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Winter 2010 issue (pdf)

She'll be coming 'round the mountain

Alumna directs medical efforts, training on Denali

At 14,000 feet, base camp altitude for any high-mountain rescue on Denali, temperatures are continuously below freezing. Your hands are always cold, and fine dexterity is a challenge. National Parks Service rangers maintain two double walled tents, including one that is heated just above freezing to keep their radios working. Drinking water consists of melted snow, and solar panels must be moved three times a day to keep battery equipment charged.

Now imagine practicing medicine.

For several months a year – climbing season on and around the tallest mountain in North America – this is the office of Jennifer Dow, MD ’94. Since 2001, Dr. Dow has been the Medical Director for Denali National Park in Alaska, initially working with the south, mountaineering side but adding the responsibilities of the north side in about 2004.

“My responsibilities, both by design and by self-infliction, include training, participating in the training that the rangers do so that I can actually perform the same duties that they do, if need be, but also then providing the medical training for what they may encounter on Denali,” she said.

Extreme medicine

Jennifer Dow, MD ’94, (right) and other members of the mountain ranger team assess a patient on Denali following helicopter evacuation from 14,000 feet.Jennifer Dow, MD ’94, (right) and other members of the mountain ranger team assess a patient on Denali following helicopter evacuation from 14,000 feet.

Dr. Dow trains the rangers to be able to perform emergency medical services in the event of a mountain rescue and also to care for themselves as they face the dangerous elements. At the time she started, the National Parks Service did not have a standardized set of protocols, so she developed her own, dictating what level of medical intervention the rangers could attempt and when they needed to refrain. The skills Dr. Dow teaches the rangers are comparable to those of an EMT, plus a set of extended skills for their unique environment.

In addition to being available to the rangers every hour of every day to provide medical advice and support by phone or radio dispatch, Dr. Dow also spends weeks at a time on the mountain as part of a rotating ranger patrol directly providing services to both the rangers and especially the many mountain climbers who test their resolve on Denali’s peaks.

“I take an exceptionally active role as the medical director because my own feeling is that I need to understand exactly what the rangers are doing and what extreme conditions they are going to find themselves facing vs. what I may be imagining that they’re facing, which is why I choose to spend so much time up on the mountain,” she said.

Dr. Dow pulls a toboggan to the heli-pad.Dr. Dow pulls a toboggan to the helipad.

What Dr. Dow and the rangers do often see is altitude-related illness including high-altitude pulmonary edema and high-altitude cerebral edema. The debilitating nature of these conditions renders the climber unable to proceed up or down the mountain, so the ranger/medical team’s job is to get them back down to the base for recovery or transport. On Denali, the difficulty reaching the injured or ill person rivals that of providing care.

In 2008, they had a solo climber fall from a height of about 16,000 feet down a slope approximately 2,000 feet onto the Peters Glacier, which is the wrong side of that particular ridge. Rescue required the teamwork of myriad climbers whom the rangers recruited off the mountain to assist. Patrol teams usually consist of five people, but a significant rescue requires many more. This is where Dr. Dow notices a strong sense of community and mountain ethics on Denali.

“Climbers will stop what they’re doing and help participate in a rescue,” Dr. Dow said. “People from all over the world will come together to haul ropes and do what needs to be done to get someone off the mountain safely, and that is something that has been very striking to me. The rangers I work with are also very well trained. They are out in the most extreme situations, and we work with minimal equipment, and they manage to pull off some amazing feats.”

The fallen climber was rescued by the ranger team and in Dr. Dow’s care within 11 hours, remarkable under the circumstances. For that incident, she had remained at high-altitude base camp coordinating communications and medical direction for the rescuers. She then treated the patient through the night.

He survived.

The extreme conditions on the mountain make every lesson Dr. Dow conveys during pre-season medical refresher courses and in-season training a matter of safety and survival.

“You’re dealing with altitude, cold and wind,” she said. “You have to be prepared for the extreme conditions with the right gear. Also, you have to be aware of what all of your colleagues are doing – making sure they are staying warm enough, that they are staying fed, that you don’t add additional victims to a rescue because we’re so focused on getting whomever we are retrieving that we forget about taking care of ourselves.”

Dr. Dow clears snow from base camp.Dr. Dow clears snow from base camp.

Dr. Dow had experience with mountaineering, skiing and survival skills from an early age, although she learned high-altitude climbing on the job. She grew up in southern California and often climbed in the Sierra Nevada range. Her father has been a member of the National Ski Patrol for 45 years, and Dr. Dow became a patroller at the youngest possible age, 15.

She remained active with the National Ski Patrol through high school, college, medical school and residency – wherever life took her. Now that she is a physician, her current involvement is focused on instruction. She helps patrollers obtain outdoor emergency care certification.

This is not her only teaching role. She also is the medical advisor for Alaska Pacific University’s Outdoor Studies program. Students in the program learn how to be expedition leaders. Dr. Dow trains the program’s instructors so they are capable of caring for a student if an injury occurs in the field.

