At the beginning of March, with snow still topping the hills of the Lake District, I attended an Expedition Medicine course run by Expedition & Wilderness Medicine. The course has been developed to equip medical professionals with the knowledge and skills they may need as part of a medical team on an expedition. Participants (mostly doctors) arrived from far and wide, and camaraderie among the group grew with the cosy hostel accommodation, communal meals (included in the price) and the evening bar (not included). A beautiful, isolated location, no mobile phone reception, and an exceptionally slow internet connection, enhanced the expedition feeling.
The course itself was 3 ½ days, packed to the brim with a good mix of lectures and small group activities. We spent some time outdoors each day and some especially active souls were up early each morning for a walk or a run. We learned about medical aspects of very hot, very cold, very high and underwater environments, as well issues that surround clinical work on an expedition: pre-departure planning; legalities; kit and equipment; communication and group dynamics. In the practical sessions we learned how to choose and use equipment, such as ropes and radios. My favourite weird tips came in the wound care session: if nothing else is available you can prevent blisters by taping a crisp packet to your foot, but you should never try to cauterise a wound with gunpowder. Thankfully, if you’ve done your pre-departure planning, something else certainly should be available. The highlights of the course had to be the simulated search and rescue activities which gave us the chance to try out our new skills, by stabilising and evacuating a realistically groaning casualty.
The lectures didn’t rely on a medical training so I didn’t feel out of my depth, and there were always people (faculty and participants) to explain the details. The speakers were expert, experienced and eloquent with fascinating stories to spice up the theory. Overall, the course really whet my appetite to get out and about!
At first glance, there don’t seem to be many opportunities for nurses to get involved in work like this. Some organisations (e.g. www.raleighinternational.org, www.opwall.com..others?) are notable exceptions and you can also register with the Royal Geographical Society as available personnel. Not to be defeated at the first hurdle (a valuable characteristic for any nurse on an expedition!) I contacted some organisations that advertised for doctors or paramedics, to find out their reasons for not seeking out nurses. In most cases, I received a friendly response and the offer to consider my CV, as well as some useful advice.
- • Many organisations look for A&E experience
- • To be a solo medic, you may need to be able to prescribe everything in the medical kit, so being an independent prescriber is a definite advantage.
- • Gaining wider expedition skills such as qualifications as a mountain leader, rock climber, or diver could also be valuable.
- • Consider finding a like-minded doctor and work as a team.
I am convinced that nursing skills are well-suited to expedition work, certainly when working alongside a prescribing paramedic or doctor. In our day-to-day jobs, part of the nurse’s role is to ensure that each patient receives the necessary interventions in a way best suited to the individual’s personality and circumstance; we are experienced at making sure the ‘why’ (maintaining a rationale so that the treatment will work) takes place even when the ‘how’ (the patient’s circumstances) is a little unusual. Throughout our work, whether planning patients’ discharge, transferring a sick patient, or changing an occupied bed, we constantly anticipate risk and prepare our patients, our colleagues and ourselves to manage it and achieve our shared aims. Added to this, it is increasingly nurses who see and treat patients with minor and treatable complaints (including sexual health), nurses who provide health promoting (and illness preventing) advice, and nurses who see and treat injuries and manage wound care – work that makes up an estimated 96%(?!) of medical problems on expeditions (REF???). Our skills are easily and usefully transferred to expedition nursing.
Working in extreme and remote environments means testing and pushing our routine nursing abilities in new and satisfying ways. I think it’s fair to say that expedition medicine is unlikely to be a big money-spinner, but we are fortunate that our professional skills can give us access to extraordinary experiences. Although it might take a little bit of chasing, expedition nursing is road worth travelling.
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