Imagine that a member of a wilderness expedition team comes down with an ear infection, a 104-degree fever and dizziness. To make matters worse, the team reaches a 50-foot-wide gorge that it must cross suspended on ropes above a rushing stream, a procedure known as a Tyrolean traverse.

This was the crisis presented to 20 physicians and emergency medical technicians attending a breakout session at the three-day Northeast Wilderness Medicine Conference, Sept. 26-28, at Cornell. The Wilderness Medical Society, Weill Cornell Medical College, NewYork-Presbyterian Hospital and Cornell Outdoor Education sponsored the conference.

More than 150 conference participants heard from Cornell faculty and emergency doctors about such topics as animal injuries in the backcountry, medical complications of high altitudes, snakebites, dive medicine, hypothermia, geriatric concerns and, of course, how to cope with injured patients in precarious outdoor environments.

"A lot of the participants are physicians -- family practice and emergency medical doctors -- who see this as a way to combine their love for the outdoors with their profession," said Todd Miner, executive director of Cornell Outdoor Education and the convener of the conference.

Afternoon breakout sessions included hands-on training in rock climbing safety, swift water rescue, backcountry preparation, vertical rope rescue techniques, wilderness survival and sea kayaking safety and rescue.

During the Tyrolean traverse workshop over Fall Creek, for example, the group of about 20 participants crowded by the edge of the gorge while Cornell Outdoor Education instructor Dan Tillemans explained that the first step in crossing a gorge is to get one person to the other side by either rappelling or climbing down, swimming across and climbing up the other side. That person can either carry the end of a rope or, once across, catch a fishing line on a lead weight tossed or slingshot across. Ultimately, two 5,000-pound test weight ropes traversing the gorge are tied to anchors, preferably large tree trunks. Fortunately, a nearby footbridge meant instructors were able to easily prepare the ropes ahead of time.

Tillemans and Cornell Outdoor Education instructor Tim Woods, a former special operations military rescuer, also gave a crash course in knot tying, including the overhand knot, a figure eight, a figure eight on a bight, a water knot, a girth hitch, a double girth hitch and a prusik loop. "With that series of knots, you can set up this [gorge traversing] system," said Tillemans.

Each participant played a role in the hypothetical situation of crossing the gorge with a sick comrade. Mária Némethy, an emergency medicine resident at St. Luke's Rosemont Hospital in New York City, played the victim with a debilitating ear infection.

"I like to spend a lot of time outdoors," she said, lying on a poncho waiting her turn to traverse. "So even hiking with a group of friends or even in the future professionally, a lot of this is very useful."

Once the ropes were tightened, pulleys and carabiners attached and the system checked, Doug Girling, an emergency medical doctor from Glen Falls, crossed first, suspended over the gorge in his waist harness and red helmet, pulling himself across hand over hand on the ropes. He also works on a wilderness emergency team that conducts up to 10 rescues a year mainly in the Adirondacks. Rescue operations often require overnight stays and wilderness survival skills, he said.

When Némethy's turn came, she dangled helplessly from her harness and was pulled across with a rope. Flavio Gaudio, a WCMC attending physician, made it across easily but not before slashing his leg on a sharp rock.

"It's just skin," he said, squeezing the blood gently from the 5-inch gash near his shin. When others offered to help, he waved them off. He had sutures and gauze in his bag, he said, and could stitch it up himself.