This is a one-year fellowship for physicians, nurse practitioners and physician assistants. Physicians should be residency trained and board eligible; N.P./P.A.s should have clinical experience in their field. The fellowship is designed to help graduates obtain opportunities, experiences and education support to excel as leaders in the field of Wilderness Medicine.

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Eligibility and Requirements

Emergency Medicine Physician - Wilderness Medicine Fellowship Completion of an EM residency with recommendation from your program director; ABEM or AOBEM board eligible or board certified; ability to obtain Virginia Medical License and be credentialed at Carilion Clinic. Work 1,200 clinical hours at a Carilion urgent care facility as an attending physician. Time will be split between Carilion Roanoke Memorial Hospital (CRMH) and Carilion outlying hospitals. Salary of approximately $80,000 plus institutional benefits will be available. There will also be a fellowship stipend to cover portions of course tuition and travel. Expect to spend 80 to 100 hours on average each month on fellowship activities outside of clinical expectations.

Family Medicine or IM/Peds Physician (Urgent Care) - Wilderness Medicine Fellowship Completion of an FM or IM/Peds residency with recommendation from your program director; board eligible or board certified; ability to obtain Virginia Medical License and be credentialed at Carilion Clinic. Work approximately 1,200 clinical hours at a Carilion facility as an attending physician. Time will be split between VelocityCare by Carilion (urgent care) locations. Salary of approximately $80,000 plus institutional benefits will be available. There will also be a fellowship stipend to cover portions of course tuition and travel. Expect to spend 80 to 100 hours on average each month on fellowship activities outside of clinical expectations.

Internal Medicine or IM/Peds Physician (Hospitalist or Observationalist) - Wilderness Medicine Fellowship Completion of an IM or IM/Peds residency with recommendation from your program director; board eligible or board certified; ability to obtain Virginia Medical License and be credentialed at Carilion Clinic. Work approximately 1,200 clinical hours at a Carilion facility as an attending physician. Time will be spent working in an inpatient and/or observation floor setting at a Carilion hospital location. Salary of approximately $80,000 plus institutional benefits will be available. There will also be a fellowship stipend to cover portions of course tuition and travel. Expect to spend 80 to 100 hours on average each month on fellowship activities outside of clinical expectations.

N.P./P.A. - Wilderness Medicine Fellowship Completion of an NP or PA program, two years of postgraduate clinical experience; board certified (e.g., ENP specialist or CAQ) preferred; ability to obtain Virginia Medical License and be credentialed at Carilion Clinic. Work 1,200 clinical hours at a Carilion facility as an N.P. or P.A. Time will be spent in Carilion Clinic emergency departments, urgent cares, inpatient settings or observation units based on prior experience. Salary of approximately $52,000 plus institutional benefits will be available. There will also be a fellowship stipend to cover portions of course tuition and travel. Expect to spend 80 to 100 hours on average each month on fellowship activities outside of clinical expectations. Applying Applications should include a personal statement, CV and two letters of recommendation.

Applications will be accepted on a rolling basis but are suggested to be submitted in July or August, 12 months (M.D./D.O.) or eight months (P.A./N.P.) prior to your intended start date. Interviews will be conducted (generally September/October) and offers will be presented on the national offer date, as per the Wilderness Medical Society match process. The WMS match generally opens August 1 with an update to the website at https://wms.org/affiliates/gmefellowships.asp. Rank lists close on October 28. Preliminary results go out October 31 and unmatched programs and applicants are encouraged to discuss opportunities on this day. Final results go out November 1. Any remaining fellowship opportunities remain open to applicants until ~90 days prior to start dates as required for credentialing.

Send applications to salareau@carilionclinic.org.

Starting The M.D./D.O. fellowships start on July 1 or August 1. N.P./P.A. fellowships start on February 1.

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Program Description

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Fellowship Director

Stephanie Lareau, M.D., FAWM, FACEP, DiMM, DiDMM

Dr. Lareau is an Emergency Medicine physician at Carilion Clinic in Roanoke, Virginia and associate professor at the Virginia Tech Carilion School of Medicine. She is the medical director for the ED at Carilion Franklin Memorial Hospital. She completed a Wilderness Medicine fellowship at Georgia Health Sciences and completed her EM residency and medical school at Wake Forest University. She is the Wilderness Medicine fellowship director at VT-Carilion.

Dr. Lareau earned the fellowship of Wilderness Medicine and diploma in Mountain Medicine. She is a member of the WMS board of directors. She also serves as WMS DiMM faculty and as a director for the WMS Student/Resident Elective in Virginia and the VTC/Radford WM Student Elective.

Her research interests include injuries in endurance mountain biking races, the effectiveness of high-fidelity simulation in WM education, student WM elective curriculum and Lyme disease within southwest Virginia. She is the education section editor for the Journal of Wilderness and Environmental Medicine. She is a certified level 4 river safety and rescue instructor through the ACA. She is an AWLS course director and instructor. She is also a WFA and CPR/AED instructor through ECSI and a dive physician through UHMS/NOAA. She has earned a diploma in Dive and Marine Medicine from the WMS. Outdoors, Dr. Lareau enjoys mountain biking, sailing, paddling, rock climbing, skiing and SCUBA diving with her husband and dog.

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Assistant Director

Joshua Nichols, M.D.

Dr. Nichols completed his emergency medicine training at Virginia Tech Carilion School of Medicine in Roanoke, VA. He is an avid whitewater kayaker and distance trail runner. His research interests include medical simulation and education. During his fellowship, he continued his research in medical simulation as well as expanded his experience in the areas of maritime and dive medicine. Josh also completed the DiMM, taught WFA in Peru, provided endurance race support and worked on WM protocols for the Roanoke County EMS. After graduation, Dr. Nichols stayed on as clinical faculty at VTC as an Emergency Medicine physician and serves as one of the assistant Wilderness Medicine fellowship directors.

https://www.carilionclinic.org/gme/emergency-medicine-residency

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Assistant Director

Christopher Waasdorp, D.O., FAWM, FAAEM

Dr. Waasdorp worked previously in mountain and marine environments, completed medical school in Colorado including a specialty track in Rural and Wilderness medicine, then completed a combined Emergency Medicine and Family Medicine residency at Jefferson Health Northeast in Philadelphia, PA in 2019. He was very active in education within his residency and with medical students, having served as a resident director for the WMS elective for his last two years. He enjoys outdoor sports in a multitude of settings from mountains to marine, frontcountry to backcountry: splitboarding, mountain biking, rock climbing and sailing.

In fellowship, he learned to scuba dive, completed his FAWM and his DiMM (Uniformed Services University), continued to pursing learning to be a better educator and became more involved in Wilderness Medicine education for the public, EMS and other medical professionals as well as in the Wilderness Medical Society. He enjoys teaching AWLS, WFA, WFR, SWR, ATLS and other WM and Emergency Medicine education topics.

