Mountain Doctor: AMC Medical Advisor Discusses Hiker Safety and Wilderness First Aid

Courtesy of Tom TrimarcoWhen not working in the ER, mountain doctor Tom Trimarco assists with backcountry rescues and tackles hiking trails for fun.

If a hiker, skier, or cyclist is seriously injured in New Hampshire, Vermont, or Western Maine, there’s a good chance they’ll be cared for by Dr. Thomas Trimarco. An attending emergency department physician, Trimarco is the emergency medical services director for Dartmouth–Hitchcock Medical Center in Lebanon, N.H.—the North Country’s only level 1 trauma center. He also serves as the medical director for the Upper Valley Wilderness Response Team and, since 2018, as AMC’s medical advisor. We talked with Trimarco, an avid outdoor lover and longtime AMC member, about his role with AMC and how hikers and paddlers can avoid meeting the 39-year-old doctor in the emergency room.

What does AMC’s medical advisor do, exactly?

I help, along with AMC’s director of risk management [Aaron Gorban], with all things that may have a potential medical bent to them: determining a potential participant’s ability to participate in an AMC-led trip, based on a person’s pre-existing medical conditions or fitness level; defining some of the medical treatment protocols AMC staff members function under and are held to when fulfilling their duties in the backcountry; and offering on-call medical advice [to local EMS professionals, group leaders, and hut croo] for medical emergencies that might happen in the backcountry.

What are the most common injuries and illnesses you see at the ER stemming from outdoor recreation?

We see patients who’ve been in accidents from all types of things: everything from mountain biking to skiing to the simple slip and fall while out on the hiking trail. We unfortunately see a lot of head injuries associated with the higher speed activities that happen out there. In the winter, we see hypothermia and frostbite, and in the summer, heatstroke and other types of metabolic derangement because of the stress on the body. 

People don’t lose their underlying medical conditions when they go to the backcountry; the patient with hypertension, diabetes, and cardiac disease still have that when they go out on a walk.

What mistakes do you see over and over again in the backcountry?

If you look at a lot of the accidents that happen in the backcountry, many of them, unfortunately, are due to poor decision making. I would say one of the biggest things is what I would call an underappreciation for Mother Nature, for lack of a better way to put it. Environmental exposure for patients—whether it’s the heat, the cold, the distance, the strenuousness of the hike or the activity—usually plays a role with the majority of accidents that happen. [The ability to make a] go/no-go decision on trips—whether or not to go for another loop around the trail, or if you’re going to push for that next summit—those are the things that will often lead directly to someone getting injured or just fatigues the person enough that it predisposes them to a twisted ankle.

You joined AMC as a teenager on Long Island. What has it meant to you to assist AMC for the last year in the role of medical advisor?

I love the outdoors and I love emergency medicine, caring for sick and injured people. The ability to combine those, to deliver high-quality, cutting-edge, advanced medical care in an austere, resource-limited environment is really what gets me excited. I’m very thankful for the opportunity to work with AMC. 

LEARN MORE:

• Don’t get caught unprepared! Sign up for the next AMC-led wilderness first aid course.
• When emergencies happen in the backcountry, AMC staff and croo are often some of the first on the scene.
• Browse the Croo archives and meet lots more interesting folks in the AMC community.