Epic, I have no idea how to add a patient into the EMR)
if you keep paper charts, they will need to be kept somewhere and accessible for reference by future providers.

LIhikers
05-02-2018, 21:14
How about a foot care station?
Wash hikers feet, massage their feet, tend to blisters and missing toe nails.
Clip the hikers toe nails if it's needed

Bati
05-03-2018, 18:22
how about malnutrition or dispensing nutritional advice, testing and treating lyme disease, and information about potential organ damage from vitamin I overdose.

Mclarenmp
05-03-2018, 20:19
Thanks to everyone for all the advice, this was exactly what I was looking for!

The short of it is that looking at the logistics of trying to provide this service: too much to do in too short a time and very little in the way of support from my program to make it happen.

Will just shoot for something similar in the future on my own once all the joys of residency are over.

Thanks again to everyone.

oldwetherman
05-03-2018, 20:41
Your intentions are very admirable. I would suggest that you contact existing clinics in trail towns and ask what they treat hikers for. They may have some suggestions as to how you could best be of service. I live near the trail town of Hot Springs NC and do volunteer work at facility that is geared toward hikers. We refer several hikers a week to the clinic in town for various reasons.

Leo L.
05-04-2018, 02:51
Not from the AT, but when I'm coming right out from a desert hike, the things I'd wish most would be foot care and massage.