Dr. Waasdorp now serves as a co-director for the WMS student/resident elective in Virginia, and continues to serve as faculty for the WM fellowship at Carilion, Virginia Tech Carilion and Radford University Carilion. While continuing to work in the Emergency Department, CJ also practices Family Medicine, serving patients out of Community Care. He has a particular scholarly interest in hypothermia, anaphylaxis, WM applications for EMS and SAR personnel, and developing protocols and education for a spectrum of audiences from the outdoor interested to professional rescuers and medical professionals.

Current personal pursuits include additional SCUBA certifications working toward Master Diver, training in hyperbarics and dive medicine, experience in caving and learning cave rescue, completing a second DiMM with the WMS and learning to be a better kayaker and rafter on top of the water.

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Assistant Director

Jessie Gehner, M.D.

Dr. Gehner was the first WM fellow to complete the fellowship at Carilion Clinic. She completed her Emergency Medicine training at Virginia Tech Carilion School of Medicine in Roanoke, Virginia. Prior to medical school, she through-hiked the Appalachian Trail (AT), with a short hiatus including a visit to Carilion Roanoke Memorial Hospital. She later went on to through-hike the John Muir Trail. Her interests include altitude medicine and AT hiker health and safety. During residency she researched acute mountain sickness at Everest Base Camp. As a fellow she worked on projects on AT hiker health and safety and a Nepali exchange program to give Nepali doctors exposure to our Emergency Medicine systems. Dr. Gehner accepted a clinical faculty position at VTCSOM and continues to remain active as an assistant WM fellowship director. She continues education projects leading annual trips to Nepal with students and leading an AT CME trip through the WMS.

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Assistant Director

Alex Axtell, P.A.-C.

Alex is a P.A. who graduated from Elon University in 2017. He worked with a hospitalist service in Grand Rapids, MI for several years prior to moving to Roanoke. His interest in the outdoors and first aid began in Boy Scouts on his journey to earning his Eagle Scout in 2005. He discovered the WMS while a member of the medical council for the Fortune Bay Expedition Team, an outdoor adventure group located in West Michigan.

Alex became a FAWM candidate in 2017 and is currently awaiting confirmation of his FAWM completion. Skiing has been a lifelong passion of his and as a member of the National Ski Patrol, he continues his ski patrol service while in Virginia. He has also earned his Rescue Diver certification as a Fellow and is a member of the Scruggs Public Safety Dive Team on Smith Mountain Lake. One of his favorite parts of the Fellowship is the opportunity for teaching, both with other medical providers as well as the general public.

After fellowship, Alex has stayed on as a staff PA in the ED run observation unit and continues to teach, serve and play with the fellowship. This includes continued service with Ski Patrol, Dive Rescue and Recovery, and taking the lead on teaching initiates such as our WFR courses.

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Fellowship Leadership

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Current Fellows

2023-24 Emergency Medicine: TJ Malik, D.O., M.S.

TJ Malik grew up near the Santa Cruz Mountains in Northern California. He studied Molecular Biology at UCLA, conducted research in New York, and pursued a master's degree in Illinois. Later, he worked as a scribe for ER doctors in California's wine country, where he discovered a passion for climbing the massive trees of northern california and through that, was led to indoor rock climbing. During medical school in South Florida, he found time for outdoor rock climbing in Kentucky, Tennessee, California, Nevada, Ontario, Cuba, and Puerto Rico but also developed his tree climbing on the world class banyans and ficuses around fort lauderdale. Completing his Emergency Medicine Residency in Harlem, New York, TJ developed his traditional climbing skills and taught friends to climb at The Gunks. Now, driven by his passion for the outdoors, TJ joined The VTC Wilderness Medicine Fellowship to develop his backpacking, alpine, white water and rescue skills; to meet like minded people to adventure with and to gain teaching experience. He's excited to earn his DiMM and continue learning while pursuing his love for climbing and outdoor exploration.

2023-24 Emergency Medicine: Bri Bennett, M.D.

Bri attended medical school at The Medical College of Georgia and completed residency at Virginia Tech Carilion in Roanoke, Virginia. They found their passion for wilderness medicine during an elective as a first year medical student. Bri's main outdoor interests include rock climbing, caving, and hiking/backpacking with their dog, Denna. In Bri's free time, you can find them gardening, reading a book, climbing at the rock gym, or practicing aerial arts. They love teaching and want to work with local communities to improve outdoor safety and skills. Bri was a MedWAR director and racer during medical school, and they have helped create Blue Ridge MedWAR in Roanoke, VA. During fellowship, Bri plans to complete the FAWM and DiMM. Bri's interests for fellowship are technical rescue, environmental health and advocacy, and event medicine.

2023-24 Family Medicine: Janel Mathews, M.D, MPH

Janel completed her undergraduate studies at Youngstown State University and graduated from medical school at NEOMED. In medical school, she also completed an MPH to pursue her interest in improving healthcare access. She completed her family medicine residency at Bethesda Family Practice in Cincinnati, OH, where she served as chief resident. She stayed in Cincinnati to complete her sports medicine fellowship at Trihealth, where she enjoyed providing medical coverage for sporting events at the high school and collegiate levels. While in sports medicine fellowship, she had the opportunity to experience wilderness medicine while working with a talented ski patrol in Leadville, CO. This experience inspired her to pursue wilderness medicine as it is an intersection of her deep love for the outdoors and healthcare.

Janel looks forward to working toward her DiMM, DiDMM, and FAWM during her fellowship. She is passionate about promoting access to outdoor recreation and teaching outdoor safety, and also looks forward to giving back in the realm of medical education. Her professional interests include endurance race medicine, altitude medicine, and exercise as medicine. In her free time, you can find her out adventuring on a new hiking trail.

2023-24 Internal Medicine: Christine Schwartz, M.D.

Christine came to Virginia from the midwest. She completed her undergraduate and medical schooling at the University of Iowa, then moved 1 state down to Missouri for IM residency at the University of Missouri-Columbia. Christine re-discovered wilderness medicine through her passion for space exploration. She has been an active member of the aerospace medicine community and loved her experience as a NASA intern where she hopes to work someday as a flight surgeon. She is focusing her fellowship on diving and altitude medicine with the goal of obtaining a FAWM and DiDMM distinction. She is working on becoming rescue diver certified and obtaining a private pilot's license. She is looking forward to traveling to Nepal, learning EM and wilderness skills, and exploring new hobbies during fellowship excursions.

2023-24 NP/PA Family Medicine: Jenice Palachick, CRNP

Jenice completed her undergraduate studies at Pennsylvania College of Technology and her RN-BSN at University of Maryland School of Nursing. She worked in critical care/emergency medicine in inner city Baltimore before obtaining her MSN at Johns Hopkins University School of Nursing in family medicine. Jenice worked in several rural family medicine practices before deciding to pursue a fellowship in wilderness medicine. She is currently working toward her DiMM as well.

Jenice has always had a passion for the outdoors and enjoys hiking, backpacking, cycling and anything that involves being outdoors. She also is an avid gardener, homesteader and beekeeper. She also loves to travel and looks forward to traveling after the fellowship to work in austere environments to bring care to those who have very little access to medical services.

