What’s in Your Expedition Med Kit?

A Deep Dive into Remote Pharmacology with Daniel Grace

Expedition medicine isn’t about packing a full hospital into a duffel bag. It’s about intelligent preparation, clinical realism, and prioritising what truly matters.

In an episode of the World Extreme Medicine Podcast, host Eoin Walker sits down with Daniel Grace, GP, expedition doctor, and WEM faculty member, fresh from a deployment in Zambia*. Together, they unpack one of the most frequently debated topics on WEM courses: what medications should you take on an expedition?

The answer, as Daniel explains, is always: it depends.

Core Principle: Essential vs. Ideal

No kit is perfect, but it can be fit for purpose.
Daniel recommends framing your approach around three types of medical needs:

• Critical emergencies (e.g. sepsis, anaphylaxis, trauma)

• Common, high-frequency conditions (e.g. diarrhoea, wound infections, musculoskeletal injuries)

• Chronic health issues (e.g. diabetes, asthma)

Key considerations include:

• Which drugs offer the most versatility

• What is legal and realistic to transport

• Weight and storage limitations

• The risk profile of your participants

Environmental Factors Shape Your Kit

The location dictates the likelihood and severity of risk. Daniel shared examples from Zambia and beyond:

Hot Environments

• Oral rehydration salts

• Antihistamines for insect reactions

• Careful planning for cold chain–dependent medications

Cold, Polar & Altitude Conditions

• Aspirin and aloe vera for frostbite

• Dexamethasone and acetazolamide at altitude

• Protection against freezing of vials and denaturation of temperature-sensitive drugs

Jungle or Humid Environments

• Emphasis on wound care and dressings

• Malaria prophylaxis

• Durable, waterproof storage solutions

Managing Pain Without Opiates

With strong opiates difficult or illegal to transport into many countries, alternatives are essential.
Daniel’s recommended options:

• Methoxyflurane (Penthrox) for moderate to severe pain

• Paracetamol and ibuprofen for baseline pain control; beware of the potential risk of acute kidney injury and ensure patients are well hydrated

• PR diclofenac for targeted interventions

• Reassurance, realignment, and splinting as non-pharmacological pain strategies

Medication Storage: Underestimated and Often Overlooked

Improper storage can render even the best-stocked med kit useless. Some key advice:

• Use vehicle A/C or insulated packs for heat-sensitive drugs

• Be aware of degradation risks from freezing or humidity

• Capsules and vials are particularly vulnerable in extremes

Wound and Gastrointestinal Management

Wound infections are common, especially in jungles or hot, dusty conditions. Daniel advises:

• Prioritise irrigation and debridement

• Use impregnated dressings (iodine, silver, or hydrogel)

• Review wounds frequently and use antibiotics judiciously

On gastroenteritis, Daniel warns against premature antibiotic use. Most cases are viral. Antibiotics should only be considered when symptoms are severe, prolonged, or accompanied by systemic signs.

Antibiotics: What to Pack and Why

Antimicrobial stewardship still applies, even in remote environments. But when you do need antibiotics, Daniel recommends:

• Ceftriaxone (IV) for suspected sepsis

• Co-amoxiclav for skin infections and bites

• Clarithromycin if penicillin allergy

• Azithromycin for bacterial gastroenteritis

• Flucloxacillin or doxycycline based on local context

• Trimethoprim or nitrofurantoin for urinary infections if appropriate

Tailor your choices to the medical backgrounds of your participants and the clinical scenarios you’re most likely to encounter.

Chronic Disease Management and Ethical Care Limits

With an ageing and more diverse participant population, it’s increasingly important to prepare for chronic illness.
Recommendations include:

• Encouraging redundancy in participants’ own medication supplies

• Planning for tech failure (e.g. insulin pumps, glucose monitors)

• Stocking emergency treatment for hypoglycaemia and asthma exacerbations

• Honest, documented conversations about care ceilings before departure

Expired Medications and Rationing

When supplies run low, pragmatism is key. While certain medications (e.g. adrenaline, insulin) degrade quickly, many remain viable beyond their labelled expiry dates under proper storage. Always check guidelines, weigh risks, and document decisions.

Daniel also reinforces the importance of statistical planning: you can’t pack for every scenario, but you can plan for the most likely.

Final Takeaways from Daniel

• Planning is your best medicine. A robust risk assessment and kit checklist reduce the need for improvisation later.

• Accept clinical limitations. You will never be able to deliver hospital-level care in the field, and that’s okay.

• Create reach-back support. Even experienced medics benefit from external clinical advice. Build it into your operating procedure.

• Tailor your kit to your environment and team. There is no universal formula, only informed judgement.

*Please note that this session was recorded in October 2024.

→ Find this conversation on the World Extreme Medicine Podcast via Spotify, Apple Podcasts, or your preferred platform.

→ Learn more about field skills training on one of our courses!

→ Learn more about Daniel Grace and his work