Above the humming of insects and singing of birds, laughter and inquisitive voices could be heard at the University of Lynchburg’s Claytor Nature Center. It was there, between May 10 and 15, that the third-annual cohort of the Doctor of Medical Science’s Emergency Management and Global Health concentration completed its intensive practicum.
The group of PAs underwent advanced disaster response training during a six-day, hands-on session, where they also earned the Wilderness Advanced Life Support certification.
Dr. Travis Kaufman ’20 DMSc, deputy brigade surgeon and senior medical advisor at the 4th Security Force Assistance Brigade of the U.S. Army, brought in-depth knowledge and a global perspective on emergency medicine to the program as the lead instructor.
“I actually call it knee-in-the-dirt medicine,” Kaufman said. “How are you going to put that airway into the patient when your knees are in the dirt? How can you keep it as sterile as possible? Say you get a patient that’s hurt in the wilderness, how can you evac that patient?”
Before the practicum, Kaufman was acting exercise control deputy chief for the NATO Centre of Excellence for Military Medicine’s Vigorous Warrior Exercise in Hungary.
The exercise brought military and civilian organizations from 39 nations together to simulate the activation of NATO forces under Articles 3 and 5 situations. Article 3 focuses on maintaining and developing defense capabilities among member states, while Article 5, the principle of collective defense, treats an attack on one member as an attack on all.
The exercise combined diverse military combat and disaster medicine situations, covering chemical, biological, radiological, and nuclear challenges into a unified disaster and combat medicine training scenario. This approach enhanced participants’ preparedness and coordination for real-world emergencies.
Coming directly from the Vigorous Warrior Exercise and in combination with his active-duty military experience and time advising in the COVID-19 pandemic-era White House, Kaufman brought critical, firsthand knowledge and instruction to the DMSc students.
“This cohort especially wants to be emergency management or disaster medicine leaders, so I’m trying to bring the skills I’ve learned and developed over the years and share those experiences with the students,” Kaufman said.
Kaufman added that he also wanted to show the students that “PAs can be leaders in … other areas, like NGOs or the Red Cross” and “not just the clinic.”
Kaufman and the other DMSc instructors were not the only ones bringing their experiences to the outdoor classroom at Claytor. At times, it was hard to distinguish who was the instructor and who was the student, as both collaborated on simulations and shared the experiences that influenced their decision-making.
While students worked together to find improvised methods for stabilizing injuries to the lower extremities, for example, they could be overheard discussing the merits of traction splints. The group’s instructor explained that in wilderness environments, this type of splint was no longer preferred, due to a common complication that comes from prolonged use.
Two of the DMSc students were quick to add to the conversation, based on their own experiences, revealing a separate problem the instructor had not addressed: These splints cannot always be used in a helicopter evacuation. The limited space in the helicopter combined with the length of the splint often means it must be removed before the patient can fit.
This opened the floor for discussions, not only about alternatives to traction splints but also to the lived realities of the students with experience in emergency medical evacuation.
The DMSc students in the cohort came from a variety of professional backgrounds, including military, first-responder, ICU, and traditional clinics. There also were a variety of experience levels, from freshly licensed PAs to experienced professionals already instructing the next generation.
While “knees-in-the-dirt” medicine was a new experience for some, for others the emergency management and global health concentration enhanced and complimented their existing skills.
“I was deployed recently to the Indo-Pacific and everything I did over there is similar to what we’re doing now,” said Alvaro Ramos ʼ24 DMSc, a senior medical advisor in the U.S. Navy. “A lot of it is a bettering of what I already do.”
Mark Crawford ʼ24 DMSc, another active-duty service member, reflected on the reality of living in a globalized society and the need for more clinicians with the ability to face anything the world may throw at them.
“When I looked at the emergency medicine global health track, it appealed to me because disaster management, the idea of globalization, is not going anywhere,” Crawford said.
“There needs to be people with the core training, values, leadership, and competency to help us manage this going forward and to protect the patients of the world. That’s what we’re here to do.”
When asked how the program is developing the emergency medical leaders the world needs, Crawford explained.
“Disaster management is a cohesive combination of resources between EMS, hospitals, National Guard, Army, etc.,” he said. “This intensive is bringing us together from all of our various backgrounds and actually having us do in-person training.
“That’s how you build connections, learn how to work with people from different backgrounds, and better not only yourself as a provider but the entire medical care industry.”
The EMGH training prepares PAs to take on a variety of roles, from being the boots-on-the-ground emergency care providers to planning medical evacuation routes for hospitals during a natural disaster.
Kaufman emphasized that a PA may not always be the highest authority in the room, but that doesn’t stop them from being one of the most influential.
“Not every PA is going to be the CEO or the highest-ranking person,” Kaufman said. “But they can be the person that comes to the table with the most experience [and] with the most enlightened education.
“They can bring their experiences to the table and make the best decisions and plan possible.”
In summing up the course, its goals, and the potential this DMSc cohort has to make an impact, Kaufman added, “This program helps you bridge the gap from PA to PA leader. It’s about helping your fellow human beings in their time of need and that’s a big part of what disaster medicine is all about.”