Past Fellows

2022-23 Emergency Medicine: Greg Fischer, D.O.

Greg completed his undergraduate studies at La Salle University in Philadelphia and went on to LECOM for medical school. He joined the Wilderness Medicine Society as a medical student and began attending conferences in his third year of medical school. During his EM residency at Jefferson Northeast in Philadelphia, Greg created the WM interest group. During his time there, he expanded the interest group to include an enduring lecture series and a MedWAR that was enjoyed by residents and medical students alike. Greg completed his Fellowship American Wilderness Medicine (FAWM) during his final year of EM residency.

Greg looks forward to working toward his DiMM and DiDMM during his fellowship. He most enjoys teaching WM to junior learners, colleagues and the public and plans to continue a career in medical education following his fellowship. He looks forward to the teaching opportunities that VTC has through the local medical schools and AWLS programs. His professional interests include expanding access to wilderness medicine training, outdoor simulation, endurance recreation medicine and altitude medicine. In his free time, you can find Greg fly fishing, climbing, hiking and backpacking in his new backyard in beautiful southwestern Virginia.

2022-23 Family Medicine: Shefali Shah, M.D.

Shefali grew up traveling the world with her family. Nowadays, she does it more with her Cloud Spitz, Minni. So far, she has visited 34 countries and plans on traveling more post-COVID. During her travels, she also gained a love for outdoor activities, including skiing, SCUBA diving, sailing, backpacking and rock climbing. Shefali realized that she could pursue these interests as a career during her Wilderness Medicine elective at Prisma Health in Columbia, SC. Shefali graduated medical school from Northeast Ohio Medical University (NEOMED) as part of an accelerated BS/MD program. She proceeded to a Family Medicine residency at the Duke/Southern Regional AHEC program in Fayetteville, NC, where she served as chief resident for one year. She realized her passion for teaching and hopes to cultivate this skill during her fellowship. Shefali is AWLS certified and hopes to complete her FAWM, DiMM, SWR, Advanced Open Water and Rescue Diver training.

2022-23 Hospitalist Medicine (IM/Peds): Lydia Kuhn, M.D.

Dr. Kuhn attended medical school at the Medical College of Georgia and completed a Internal Medicine & Pediatrics residency at UTHSC in Memphis, TN. Remaining in Memphis, Dr. Kuhn worked as an Internal Medicine hospitalist until she moved to London, England to study tropical medicine at the London School of Tropical Medicine & Hygiene. After finishing her diploma in England, she returned to Georgia to complete a Point of Care Ultrasound fellowship and work as an Internal Medicine hospitalist at Augusta University. She will now be joining the Wilderness Medicine Department as a fellow and working as a hospitalist at Carilion Rockbridge Community Hospital in Lexington, Virginia.

2021-22 Family Medicine: Carver Haines, M.D.

Carver grew up participating in outdoor activities including mountaineering, canyoneering, caving, diving, backpacking and more. He obtained his EMT and Wilderness EMT certifications in college, as well as mountain rescue and swift water rescue training. Carver worked as a Wildland Firefighter and Wildland EMT, responding to many large fires and firefighter rescue operations in the Northwestern United States. During this time he was part of the Medical Reserve Corps and pursued additional training in disaster medicine and search and rescue. Carver has been involved in equestrian sports since a young age, competing in 3-Day Eventing across the southwest and pacific northwest, and eventually becoming the chair and coach of the Oregon State University's equestrian teams. During residency Carver worked on promoting telemedicine and rural care, became the medical advisor for local caving grotto, and was chief resident during his final year of residency. Carver completed his Fellowship in Wilderness Medicine at Virginia-Tech Carilion Clinic and has since joined the program as part time faculty. He is pursuing his DiMM and DiDDM certifications, and has a strong interest in wilderness medical education.

2021-22 Emergency Medicine: Ty Stannard, M.D.

Ty graduated medical school from East Tennessee State University in 2018 with a focus in rural medicine. He completed his emergency medicine residency in 2021 at the University of Texas Southwestern/Parkland Hospital where he served as a Chief Resident. Ty became a WMS member and started working on his FAWM in 2019. During residency, he participated in the WMS-VTC Appalachian trail hike, MedWAR, and led the UTSW Medicine in Extreme Environments elective. Ty’s hobbies include mountain biking, rock climbing, fly fishing, snowboarding, and aviation. He enjoys spending time with his wife, Shelby, his one year old daughter, Scout, and two dogs, Jazz and Luna. During Fellowship, Ty plans to complete his FAWM, earn his Swift Water Rescue certification, Rescue Diver SCUBA license, SWR instructor certification, and to complete his DIMM and AIARE. He plans to become an instructor for AWLS, WFA, and WFR. Ty’s particular interests for fellowship include search and rescue, expedition medicine, and education.

2021-22 N.P./P.A. Observation Medicine: Alex Axtell, P.A.-C.

Alex is a PA who graduated from Elon University in 2017. He worked with a hospitalist service in Grand Rapids, MI for several years prior to moving to Roanoke. His interest in the outdoors and first aid began in Boy Scouts on his journey to earning his Eagle Scout in 2005. He discovered the WMS while a member of the medical council for the Fortune Bay Expedition Team, an outdoor adventure group located in West Michigan. Alex became a FAWM candidate in 2017 and is currently awaiting confirmation of his FAWM completion. Skiing has been a lifelong passion of his and as a member of the National Ski Patrol, he continues his ski patrol service while in Virginia. He has also earned his Rescue Diver certification as a Fellow and is a member of the Scruggs Public Safety Dive Team on Smith Mountain Lake. One of his favorite parts of the Fellowship is the opportunity for teaching, both with other medical providers as well as the general public. After fellowship, Alex has stayed on as a staff PA in the ED run observation unit and continues to teach, serve and play with the fellowship. This includes continued service with Ski Patrol, Dive Rescue and Recovery, and taking the lead on teaching initiates such as our WFR courses.

2020-21 Emergency Medicine: Justin Gardner, D.O.

Justin completed an Emergency Medicine residency at Henry Ford Macomb hospital in Clinton Township, MI in 2020, followed by a Wilderness Medicine Fellowship with Carilion Clinic in 2021. He is now faculty with the Carilion Wilderness Medicine Fellowship and Clinical Preceptor with VTCSOM.

Justin is an AWLS, WFA, and ACA River Safety and Rescue instructor.

Justin has completed his FAWM and is working on his DIMM. He is a PADI Rescue Diver and is working towards his Master Diver certification. He is the current chair of the WMS Student/Resident Education Committee and runs a monthly wilderness medicine journal club series. He has completed his AIARE level 1 course and plans to take the AIARE Avalanche Rescue course next.

He hopes to increase cooperation amongst Wilderness Medicine interest groups and make it easier for students and residents to access wilderness medicine training. He also wants to become more active in Search and Rescue, Expedition medicine, and teaching Wilderness Medicine and Emergency Medicine. Justin enjoys mountain biking, hiking, kayaking, backpacking, camping, and snowboarding. He looks forward to upcoming adventures and incorporating wilderness medicine into his career.

