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USU Medical Students Live Austere Medicine in Greenland

Lodge on stilts in the Arctic
Courtesy article

Two students from the F. Edward Hebert School of Medicine at Uniformed Services University spent four weeks each in different parts of Greenland during the summer as part of their austere medicine capstone projects.

Army 2nd Lt. Samuel Brown traveled at the invitation of the National Science Foundation (NSF) to Summit Station in the middle of the Greenland Ice Cap to live and learn about wilderness medicine and the scientific work performed there. Air Force 2nd Lt. Thomas Powell visited Thule Air Base in the far north of Greenland to learn about daily operations, medical care, and aeromedical evacuations at the Air Force’s northernmost installation. While in their respective locations, both students lived and worked with the clinic staff to learn more about the unique medical challenges each location experiences. Both USU students recently began their fourth year of medical school as members of the class of 2019.

Thule Air Base, situated 750 miles north of the Arctic Circle, was secretly built in 1951 as an early warning and strike base against the former Union of Soviet Socialist Republics, or USSR. Although the Cold War is long over, the base continues to serve its original mission of providing early missile warning, as well as supporting space operations and acting as a forward base for scientific missions in the area. It is home to 150 U.S. Air Force personnel and 600 Danish contractors and government officials who maintain the base. Air Force members typically serve one year assignments at this remote location. Medical care is provided by an Air Force-managed and Danish-staffed clinic that can serve the base’s primary care needs. Higher acuity or specialty care requires aeromedical evacuation, which has its own set of rules and weather requirements. The base operates as both a port during the summertime and as an airfield all year round due to its coastal location. Surrounded by glaciers and sea ice, it is picturesque in a harsh, arctic sort of way.

Young man in cold weather gear on barren terrain
Air Force 2nd Lt. Thomas Powell on a hike up to Wolstenholme Fjord, the only place in the world where four glaciers converge at the same point. The massive ice bergs seen in the background are locked in the frozen sea ice of the fjord.

“The place is like a small village, situated at the top of the world,” said Powell. “It has a beautiful, otherworldly feel to it.”

Although Powell was there in April and May, temperatures were still in the negatives even with the 24 hours of daylight the base experiences that time of the year.

During his two-month assignment in Thule, Powell tested a prototype cold weather uniform, learned about the clinic’s capabilities, and how the cold weather challenges life on the base.

“Learning about the unique challenges of running an Air Force base in this remote environment were lessons I’ll take with me the rest of my career. The base perfectly highlights the Air Force’s mission of global reach, with Airmen performing their vital missions so close to the North Pole and so far from everything else.”

In July, Brown flew on one of the New York National Guard’s ski-equipped LC-130s from Stratton Air National Guard Base in Schenectady to Summit Station, a polar research station run by the NSF. Located at the peak of the Greenland Ice Sheet at 10,000ft above sea level and 250 miles across the ice from the next nearest populated region of Greenland, the station operates year-round to collect atmospheric and ice data with a minimum of a four-person crew.

Lodge on stilts in the Arctic
The “Big House” at Summit Station and “Tent City” at Sunset.

Summit is only accessible in the summer during good weather conditions via the ski-equipped C-130s operated by the Air National Guard. During the summer, the population grows to a maximum of 60 researchers, engineers, and construction workers when “warm” weather supports building maintenance and construction. A doctor or physician’s assistant staffs a small field clinic during the summer months because of the industrial nature of the work and the higher population. While at Summit, Brown worked with a wilderness medicine fellow from the Colorado University School of Medicine.

“Summit Station is an amazing place to practice austere medicine, prepare for military medical contingencies, and gain a new perspective on life,” Brown said. “When your medical evacuation plan calls for a plane to fly for two hours to your location and then land on an ice runway just to fly two-four hours to the nearest hospital, you start to play a lot of ‘what if’ games. Thankfully, we did not need to medically transport anyone, but we trained and prepared for many contingencies.”

It wasn’t all medical work for Brown, however. While at Summit, he was able to participate in a number of research projects that included weather balloon launches and surveying ice movement on snow machines. He also served as ground crew for flight operations, and helped cook and clean in the kitchen. Brown also participated in scholarly activity by furthering the testing of the Air Force’s prototype cold weather uniform and writing about unique cases and capabilities encountered at Summit Station.

Man directing large place in the Arctic
Army 2nd Lt. Samuel Brown directs an LC-130 aircraft to the refueling point immediately after it landed on an unimproved ice “runway” at Summit Station, Greenland. The LC-130s brought vital fuel, food, and equipment every two to three weeks and served as the only link to civilization outside of Summit Station.

“A hallmark of austere medicine is that you have to be a team player. You can’t simply ‘do your job.’ Everyone in an austere environment pitches in to complete the mission; if you enjoy learning new things, teaching medicine to lay persons, and seeing how your medical capabilities fit into a larger mission, then you would likely enjoy working at a remote camp like Summit Station,” said Brown.

Students are required to set up their own capstone opportunities, with the guidance of USU faculty. Powell petitioned support of the medical school’s capstone leadership and negotiated his entrance to the normally-closed location by talking to Thule Air Base Base leaders about his scholarly project which was intended to improve cold weather procedures and training in the Air Force.

Brown’s trip to Summit Station was originally conceived by now-Air Force Capt. (Dr.) Jason David, a 2018 USU School of Medicine graduate, who was invited by the National Science Foundation to go but graduated before being able to attend. After a call went out for volunteers to go in his stead, Brown was selected as the highly qualified student to participate. He then had a very short time to get all of the required paperwork together.

“It very nearly didn’t happen” recalls Brown. “The approval to go came just a few days before I actually left.”

“As ‘America’s Medical School’, with our unique service mission, our students can explore a fantastic variety of important scholarly projects,” said the school’s capstone director, Dr. Martin Ottolini. “Tom and Sam did the legwork to make these experiences possible, with strong support from our leadership. This opens the door for subsequent students to perform similar exciting operational research projects.”

Tent in front of a lodge on stilts in the Arctic
“The Town” at sunset at Summit Station. Tents like the one pictured could shelter up to 20 individuals during the summer months and were located outside of the multifunctional “Big House” which served as a kitchen, office, and bathing facilities. The Big House and the buildings in the background made up what those at Summit lovingly referred to as “The Town.” This picture was taken in early August as the sun was setting for the first time in several months.

Both students felt they had become better providers and medical leaders as a result of their experiences, especially in the realm of cold weather and austere medicine.

“The Arctic continues to be a challenge both logistically and medically,” said Powell, “and will remain so. These experiences have allowed us to have a much better appreciation for the unique roles military and wilderness providers have in supporting these endeavors.”

“The Arctic tests your suppositions and comfort in caring for highly motivated men and women in harsh environments; it is an amazing training ground for military providers who will do the same in future conflicts and endeavors of human exploration,” agreed Brown.