The Royal Australian College of General Practitioners features WEM
The Royal Australian College of General Practitioners magazine features our very own John Apps and the Polar Medicine course in New Zealand – see
pages 14-15
Medicine in the wilderness by Nick Johns-wickberg – see the full article here
Dr John Apps’ career in wilderness medicine has taken him on some extraordinary adventures. He now passes on his skills to other doctors.
There aren’t many people in the world who can run a marathon, let alone one at nearly 5000 metres elevation through the Himalayas. Rarer yet is a doctor who can keep up with the runners and tend to them in harsh conditions if anything goes wrong. John Apps is such a doctor. Overseeing the medical services for the Everest Marathon is all in a day’s work for the British-born adventure doctor and part-time GP.
‘I stationed a number of doctors on the descent route and my job was to jog behind the slowest person,’ Apps said. ‘There’s a lot of up and down, there’s a lot of rough ground, a lot of yaks to avoid.’
Apps’ work throws a wide range of challenges his way – yaks included. Overseeing the marathon isn’t easy, but Apps said the hardest part of that job is convincing the ultra-competitive runners to take it easy while acclimatising to the high altitude. He has also provided medical support for an extreme marathon in Antarctica, where the flatness of the course is offset by the fact that, as he puts it,
‘it’s just blooming cold’.
‘You’re hauling in all these huge lungfuls of air at minus 15°C and it does take it out of people,’.
But there is much more to Apps’ work than the marathons. He recently returned to his New Zealand hometown of Westport after completing his ninth season in Antarctica, where he works for Antarctic Logistics and Expeditions, a private company that provides logistical and medical support to visitors, including emergency search and rescue. Clients range from ultra-fit adventurers setting off for the South Pole to elderly sightseers.
Each case presents its own set of challenges; older tourists need to be monitored for cardiac risk factors, joint problems and other issues associated with age, whereas those heading off on expeditions are at risk of trauma such as impact injuries and frostbite. Apps recalls an incident where a climber fractured his leg in a remote area that was unreachable by plane or vehicle. He and his colleagues had to call on all of their skills and experience to get the man back to safety.
‘The rescue probably took about 4 days to complete fully because of weather conditions and difficulty with access,’ he said. ‘We basically got our little ski plane as close as we could, and then it was a matter of putting the skis on, roping up the glacier and going off to collect this person, then dragging them back on a sledge.’
There have been some incredible moments at the other end of the globe, too. Before he moved down south, Apps did similar work in the Arctic, which he considers the toughest environment he has encountered.
‘Probably the harshest place I’ve ever worked has been up in the Arctic, where itis actually much colder than the Antarctic.’ ‘Although you’re at sea level, you’re actually on sea ice, so there’s an awful lot of moisture in the air. The combination of moisture plus cold really does suck it out of you.’
He tells the story of particularly memorable Arctic expedition, during which he was woken by a large piece of wood that had fallen onto his tent and just missed him.
‘One storm we lost one-third of our tents, and my tent was flattened by a piece of timber that got blown off a structure,’ he said. ‘I was quite lucky. ‘Quite literally you could not stand up in this storm. I remember crawling out of the wreckage of my tent and just being bowled over.’
Apps’ experience working in hostile conditions has taught him that wilderness medicine is as much about survival skills and teamwork as it is about medical knowledge.
This July, for the third consecutive year, he and several of his colleagues will conduct a Polar Medicine course in the mountains of New Zealand’s South Island to share their practical expertise with doctors from around the world. If someone on your rope falls into a crevasse, you need to be able to know what to do instantly. The hands-on, 6-day course in the Pisa Range near Wanaka will show doctors how to apply their existing medical knowledge in completely different and adverse conditions.
‘The skills we impart are how to apply what they already know in a different environment where you haven’t got an ambulance, you haven’t got lots of nurses and a nice warmroom,’ Apps said.
Some of the practical training includes dogsledding, snowmobiling, cross-country skiing, travelling on glaciers and building shelters in the snow. Participants learn how to extract patients from dangerous situations and treat them in the cold, but equally important they learn how to keep themselves safe and ensure they are a competent and useful member of the rescue team.
‘We always teach that safety is the number one, and you need to not be aliability to the team,’ Apps said. ‘If someone on your rope falls into a crevasse, you needto be able to know what to do instantly, rather than say “Oi, what do I do?”
Apps’ fellow instructors include Dr Dick Price, an experienced search and rescue medic and Everest summiteer who Apps describes as a ‘legend’ in the field, Mike Roberts, who works as an Everest guide aswell as for the US Antarctic program, and Simon Murfin, a remote nurse and medic with Arctic experience. The course is accredited by the Wilderness Medical Society.
‘What I love to see is on about the third or fourth day, people have relaxed into their various groups and I think they’re suddenly realising the potential of what they can basically now get out and do,’ Apps said. It’s not feasible for all doctors to find a job where they can use these skills. Apps said the combination of ‘big bills and big mortgages and kids going through school’ – none of which he has to worry about – make the travelling life of an adventure doc impractical for many. But for those who do make the leap and choose this career path, the one guarantee is that ‘another day at the office’ is never just another day at the office.
Of interest