2019-20 Emergency Medicine: Christopher Waasdorp, D.O., FAWM, FAAEM, DiMM

CJ completed a combined Emergency Medicine and Family Medicine residency at Jefferson Health Northeast in Philadelphia, PA in 2019. He was very active in education within his residency and with medical students, having served as a resident director for the WMS elective for the past two years. He enjoys outdoor sports in a multitude of settings from mountains to marine, frontcountry to backcountry: splitboarding, mountain biking, rock climbing and sailing. In fellowship, he learned to scuba dive, completed his FAWM, his DiMM (Uniformed Services University), continued to pursing learning to be a better educator, and became more involved in wilderness medicine education for the public, EMS and other medical professionals as well as in the Wilderness Medical Society. He enjoys teaching AWLS, WFA, WFR, SWR, ATLS and other wilderness and emergency education topics. He now serves as a co-director for the WMS student/resident elective in Virginia, and continues to serve as Faculty for the Wilderness Medicine Fellowship at Carilion, Virginia Tech Carilion, and Radford University Carilion. While continuing to work in the Emergency Department, CJ also practices Family Medicine, serving patients out of Community Care. He has a particular interest in hypothermia and wilderness medicine applications for EMS and SAR personnel. Current pursuits include additional scuba certifications working toward Master Diver, training in hyperbarics and dive medicine, experience caving and learning cave rescue, and completing the WMS DiMM while learning to be a better kayaker and rafter on top of the water.

2019-20 Family Medicine: Jeremy Kessler, M.D., FAAFP, FAWM

Originally from Queens, New York, Jeremy Kessler studied medicine at the Universidad Autónoma de Guadalajara, in Mexico and then completed a one-year internship at New York Medical College. Jeremy initiated residency in General Surgery at the University of Florida - Gainesville, and subsequently transferred into and completed a Rural Family Medicine residency at the University of Wyoming - Cheyenne. Jeremy has worked with the Himalayan Rescue Association in Nepal, assisting with setting up Everest ER at Everest Base camp. He also is certified as a Diver Medic Technician and has worked in Roatan, Honduras in the Cornerstone clinic at Anthony's Key resort focusing on scuba dive and hyperbaric medicine while treating the local Meskito Indians, who suffer from frequent dive related injuries. Jeremy set up a Pediatric/Adolescent medicine practice at the sleep away camp he attended as a youth, located in the Berkshire Mountains of New York State. He spent 5 years as medical director of this not-for-profit practice. Jeremy is a board-certified Family Medicine physician and has practiced both rural family medicine and in the urgent care settings of Cheyenne, WY and Roanoke, VA. Jeremy completed his Wilderness Medicine fellowship at Virginia Tech Carilion Clinic School of Medicine in July of 2020 and since has transitioned to faculty with an academic appointment as assistant professor with VTCSOM. Currently Jeremy is doing a fellowship in Undersea and Hyperbaric Medicine at Aurora Health in Milwaukee, Wisconsin. He is passionate about teaching in both the austere and clinical settings. Presently, he has completed his SWR, AWLS, AIARE, Mountain Medicine, FAWM, Wilderness Lifeguard, Open water and Advanced Open water scuba dive certifications. He plans to complete the last remaining portion of the DiMM requirements shortly. He has co-authored a chapter on the emergency treatment of submersion injuries which was published in the Corependium online textbook by Emergency Medicine Reviews and Perspectives. He has become an instructor for courses such as WFA, WFR and AWLS. In his free time, Jeremy has been a medical and surgical brigade volunteer across Latin America, giving back to the underserved Spanish speaking population. He is enthusiastic and enjoys working as an instructor with the Blue Ridge Adventure Medicine group and looks forward to upcoming adventures, incorporating wilderness medicine into his future career path, while satisfying his passion for travel by exploring the globe.

2019-20 N.P./P.A. Emergency Medicine: Claire Wilsey, P.A.-C., CAQ-EM

Claire Wilsey is an Emergency Medicine PA at Carilion Clinic.

She has completed an Emergency Medicine Fellowship at Upstate Medical Center in Syracuse, NY, and a Wilderness Medicine Fellowship at Carilion Clinic in Roanoke, VA. Claire has earned the Fellowship in Wilderness Medicine and Diploma in Mountain Medicine. She has lectured at the Wilderness Medicine Conference and Southeastern Student Wilderness Medicine Conference. Outside of work, she is a volunteer instructor for wilderness first aid (WFA) and advanced wilderness life support courses (AWLS). As an avid outdoor enthusiast, Claire enjoys downhill skiing, paddle boarding, hiking, photography, backpacking, yoga, mountain biking, and international travel.

2018-19 Family Medicine: Theophile Lyotard, M.D.

Theo finished his residency in family medicine at Creighton University in Omaha, Nebraska in 2017. He then went on to complete a fellowship in emergency medicine at the Monroe Clinic in Wisconsin. He is currently working towards his Di.M.M. and F.A.W.M. through the Wilderness Medical Society and teaches wilderness medicine to medical providers and the public whenever the occasion arises. Theo is certified in AWLS and as a Diving Medical Physician through NOAA and the UHMS. Whenever he is not working or teaching, Theo enjoys rock climbing, mountain biking, running, skiing and scuba diving.

2018-19 Emergency Medicine: Matt Robichaud, M.D.

Matt is a graduate of the University Of Vermont College of Medicine, 2015, and a graduate of the Virginia Tech Carilion Emergency Medicine Residency, 2018. He initially stayed on in Roanoke after fellowship before relocating to Lake Tahoe where one can sail and ski in the same day. Matt’s areas of interest in wilderness medicine are numerous, but he has maintained a focus on maritime medicine and sailing safety. During fellowship he completed his American Sailing Association degrees 101, 103 and 104, enabling him to captain his own sailing vessels anywhere in the world. He is also taking a three-part class currently to become certified as the Medical Care Person in Charge (MCPIC), enabling him to provide medical support for sailing races, yachts, cruise ships, etc. with the hopes of eventually being involved in the America’s Cup in the future.

Matt is currently working on his Diploma in Mountain Medicine (Di.M.M.) degree, a four-week intensive series including avalanche training, crevasse rescue, mountain medicine and high angle rescue. During fellowship Matt taught wilderness first aid in Peru, as well as to the larger Roanoke community. He completed his AWLS certification (Advanced Wilderness Life Support) and went on to teach the course later in fellowship in Utah. His area of research lies in snake envenomations and currently has an ongoing research project reviewing management of snake envenomations within the Carilion hospital system in Virginia. Before medical school, Matt was a semi-professional mogul skier, competing for Breckenridge, Vail and Killington teams in 2003-2006. In 2006, he skied in the North American Tour (NorAm Tour), which is comprised of the top 30 mogul skiers from the U.S. and Canada on a four-competition tour. For fun, Matt still skies during the winter as much as possible and spends as much time as he can sailing on Smith Mountain Lake, as well as at the Outer Banks and the British Virgin Islands. He enjoys cooking, all outdoor sports including rock climbing, hiking, camping, fly fishing, hunting, mountain biking, scuba diving, skiing, surfing, yoga, trail running and adventure traveling. Matt has a passion and enthusiasm for life and medicine and enjoys the fast pace of the Emergency Department.

