The screaming stops and the silence is not welcome... tremors are beginning in the climber's legs... Oh hell, here we go again... His body begins to convulse uncontrollably. Three rescuers dive across him in an effort to prevent further injury in the rocky terrain. Two people have sacrificed their rain gear and jackets to help keep the injured climber warm. They now stand shivering and soaked in the pouring rain. The convulsions cease for a moment and the team goes into action. Airway, Breathing, Circulation (ABC). The climber is beginning to mumble incoherently. Airway is clear, Breathing is present. Capillary refill at the extremities indicates that circulation is not impaired. A serious head injury is the major concern and probably responsible for the convulsions. Level of Consciousness times 0 to times 1 - a bad sign. The rain is really coming down now. It's very dark out, the sun set long ago. Flashlights fitfully illuminate the area where small groups surround the three injured men. One climber is actually laying in the creek. He is slowly turning blue as the icy water flows around him. Fist sized rocks are washing off the cliff face next to us. 30 more minutes until the Medivac helicopter is expected. It can only carry two victims and all three need immediate evacuation; which ones to choose? A figure in a poncho looms out of the dark. She looks down at our victim and says "I'm afraid his head injuries were just too severe... he's dead". "Let's get out of the rain". As the other "injured" begin to arise, our "climber" gets up as well and we all begin to scramble out of the creek bottom and back to camp. It's been the final "scenario" for our Earthbound Medical Rescue training class, a two day intensive course on backcountry medicine. The injuries were simulated, the "victim" in the creek was wearing a wetsuit, but everything else was real. This superb class teaches the essentials required to deal with major injuries sustained beyond the reach of professional aid. While targeted at backcountry explorers and wilderness trip leaders, the skills would be equally useful after an earthquake or hurricane when local resources are overwhelmed. Earthbound Medical Rescue is the current Wilderness Medicine contractor to the US Geological Survey. They have recently made their classes available to the general public. The instructors bring with them a wealth of practical experience as EMTs with wilderness certification. No prerequisites are required, although a general knowledge of basic first aid procedures is quite useful. The class I took was about half medical professionals and half interested outdoorspeople like myself. The class was taught outdoors and was evenly divided between lecture and exercises, culminating in the "emergency" described above. I viewed the "hands on" portion as being, perhaps, the most valuable portion of the course. Practicing skills as they taught reinforced the lessons and builds the confidence necessary to handle an actual situation. Class size was small which allowed us to work with the instructors on an individual basis. Briefly, the course contained sections on Lyme disease, Cervical Spine immobilizations, Level of Consciousness evaluation, Wilderness vs. the Urban environment, Patient assessment, Chest injuries, Shock, Spinal Injury, Environmental (Hypo/Hyperthermia/AMS...), Orthopedics, Wound Care, Bites & Stings, Medical Emergencies, Long term care, Rescue Considerations, and Ethics. This is not a comprehensive list, but provides some idea of the breadth of training provided. A brief introduction to alternative medicine, specifically homeopathy, was also given by a guest lecturer. All in all, I was well satisfied with the course and would not hesitate to sign up for any further classes that Earthbound might offer. If you ever expect to be in a situation beyond the reach of 911, I highly recommend this training. The cost for the weekend was $100. I have no affiliation with Earthbound Medical Rescue other than being a satisfied customer. You can contact Earthbound Medical Rescue at 390 N 12th St. San Jose, CA 95112 rah@btr.com