Foreword by Dr David Hillebrandt Vice President International Society of Mountain
Medicine,GP and Pre Hospital Care doctor.
In 2014 the Royal College of Surgeons of Edinburgh Faculty of Pre-Hospital Care (FPHC)
were getting at least two enquiries a week asking for guidance about what skills an expedition medic should possess. This is in line with the numbers of approaches to established expedition doctors regularly asking the same question. Like most medical questions “it depends….” There was an obvious need for some information and the FPHC established a working party which published its guidance on the provision of wilderness medicine [1]. These guidelines have now had their first review in conjunction with Fellows of the Royal Geographical Society.
This working group is made up of representatives from many aspects of the UK expedition
world including ocean sailors, kayakers, mountaineers, divers, jungle and desert fanatics,
youth leaders and commercial expedition companies. All are united by their enthusiasm for working in remote and austere environments and their insight into the realities of working in these conditions. The working group members had experience of enjoying adventure on all continents of the world and from well below sea level to 8848m.
The group enjoyed challenging discussions around the topics but we were all united on one point: Whatever expedition you undertake as a medic, your own personal skills in the
environment backed by the confidence and ability to live with your decisions. If you expect to be providing dramatic lifesaving medical skills on an expedition you are most likely in the wrong place with the wrong people attempting the wrong objective. Medical planning for an expedition involves preparation for situations that you will spend the whole trip trying to avoid. Once away it is most likely to involve hand holding, acting as a sounding board for members and managing conditions such as blisters, travellers' diarrhoea, fungal skin infections and mild AMS but having the confidence, reserve and ability to cope in the rare event of severe illness, trauma or even death which may involve a personal friend.
We appreciate that expeditions come in many shapes and forms. There is always a medical and ethical duty of care but it may be dealt with differently when dealing with a group of young people, a commercially run trip with adults or a group of friends pushing the limits of exploration or their sport who all fully understand the environmental and inherent risks.
After much thought and a small bit of evidence we can now present a revised matrix of medical skills potentially needed by a medic and related to skill levels ranging from a first aider to an established doctor. It also takes into account the time to reach any back up care. We hope this will give you food for thought. Ponder it but do not hesitate to approach expedition leaders for advice since this is one branch of medicine where most enthusiasts are keen to share their knowledge. Above all get out into your chosen environment and enjoy building up your skills and ability to make decisions when operating in a challenging situation. If you do become involved in the expedition medical world do keep your day job since you will not be making any money and not be able to retire early! When you do eventually retire you will have great memories of working with great people in great places.
David