2018-19 Mary Carroll Lee, M.D.

Mary grew up in Atlanta, GA and became interested in the outdoors through trips to the north Georgia mountains with her dad. After college she became interested in camping, hiking, climbing, water sports and international medicine. She still enjoys combining both her interest in medicine and the outdoors. During her fellowship she completed the NOAA/ UHMS Dive Physician Course, traveled to Peru to teach WFA skills, became an AWLS instructor, and she will earn the Diploma in Mountain Medicine. After fellowship graduation she relocated to Salem, OR and plans to remain active in wilderness medicine there.

2018-19 N.P./P.A. Emergency Medicine: Keri Baker, N.P.

Keri was the first Nurse Practitioner Wilderness Medicine Fellow at Carilion Clinic in Roanoke, VA. In 2015, she completed a one-year fellowship in emergency medicine at Carilion Clinic and now works in the Emergency Department. She is the executive director and co-founder of Sacred Valley Health, a nonprofit organization based in Peru that trains and supports women in remote areas who are becoming health care workers in their communities. She is enthusiastic about teaching others about medicine in remote and limited resource environments. She was a co-author and grant recipient from the Carilion Clinic Foundation and developed a community wilderness medicine education program in Roanoke. Her project reached over 500 community members. She is an AWLS and WFA instructor. Her outdoor interests include running, cycling, paddling and international travel. Keri has stayed on at Carilion as an Emergency Department N.P. and is an assistant fellowship director for the N.P./P.A. wilderness medicine fellowship.

2017-18 Emergency Medicine: Joshua Nichols, M.D.

Josh completed his emergency medicine training at VT-Carilion in Roanoke, VA. He is an avid whitewater kayaker and distance trail runner. His research interests include medical simulation and education. During his fellowship, he continued his research in medical simulation as well as expanded his experience in the areas of maritime and dive medicine. Josh also completed the Di.M.M., taught WFA in Peru, provided endurance race support and worked on wilderness medicine protocols for the Roanoke County EMS. After graduation, Josh stayed on as clinical faculty at VT-C as an emergency physician and serves as one of the assistant wilderness medicine fellowship directors.

2016-17 Emergency Medicine: Jessie Gehner, M.D.

Jessie completed her emergency medicine training at VT-Carilion in Roanoke, VA. Prior to medical school, she through-hiked the Appalachian Trail, with a short hiatus including a visit to Carilion Roanoke Memorial Hospital. She later went on to through-hike the John Muir Trail. Her interests include altitude medicine and Appalachian Trail hiker health and safety. During her residency she researched acute mountain sickness at Everest Base Camp. As a fellow she worked on Appalachian Trail hiker health and safety projects and on a Nepali exchange program to give Nepali doctors exposure to our emergency medicine systems. Jessie accepted a clinical faculty position at VT-C and continues to remain active as an assistant wilderness medicine fellowship director. She continues education projects leading annual trips to Nepal with students and leading an Appalachian Trail CME trip through the WMS.

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Fellows

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Claire Wilsey, P.A.-C., CAQ-EM

Claire Wilsey is an Emergency Medicine P.A. at Carilion Clinic.

She completed an Emergency Medicine fellowship at Upstate Medical Center in Syracuse, NY, and a Wilderness Medicine fellowship at Carilion Clinic in Roanoke, VA. Claire has earned the fellowship in Wilderness Medicine and Diploma in Mountain Medicine. She has lectured at the Wilderness Medicine Conference and Southeastern Student Wilderness Medicine Conference. Outside of work, she is a volunteer instructor for wilderness first aid (WFA) and advanced wilderness life support courses (AWLS). As an avid outdoor enthusiast, Claire enjoys downhill skiing, paddle boarding, hiking, photography, backpacking, yoga, mountain biking and international travel.

Jeremy Kessler, M.D., FAAFP, FAWM

Originally from Queens, New York, Jeremy Kessler studied medicine at the Universidad Autónoma de Guadalajara, in Mexico and then completed a one-year internship at New York Medical College. Jeremy initiated residency in General Surgery at the University of Florida - Gainesville, and subsequently transferred into and completed a Rural Family Medicine residency at the University of Wyoming - Cheyenne.

Jeremy has worked with the Himalayan Rescue Association in Nepal, assisting with setting up Everest ER at Everest Base camp. He also is certified as a Diver Medic Technician and has worked in Roatan, Honduras in the Cornerstone clinic at Anthony's Key resort focusing on scuba dive and hyperbaric medicine while treating the local Meskito Indians, who suffer from frequent dive related injuries. Jeremy set up a Pediatric/Adolescent medicine practice at the sleep away camp he attended as a youth, located in the Berkshire Mountains of New York State. He spent 5 years as medical director of this not-for-profit practice.

Jeremy is a board-certified Family Medicine physician and has practiced both rural family medicine and in the urgent care settings of Cheyenne, WY and Roanoke, VA. Jeremy completed his Wilderness Medicine fellowship at Virginia Tech Carilion Clinic School of Medicine in July of 2020 and since has transitioned to faculty with an academic appointment as assistant professor with VTCSOM. Currently Jeremy is doing a fellowship in Undersea and Hyperbaric Medicine at Aurora Health in Milwaukee, Wisconsin. He is passionate about teaching in both the austere and clinical settings. He has completed his SWR, AWLS, AIARE, Mountain Medicine, FAWM, Wilderness Lifeguard, Open water and Advanced Open water scuba dive certifications, and has plans to complete the remaining portion of the DiMM requirements.

He has co-authored a chapter on the emergency treatment of submersion injuries which was published in the Corependium online textbook by Emergency Medicine Reviews and Perspectives. He has become an instructor for courses such as WFA, WFR and AWLS.

In his free time, Jeremy has been a medical and surgical brigade volunteer across Latin America, giving back to the underserved Spanish speaking population. He is enthusiastic and enjoys working as an instructor with the Blue Ridge Adventure Medicine group and looks forward to upcoming adventures, incorporating wilderness medicine into his future career path, while satisfying his passion for travel by exploring the globe.

Justin Gardner, D.O.

Justin completed an Emergency Medicine residency at Henry Ford Macomb hospital in Clinton Township, MI in 2020, followed by a Wilderness Medicine fellowship with Carilion Clinic in 2021. He is now faculty with the Carilion Wilderness Medicine fellowship and Clinical Preceptor with VTCSOM.

Justin is an AWLS, WFA, and ACA River Safety and Rescue instructor.

Justin has completed his FAWM and is working on his DIMM. He is a PADI Rescue Diver and is working towards his Master Diver certification. He is the current chair of the WMS Student/Resident Education Committee and runs a monthly wilderness medicine journal club series. He has completed his AIARE level 1 course and plans to take the AIARE Avalanche Rescue course next.

