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A medical team demonstrates how to package patients for helicopter hoist evacuation on Friday in the Trail Creek drainage, near Sun Valley, during the 14th annual Ski & Mountain Trauma Conference.

More than 600 ski patrollers, paramedics and other first responders gathered in Sun Valley last weekend for a three-day conference to become better equipped to extend “the golden hour”—the amount of time someone typically has to receive medical and surgical treatment that will allow them to survive a traumatic injury.

The 14th annual Ski & Mountain Trauma Conference focused on exactly what it did 14 years ago when it began: giving the tools and trainings necessary to first responders to have the skills to help save a life, stabilize a patient and improve the likelihood of survival outside of a hospital. The conference, held Thursday through Saturday, provided lectures, demonstrations and hands-on clinics to better equip first responders in dealing with injuries in the backcountry, or on the mountain.

Saint Alphonsus Regional Medical Center in Boise has been hosting the conference since one of its doctors, Dr. Richard Moore, along with St. Luke’s Dr. Keith Siverston, helped save the life of a local skier who had taken a sudden fall and fractured several vertebrae in her neck while skiing on Bald Mountain. The event sparked an idea to train first responders in the most effective ways to administer critical care to patients trapped in remote and wilderness locations.

Fourteen years later, that idea is still at the heart of the conference, according to Saint Alphonsus Trauma Medical Director Stephen Gale.

Gale said the conference is 100 percent geared toward “pre-hospital folks”—ski patrollers, paramedics, firefighters, EMTs—those who respond to a trauma first. It’s the largest conference of its kind, Gale said in an interview during the conference.

The conference itself is unique in that sense, Gale said, as most conferences are geared toward doctors and nurses who already have an extensive medical background. More importantly, the conference centers around conditions that may be present in the field—uneven terrain and a lack of medical equipment. He said simulation sessions that teach hands-on techniques are its biggest draw.

Those sessions included responding to crash victims who have spent a prolonged entrapment upside down and hands-on instruction on using Narcan, a fast-acting medicine that reverses an overdose on opioids. The sessions present real-life scenarios along with practical responses to common injuries in the backcountry or in a remote area.

This year’s conference also included a keynote presentation by Brendan McDonough, a former Granite Mountain Hotshots firefighter who suffered the loss of 19 of his crew members during a 2013 wildfire in Yarnell, Ariz.

McDonough shared his story in a packed conference room at the Sun Valley Inn on Thursday night.

He was a convicted felon and two days sober from a heroin addiction when he became a Hotshot and found a new family, a group of 19 “brothers” to re-center his life and help him become the father he wanted to be to his daughter. Then, a fire on June 30, 2013, again changed the trajectory of his life.

A wildfire roughly an hour and a half out of the town took off, creating a 3,000-degree inferno that ultimately killed the entire crew, except for McDonough, who was working as a lookout in another area of the fire and managed to escape.

He said the next two years were a blur, as he attended funerals, raised money for wildland firefighting, did interviews and nightly numbed his pain and the memories with alcohol.

“I couldn’t un-see what I’d saw,” McDonough told the audience.

Finally, he sought counseling after a suicide attempt, and today is sober and is a public speaker and works with numerous nonprofits for veterans, police officers, firefighters and emergency medical services.

As the applause faded, attendees prepared for two full days of trainings, workshops, additional lectures and learning opportunities.

“We’re looking forward to continuing to offer techniques and opportunities to pre-hospital folks to improve outcomes,” Gale said.

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