Busy in emergency department, too

Similar to her work on Denali, Dr. Dow also supports Wrangell-St. Elias National Park. And to complete her busy schedule, she has a full-time position in the emergency medicine department at Alaska Regional Hospital in Anchorage. Though in many ways, this is like working in any emergency department in the country, there are aspects that are quite unique to her location.

Patients are flown in from the Bering Sea off the fishing boats while doctors get fourth-hand information from ship captains. They are transported from the oil fields of Prudhoe Bay. Patients from remote areas sometimes arrive 24, 36 even 72 hours after the onset of injury, so Dr. Dow must deal with the complications of such a delay in treatment.

Jennifer Dow, MD ’94, Medical Director for Denali National Park and emergency medicine physician, is pictured with the A-Star helicopter, used for rescues in the Alaskan mountain range.Jennifer Dow, MD ’94, Medical Director for Denali National Park and emergency medicine physician, is pictured with the A-Star helicopter, used for rescues in the Alaskan mountain range.

“Once patients are outside of the urban Anchorage area, then the issue is time,” she said. “There’s no such thing as a golden hour.”

In a specialty that rightfully focuses on the immediate, managing complications, like those of a broken bone for example, is not something typically encountered, but it is a common occurrence for Dr. Dow. Fortunately, good relationships with the Coast Guard and National Guard, as well as well-trained flight teams help add efficiency and success to the less-than-ideal circumstances.

The coordinated work of teams permeates just about all aspects of Dr. Dow’s professional activities. Her interaction with colleagues, peers and patients provides her with ongoing motivation and strengthens her dedication to the health and safety of all who visit Denali. She prides herself on the decrease in rescuer injury attributable to the comprehensive training she conducts and oversees.

“The best part for me is I am able to give back to the climbing community this way,” she said.

“To know I am providing the rangers with the best training that I can, and that’s going to have a positive impact on the climbers with whom they interface.”

 

Denali photo gallery


“Being up there on Denali is the most amazing place to be. That mountain completely has its own personality. And it can be the most awe-inspiring experience and then the weather will turn around and smack you down, and you have to hunker down and you are reduced to your bare elements.”
- Jennifer Dow, MD ’94, Medical Director for Denali National Park
Dr. Dow (right) and her climbing partner/flight nurse talk to a patient at base camp.
Dr. Dow (right) and her climbing partner/flight nurse talk to a patient at base camp.
The Denali LAMA helicopter brings in supplies for a search.
The Denali LAMA helicopter brings in supplies for a search.
Dr. Dow fills out charts in the “headquarters tent” at base camp.





Dr. Dow fills out charts in the “headquarters tent” at base camp.
The Kahiltna Glacier as viewed from camp at 17,000-foot on Denali. The 14,000-foot camp can be seen in the foreground. Mt Foraker is in the upper right.
The Kahiltna Glacier as viewed from camp at 17,000-foot on Denali. The 14,000-foot camp can be seen in the foreground. Mt Foraker is in the upper right.
At a height of approximately 20,320 feet above sea level, Denali is the tallest mountain in North America. With its base at roughly 2,000 feet, Denali has an actual vertical rise of 18,000 feet. Mt. Everest, by comparison, reaches more than 29,000 feet above sea level, but since its base rests on the 17,000-foot Tibetan Plateau, Everest’s vertical rise is little more than 12,000 feet.
At a height of approximately 20,320 feet above sea level, Denali is the tallest mountain in North America. With its base at roughly 2,000 feet, Denali has an actual vertical rise of 18,000 feet. Mt. Everest, by comparison, reaches more than 29,000 feet above sea level, but since its base rests on the 17,000-foot Tibetan Plateau, Everest’s vertical rise is little more than 12,000 feet.
The Denali LAMA helicopter brings in supplies for a search.
The Denali LAMA helicopter brings in supplies for a search.
Denali, also known as Mt. McKinley.
Denali, also known as Mt. McKinley.
The ranger team travels across the glacier.
The ranger team travels across the glacier.
Dr. Dow makes preparations in the Talkeetna station garage.
Dr. Dow makes preparations in the Talkeetna station garage.
Dr. Dow traverses the glacier.
Dr. Dow traverses the glacier.
Dr. Dow (right) travels by skis to reach an elevation of 7,500 feet on Denali to facilitate a search for two missing Japanese climbers. The team later found them deceased.
Dr. Dow (right) travels by skis to reach an elevation of 7,500 feet on Denali to facilitate a search for two missing Japanese climbers. The team later found them deceased.
Jennifer Dow, MD ’94, patrols the Kahiltna glacier near Mt. Foraker in Denali National Park, where Dr. Dow is Medical Director.
Dr. Dow patrols the Kahiltna glacier near
Mt. Foraker in Denali National Park.

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