He hopes to increase cooperation among Wilderness Medicine interest groups and make it easier for students and residents to access wilderness medicine training. He also wants to become more active in Search and Rescue, Expedition medicine, and teaching Wilderness Medicine and Emergency Medicine. Justin enjoys mountain biking, hiking, kayaking, backpacking, camping, and snowboarding. He looks forward to upcoming adventures and incorporating wilderness medicine into his career.

Alex Axtell, P.A.-C.

Alex is a P.A. who graduated from Elon University in 2017. He worked with a hospitalist service in Grand Rapids, MI for several years prior to moving to Roanoke. His interest in the outdoors and first aid began in Boy Scouts on his journey to earning his Eagle Scout in 2005. He discovered the WMS while a member of the medical council for the Fortune Bay Expedition Team, an outdoor adventure group located in West Michigan.

Alex became a FAWM candidate in 2017 and is currently awaiting confirmation of his FAWM completion. Skiing has been a lifelong passion of his and as a member of the National Ski Patrol, he continues his ski patrol service while in Virginia. He has also earned his Rescue Diver certification as a Fellow and is a member of the Scruggs Public Safety Dive Team on Smith Mountain Lake. One of his favorite parts of the Fellowship is the opportunity for teaching, both with other medical providers as well as the general public.

After fellowship, Alex has stayed on as a staff PA in the ED run observation unit and continues to teach, serve and play with the fellowship. This includes continued service with Ski Patrol, Dive Rescue and Recovery, and taking the lead on teaching initiates such as our WFR courses.

Carver Haines, M.D.

Carver grew up participating in outdoor activities including mountaineering, canyoneering, caving, diving, backpacking and more. He obtained his EMT and Wilderness EMT certifications in college, as well as mountain rescue and swift water rescue training. Carver worked as a Wildland Firefighter and Wildland EMT, responding to many large fires and firefighter rescue operations in the Northwestern United States. During this time, he was part of the Medical Reserve Corps and pursued additional training in disaster medicine and search and rescue.

Carver has been involved in equestrian sports since a young age, competing in three-day eventing across the southwest and pacific northwest, and eventually becoming the chair and coach of the Oregon State University's equestrian teams. During residency, Carver worked on promoting telemedicine and rural care, became the medical advisor for local caving grotto, and was chief resident during his final year of residency.

Carver completed his fellowship in Wilderness Medicine at Virginia-Tech Carilion Clinic and has since joined the program as part time faculty. He is pursuing his DiMM and DiDDM certifications, and has a strong interest in wilderness medical education.

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Fellowship Faculty

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Blue Ridge Adventure Medicine Blue Ridge Adventure Medicine is a regional nonprofit organization dedicated to wilderness medicine education for the community and health care providers. Many fellowship activities are done in partnership with this organization.

Teach at the Southeastern Student Wilderness Medicine Conference
Teach at the Resident Wilderness Medicine Weekend
Teach WFA in Peru in partnership with Sacred Valley Health
Participate in the Nepal Exchange Program

Appalachian Center for Wilderness Medicine The Appalachian Center for Wilderness Medicine is a regional nonprofit organization dedicated to promoting quality medical care in limited resource ("wilderness") environments. The center serves as a regional resource to southern Appalachian states -- North and South Carolina, West Virginia, Virginia, Georgia, Tennessee, Kentucky, Maryland and Alabama.

Participate in the Advanced Wilderness Life Support Course (AWLS)
Contribute to the quarterly newsletter

WMS Student Elective An international four-week medical student elective in New Castle, Virginia which includes: Small group discussions of wilderness scenarios, formal lectures of Wilderness Medicine principles and specific topics by leaders in the field, field and hands-on instruction in survival and pre-hospital patient assessment and evacuation, supervised five-day field-practicum incorporating medical assessment, treatment, evacuation, survival and improvisational techniques and a Wilderness First Responder Course.

Function as an assistant course director
Act as a backpacking mentor
Present lectures/ workshops
Act as onsite director
Meet and network with elective faculty

Virgnia Tech-Carilon Wilderness Medicine Elective A two-week elective for fourth-year medical students and second-year PA students which includes an AWLS course, swift water rescue course, backpacking trip, caving experience and numerous outdoor scenarios.

Function as assistant course director
Earn SWR certification
Earn AWLS/instructor
Present lectures/workshops

Southeastern Student Wilderness Medicine Conference An annual wilderness medicine conference aimed at medical and health care students. The conference is in its ninth year and typically attracts between 200-300 attendees per year. The conference includes lectures, workshops and team-based realistic scenarios.

Act as mentor to student planners
Develop and facilitate conference scenarios
Lecture at regional event

Disrupting Natural Selection Lecture Series In conjunction with Roanoke Parks and Recreation and Carilion Trauma Outreach Services, a monthly free lecture series was created for the community. This project was recently funded by a grant from the Carilion Clinic Foundation. With Roanoke having so many fantastic opportunities for outdoor recreation, and with more people participating in these activities, we have selected topics that focus on outdoor safety and first aid. We have offered everything from basic trailside first aid, to speaking to local skiing and mountain biking clubs. The lectures occur on a monthly basis and topics are tailored to the season and needs of the community. Below is a link to local news coverage of our trailside first-aid workshop: virginiafirst.com

Roanoke County EMS Roanoke County EMS reports that they receive multiple calls every week for patients lost, injured or ill in the backcountry. This fall Drs. Lareau and Gehner met with Roanoke County EMS to arrange an agreement in which members of the Wilderness Medicine Fellowship can be contacted when crews receive a call involving a trail/backcountry rescue. This is a wonderful opportunity for physicians involved in the fellowship to practice wilderness medicine in the greater Roanoke area. Not only will fellowship members better understand the challenges of prolonged extrication over difficult terrain, but they will also be involved in the continued education of EMS personnel on wilderness medicine-related topics so that they not only may better care for patients in the backcountry, but care for themselves and prevent their own injuries and illnesses in remote/limited resource settings.

MedWAR MedWAR (Medical Wilderness Adventure Race) combines wilderness medicine with adventure racing to create unique events designed to teach and test wilderness survival and medical skills.

Develop a regional event
Assist with flagship event in Augusta, GA
Field a team to participate

Snowshoe Ski Patrol Snowshoe is the premier destination for mid-Atlantic and southeast skiers, snowboarders and winter enthusiasts. It consists of 11,000 acres of unspoiled wilderness. Ski patrol is very active and many of the seriously injured find their way via helicopter to Carilion Roanoke Memorial Hospital.

Earn OEC
Serve as volunteer patrol
Work with local hospitals on education

GO FEST The Anthem Go Outside Festival in Roanoke, VA is an annual event to encourage healthy, active outdoor recreation. By combining the things outdoor enthusiasts love -- camping, music, gear, races, and demos and a beautiful outdoor setting – GO Fest is a celebration of everything outdoors.

Present workshops for community on wilderness first aid
Share information about local organizations with the community

Trail Days Celebration of the Appalachian Trail in Damascus, VA.

