In resource-constrained environments like rural Alaska, time and education can mean the difference between life and death.
In mid-October of 2019 a PenAir SAAB 2000 airplane crashed and nearly fell into the ocean at Unalaska's Tom Madsen Airport.
When the plane touched down, instead of slowing and stopping at the end of the short runway like it should have, it kept going until its nose had tipped over the edge of a rocky embankment just above the waters of Iliuliuk Bay.
Dr. Murray Buttner, a family medicine physician with Unalaska's Iliuliuk Family and Health Services clinic, witnessed the crash.
"I ended up running down there," Buttner said. "And I ended up being the first person to get on the plane."
While he and a group of other healthcare professionals were unable to save one fatally injured passenger, Buttner said a particular training he had just completed made a big difference in how he handled the crash.
"I don't want to say I wasn't panicked but, that whole 'deer in the headlights' thing — which really happens when you step into emergencies if you're not used to them, and can be hard to get out of — the course kind of gets you through that," he said.
The training is called Comprehensive Advanced Life Support (CALS) and it equips people working in resource-constrained environments with life-saving skills. It has been held in several states and even in other countries for the past 25 years. But never in Alaska — until last month, when a group of healthcare professionals, like Buttner, from across the state gathered in Anchorage to attend the training.
Additional Training Fills A Critical Gap
Healthcare in Alaska is unique. Many places, like Unalaska, are hundreds of miles from hospitals or are located completely off the road system. Physicians, nurses, and nurse practitioners are all often on the front lines of emergencies like snow machine, boating and aviation accidents.
Traditional medical training for professionals like family practitioners doesn't necessarily cover emergencies that rural healthcare personnel, like Buttner may have to address in the field or a small clinic, when there isn't a hospital nearby.
He said the CALS training provides a chance for rural practitioners such as doctors, nurses or physician assistants to get hands-on trauma training.
"It's a window into paramedic training for medical practitioners," Buttner said. "Because paramedics do get trained in dealing with every emergency you can name: in someone's house, on the side of the highway, on the ski hill, in the swimming pool, etc. Whereas, healthcare practitioners are trained for how to handle that once it hits the door of the hospital. And so this course kind of fills that gap."
Like Buttner, other Alaska medical professionals have traveled Outside to take the course.
Jenny Brown is an EMT instructor in Fairbanks and course coordinator for the CALS training. She is one of the people who helped gather the nearly 50 medical professionals in Anchorage to hold Alaska's first CALS training in May.
She said she was looking for an 'emergency trauma' training for her staff, when she found the CALS course.
"It kind of combined a little bit of the street care that we see in EMS, but along with the critical thinking that we have at the provider level," Brown said.
Dr. Darrell Carter has been practicing medicine in a small Minnesota town since the early '70s. Carter co-founded and helped organize the first CALS course 25 years ago, after he noticed a lack of preparation and training in the medical field as well as in his own practice.
"I began to wonder if I should be continuing to practice in a situation where I knew that sometimes I couldn't take care of what came in," Carter said.
Rather than abandoning his trade, he decided to work with other providers and develop a curriculum he couldn't find elsewhere. With the help of what he calls "local champions," he's since been expanding the training to other remote places around the world.
When Waiting On A Medevac, Even Simple Refreshers Are Invaluable
Anna Frisby is a physician assistant from St. Paul — a small Pribilof Island community located in the Bering Sea, nearly 800 air miles from Anchorage. Frisby said she's taken several other trauma and emergency courses, but the CALS training provided a bridge, connecting the knowledge she gained in those other courses.
"I feel like it gave me confidence in what I can do," Frisby said. "For instance, gaining an airway to a patient who we cannot use an endotracheal tube [on] — we were able to practice and really understand the anatomy around the neck and how to access the airway [on them]."
Frisby said those skills, and simple refreshers on things like where best to place an EKG on certain patients, can be invaluable in an isolated place like St. Paul.
"When it comes to a Medevac, they talk about a 'golden hour' — we [in St. Paul] can say we have a golden three to six hours," she said. "It takes a while for a Medevac to come out here to us. And not only does it take time, we also have to factor in the weather."
Part of the confidence the course gives, especially for healthcare providers in remote areas, Buttner said, is a reassurance that they've done everything to the best of their abilities to help those in need. He said a lot of times, people won't survive certain traumatic accidents and there can be a lot of guilt that comes from that.
"People [in the CALS course] are trained to do what can be done and know that they did what could be done," he said. "And to therefore not beat themselves up that there was something they did, or didn't know how to do, that kept the person from living."
Roughly 10 attendees were also trained to be CALS instructors at the course in Anchorage. Organizers are hoping to offer about two courses per year in Alaska starting around September. Anyone can attend the course, but participants are encouraged to have medical practice experience and at least some previous training in a life-support course, as the class contains advanced content and only spans a couple of days.
As the course develops in the state, coordinator Jenny Brown said the curriculum will hopefully be adapted to fit uniquely Alaskan emergency scenarios.