Complete research on hiker medical needs
Teach basic first aid to hikers
Provide basic foot care

Aeromedical-Life Guard As Virginia's first air ambulatory service, Carilion Clinic Life-Guard provides 24-hour transport for the entire state of Virginia, as well as parts of West Virginia, North Carolina and Tennessee. Our specialized fleet of helicopters operates out of three bases throughout the state, providing fast emergency access to western Virginia's regional Level I Trauma Center at Carilion Roanoke Memorial Hospital.

Work with crews on survival training
Participate on ride-alongs

Carilion Resident Education Carilion Clinic has two emergency medicine residency programs, with a total of 12 residents per class.

Participate in resident didactics
Present lectures to residents on wilderness topics
Develop resident wilderness simulation cases

Carilion Clinic Faculty Development Combined series of lectures and workshop to assist new faculty with succeeding in academia. This innovative program is available to fellows.

National Opportunities

Diploma in Mountain Medicine The Diploma in Mountain Medicine (DiMM) is an exciting program designed to train the participant in the essentials of caring for patients in the technical mountain environment. The DiMM has set the standard over the past 10 years in Europe and other parts of the world for education of doctors, mid-level providers, nurses and medics in mountain medicine and rescue.

Complete Diploma in mountain medicine through Madigan (Tacoma, Washington) or WMS

WMS Annual Conferences Founded in 1983, the Wilderness Medical Society (WMS) is the world's leading organization devoted to wilderness medical challenges. Wilderness medicine topics include expedition and disaster medicine, dive medicine, search and rescue, altitude illness, cold- and heat-related illness, wilderness trauma, and wild animal attacks. WMS explores health risks and safety issues in extreme situations such as mountains, jungles, deserts, caves, marine environments, and space.

Attend Annual Summer Conference (Colorado)
Attend Annual Winter Meeting (Utah)
Present oral presentation during fellow lecture series
Work at committee level to develop educational materials
Serve as mentor for students

WMS Fellowship of Academy of Wilderness Medicine Fellowship in the Academy of Wilderness Medicine (FAWM) is designed for individuals who want to be acknowledged for their professional achievement in wilderness medicine and wish to validate their training for their patients and clients. The Wilderness Medical Society will serve as a clearinghouse for agencies, employers, and the general public wishing to verify that Fellows have met educational criteria in the discipline. Individuals should realize that neither the Academy nor the Society vouch for the competency of any individual, only that he/she has met established educational criteria.

Work toward FAWM

ACEP-Section for Wilderness Medicine Section on Wilderness Medicine is active in education, working with EMRA and enhancing wilderness medicine opportunities for ACEP members.

Work as mentor to medical students
Serve on subcommittee

Wilderness EMS Director Course As interest in outdoor sports grows, so do expectations for rescue services and the volume of EMS calls in wilderness (also known as austere or resource-deficient) areas. However, until now there has been no professional society-recognized training for physicians to provide this type of EMS oversight. Many physicians have extensive EMS training, but little wilderness medical experience. Similarly, many physicians have deep wilderness or wilderness medical training but little exposure to the EMS operational environment or EMS oversight. To address this issue, the Wilderness EMS Medical Director Course was developed to support physicians and other health care providers tasked with providing medical oversight to EMS systems operating in a variety of wilderness environments.

Obtain certification in Wilderness EMS direction
Apply knowledge assisting with local EMS protocols and training

UHMS-NOAA Physicians Training in Diving Medicine The NOAA Diving Program and the Undersea and Hyperbaric Medical Society (link is external) (UHMS) team teach this two-week course at the NOAA Diving Center every year in the fall. This course is taught by a select group of diving experts, including experienced technical divers, current professionals practicing hyperbaric medicine and physicians conducting research and teaching at top universities and hospitals around the world. It is typically attended by university Fellows, physicians, nurse practitioners, physician assistants, and nurses from the U.S. and other countries who desire advanced training in diving medicine. Students participate in theoretical and practical sessions that include work in a pressurized environment.

Participate in course
Use information to develop Dive CME curriculum

National Park/Search and Rescue Numerous opportunities exist to work with the park medic program and work with local search and rescue in many of our national parks and forests.

Work in national park clinic
Shadow and work with national SAR organizations
Develop educational programming

International Opportunities

Racing the Planet The 4 Deserts Race Series is widely recognized as the most prestigious outdoor foot race series in the world. The series consists of the Sahara Race (Egypt), Gobi March (China), Atacama Crossing (Chile) and The Last Desert (Antarctica). Competitors in the races traverse 250 kilometers in seven days over rough country terrain with only a place in a tent and water provided. They are supported by highly qualified staff, all with experience in hiking, marathons and ultramarathons, and medical teams specializing in wilderness medicine.

Participate as medical support
Learn about wilderness foot care
Treat altitude illness, heat illness and potentially hyponatremia

MedicForce MedicForce is an independent, non-sectarian organization committed to improving access to rural health care throughout the world. Our mission is to establish sustainable healthcare systems through education, infrastructure and support.

Participate as instructor/assistant medical director for Belize trip
Teach medical students
Teach local health care workers
Assist in curriculum development
Assist in conference planning

Nepali Exchange Program During the fall of 2016 VTC piloted an exchange program in which we host Nepali doctors so that they may gain exposure to the U.S. health care system in preparation for residency interviews. During this time they shadow in the ED, teach at the wilderness medical elective and community workshops, and participate in SIM lab and U.S. workshops. In turn Fellows travel to the Khumbu region of Nepal to shadow, give lectures and continue ongoing research in altitude medicine. (email jrgehner@carilionclinic.org for more details).

Help develop the field of emergency medicine in Nepal
Shadow in remote clinics and hospitals in Nepal
Participate in educational activities/give lectures in Nepal
Participate in altitude medicine research

Sacred Valley Health, Wilderness First Aid in Rural Peru VTC Wilderness Medicine Fellowship has partnered with Sacred Valley Health to design a Wilderness First Aid course for volunteers and local health care workers (prometoras) in Ollyanta, Peru. The most recent trip was in November 2017. The trip focused on educating volunteers and prometoras that work in remote communities in skills such as trauma evaluation, splinting and patient extrication. The ultimate goal is to create a sustainable program where the prometoras may continue to educate new volunteers at Sacred Valley Health. In addition to the lectures and workshops there is free time to go on a day trip to Machu Picchu as well as other day hikes. For those that wish to participate, we also plan a multi-night backpacking trip in the Andean high country.

Nepal: Everest Base Camp Trek CME trip through WMS.

Participate in CME trip

Diploma in Mountain Medicine: Nepal The Diploma in Mountain Medicine (DiMM) is an exciting program designed to train the participant in the essentials of caring for patients in the technical mountain environment. The DiMM has set the standard over the past 10 years in Europe and other parts of the world for education of doctors, mid-level providers, nurses and medics in mountain medicine and rescue.

Earn Diploma in Mountain Medicine internationally

DAN Hyperbaric and Dive Medicine Course Jointly sponsored by DAN and the Undersea and Hyperbaric Medical Society, the course is designed primarily for physicians. However, emergency medical personnel, paramedics, nurses and professionals, as well as instructors, divemasters and nonmedical, diving-related personnel with an interest in dive medicine may also find the course valuable. The program focuses on diving and hyperbaric medicine with emphasis on the latest scientific literature in the field. The course features lectures, case presentations and support materials as well as both formal and informal discussion sessions with faculty.

Attend conference
Obtain SCUBA certification

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Local/Regional Opportunities

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For calendar of local events or other opportunities:

Visit Blue Ridge Adventure Medicine.

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Curriculum

Obtain skills for teaching others and participating in academic wilderness medicine. 1.0 Teaching techniques directed to adult learner 1.1 Residents and medical student 1.1.1 Didactic 1.1.2 Bedside 1.1.3 Applied skills 1.2. Wilderness medicine prehospital personnel 1.2.1. Didactic 1.2.2. Applied skills 2.0. Quality management 2.1. Wilderness and out-of-hospital treatment protocols 2.2. Data collection, management and analysis 2.3. Quality improvement programs 2.4. Evidenced-based practice 3.0. Research 3.1. How to design a research project 3.2. Fundamental epidemiology and biostatistics 3.3. Completion of a scholarly project 4.0. Leadership skills Obtain wilderness-medicine-specific knowledge 1.0. High-altitude illness 1.1. Physiologic response to high altitude and hypobaric hypoxia 1.2. Acclimatization 1.3. Risk factors for developing high-altitude illness 1.4. Types of high-altitude illness 1.4.1. Acute mountain sickness 1.4.2. High-altitude cerebral edema 1.4.3. High-altitude pulmonary edema 1.5. Risk assessment and advising patients traveling to high altitude 2.0. Environmental exposure 2.1. Heat illness 2.1.1. Muscle cramps 2.1.2. Heat syncope 2.1.3. Heat exhaustion 2.1.4. Heat stroke 2.1.5. Dehydration 2.2. Hypothermia 2.3. Cold injuries 2.3.1. Nonfreezing cold injury 2.3.2. Freezing cold injury 2.3.2.1. Frostnip 2.3.2.2. Frostbite 3.0. Wilderness trauma 3.1. Basic principles 3.1.1. Situational awareness 3.1.2. Stabilization 3.1.3. Packaging 3.1.4. Long-term patient management 3.2. Head trauma 3.3. Spinal trauma 3.4. Chest trauma 3.5. Pelvis trauma 3.6. Penetrating trauma 3.7. Extremity trauma 3.7.1. Fracture and dislocation reduction techniques and splinting 3.8. Sprains and strains 3.9. Wound management 3.10. Foreign body management 4.0. Expedition medicine 4.1. Pretravel considerations 4.2. Evacuation criteria 4.3. Medical kit 4.4. Acute and chronic medical conditions 4.5. Infectious disease 4.6. Infectious diarrhea 4.7. Field water disinfection 4.8. Nutrition 4.9. Medical–legal considerations 5.0. Drowning 6.0. Dive medicine 6.1. Physics and physiology 6.2. Barotrauma 6.3. Decompression illness 6.4. Risk assessment 7.0. Aquatic medicine 7.1. Injuries from marine animals 7.2. Poisonings 7.3. Infections 8.0. Bites, stings and zoonoses 8.1. Animal attacks 8.2. North American snakes 8.3. Spider bites 8.4. Tick-borne diseases 8.5. Hymenoptera stings 8.6. Scorpion stings 8.7. Mosquito-borne diseases 8.8. Rabies 9.0. Wildland ﬁres and ﬁre management 9.1. Predictable injury and illness patterns 9.2. Medical complications 10.0. Wilderness medicine emergency medical services (EMS) 10.1. Interface with EMS 10.2. Air medical transport 11.0. Search and rescue 11.1. Theory and application 11.2. High-angle rescue 11.3. Swift-water rescue 11.4. Alpine rescue 12.0. Wilderness survival 12.1. Shelter 12.2. Water procurement and disinfection 12.3. Fire building 12.4. Navigation and signaling 13.0. Lightning injuries 13.1. Risk assessment 13.2. Physiology 14.0. Avalanche 14.1. Terrain and snowpack assessment 14.2. Avalanche victim physiology 14.3. Patterns of injury 14.4. Rescue equipment 15.0. Wilderness toxicology and toxinology 15.1. Poisonous plants 15.2. Poisonous mushrooms As described in Lipman, et al. “Core Content for Wilderness Medicine Fellowship Training of Emergency Medicine Graduates” Academic EM2014; 21:204-207.

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Wilderness Medicine is medical care rendered in the setting where definitive care in a formal environment will be delayed. Is is medical care in the austere or remote environment. Traditionally, anything delayed more than an hour can be considered wilderness, but the wilderness environment is often hours, days or even weeks from definitive care.

The setting may be anything from a cave with an expected three-hour extrication, to the polar climate of Antarctica with multiple weeks until the weather will allow evacuation. There is a focus on improvisation, remaining flexible and working with limited resources. It covers content ranging from common injuries/illnesses in an unusual setting, to medical conditions unique to these austere environments.

Wilderness Medicine includes a focus on the outdoor environment and injuries sustained in the backcountry hiking, kayaking, climbing, sailing, etc. As more individuals move into the outdoor environments, there has been more focus on teaching and training outdoor recreationalists to provide medical care to themselves and others, as well as teaching and training medical and rescue professionals to affect rescue and provide medical care in these environments.

In addition to understanding the medical care in the austere setting, it is also important to understand when and how to affect rescue and transfer to definitive care. Wilderness Medicine professionals need to understand when it's time to cancel the trip and evacuate, and when it's okay to continue on. They also understand what treatments can be offered to buy time, and possibly convert and evacuation into a "stay and play" situation.

Ultimately, Wilderness Medicine professionals may not be the experts in technical rescue and often get designated to the "medic" role in formal rescue operations, but they should be proficient as technical rescue operators to best understand the environment and to be most effective as part of a rescue team. Depending on the provider, focuses may include search-and-rescue operations, military/tactical medicine or travel medicine, each with their own unique considerations of their austere environment.

Environmental Medicine focuses on the identification and treatment of conditions caused by environmental conditions. This covers a wide range of conditions, including heat illness, hypothermia, lightning, drowning, envenomation, animal bites, solar injury, altitude illness, dive injuries and avalanche injuries. Fellows in Wilderness and Environmental Medicine gain expertise in both field treatment and treatment in the formal medical setting of such environmental conditions.

As so many of the environmental conditions happen in the austere setting, the two are intimately connected. Training in one begets the other and prospective fellows should find interest in the place where the two meet.

Link

Our Program Director speaks to CNN about heat illness

Local news WDBJ covers Carilion Wilderness Medicine Fellowship and Roanoke area…

Local news WSLS covers Carilion Wilderness Medicine Fellowship in light of a lo…

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Wilderness and Environmental Medicine

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What is Wilderness and Environmental Medicine?