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Doctors required for a long term contract to be based in Iraq

CLIENT: FrontierMEDEX

A global medical, safety and security solutions provider, FrontierMEDEX delivers integrated solutions focused on prevention, intervention and response.  Personnel who work with us in the field are dedicated experts committed to supporting our clients, enabling them to fulfil their duty of care to staff and operate more effectively and profitably.  FrontierMEDEX delivers:

  • a world class, worldwide assistance infrastructure
  • first-world standards of primary and emergency medical care in remote and hazardous locations
  • a strengthened global network of practising medical specialists and resources
  • robust medical, safety and security protocols
  • emergency medical and security evacuation and crisis response capabilities
  • extensive travel intelligence, insurance and protection services
  • specialist technical and operational health and safety expertise

ELG FZE on behalf of FrontierMEDEX is currently inviting applications from suitably qualified Doctors with experience in the field of Occupational Medicine, Primary Health Care and Emergency Response in support of a private clinic in the Basra region, Iraq.

Fully supported by our clients specialist medical and operations teams in the UK, the Doctor will be responsible for the management of the facility, assisted by an expatriate nurse, local national doctors and administrative personnel, to provide occupational health/employment screening, general practice services, first aid and emergency response. Working on a rotational basis, and based on a secure site with excellent accommodation facilities, this is an exciting opportunity to be involved with the organic growth of this project, providing valuable input into the future development of extended clinic services to the oil and gas sector in Southern Iraq.

Sector: Oil & Gas

Contract: Long Term

Rotation: 1 month on / 1 month off

Location:  Southern Iraq

Experience and qualifications required:

Previous occupational health/employment screening experience in the industrial sector

Minimum of six years’ post medical qualification work experience, preferably in the remote site and/or pre-hospital sector, including primary health care and emergency response.

Current medical registration/ license to practise

Advanced Cardiovascular Life Support (ACLS) certification

Advanced Trauma Life Support (ATLS) certification

High levels of health and fitness

Computer literacy

Fluency in written and spoken English language

An Occupational Health qualification would be an advantage

Experience of working within a ‘fee for service’ clinic environment would be useful

If you would like more information on these opportunities or to apply, please visit our website at www.elgfze.com or send your CV to admin@elgfze.com

Medical Courses of interest

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Dutch medical expedition to examine exhaled breath in diagnosing AMS

Marieke van Vessem,  a last year medical student. Together with a colleague (Remco Berendsen, Anesthetist, Leids University Medical Center) of the medical committee of the Dutch Mountaineering and Climbing Club (Nederlandse Klim- en  is organising a medical research expedition to Capanna Regina Margherita (Italy, 4554 m), where we’re going to preform research on a new diagnostic tool for Acute Mountain Sickness (AMS).

To diagnose AMS, we’re going to use exhaled air. Exhaled air contains volatile organic compounds (VOCs). VOCs can be measured with electronic nose (eNose) technology, which forms a breathprint of the different VOCs. We expect that the VOC breathprint of a person with AMS is different compared to a healthy person. During our research we want to assess whether it’s possible to discriminate between breathprints of healthy controls and subjects diagnosed with AMS. When we find a breathprint specific for AMS, this could provide a non-invasive and objective test for diagnosing AMS. We will stay in the Margherita hut in the first week of August 2013 (1st to the 9th) to include climbers who visit the hut.

For the quality of the study it’s important that we can include enough people in the  research. Therefore, we’re trying to reach as many climbers as we can, before the research starts. We don’t have an official website, but we use our facebook page and twitter to inform everyone about our research.

Expedition & Wilderness Medicine courses of interest…

 

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Part 2 of medically challenging week in Kenya with Dr Matt Edwards

Adventures with AMREF Flying Doctors

The Calm Before the Storm – Part 2 Matt Edwards

Matt Edwards Blog working in remote medicine

About 1900 in a place called Kisii, close to Kisumu on Lake Victoria, an over laden bus full of about 70 teenagers attending a sporting event had crashed at high speed. There were about 8 dead at the scene including the teachers and 10 or so critically injured and the other 50 with an assortment of walking wounded. The local population had mobilised and were dragging the casualties to the local hospitals including to the larger nearby town of Kisumu. The pictures and footage at the scene depict what you would expect: people running about haphazardly carrying people in bedsheets, rushing off with them in the back of pick ups and taxis, a couple of local policemen completely overwhelmed and no sign of a fire service or any ambulances. Mass casualty disasters like that must be terrifying, especially if you know that no help is coming. When you know there will be no flashing lights, no big boys in uniform telling you what to do and no one to assess and triage the injured. As I slept peacefully, Kisii had turned to complete chaos.

The local hospitals did their best but the majority of the critically injured succumbed to their injuries overnight. With current advances in trauma care I can reasonably claim that most of the critical initial survivors would not had died if there was an early, coordinated Emergency Medical Service, Fire and Police response taking them to a well-resourced major trauma centre. In the same week there has been two similarly horrific events occur in the first world – a train crash in France and an oil tanker explosion in Canada. I have watched those stories unfold on the BBC World News, CNN and Al Jezeera. I bet you didn’t even know about this tragic loss of life in Kenya though, despite it being officially declared a ‘national disaster’ by the Government or the fact that there was a worse crash back in February killing 35. The tragic thing is that Kenya has enthusiastic people with the skills and the resources to provide a better response. This is the kind of horror story that my new friends at KCEMT (the Kenyan Council of Emergency Medical Technicians), the CDC and John Hopkins University are working so hard to make a thing of the past.
This should be the part of the story in which I explain how we were mobilised and ready at first light with two planes fully equipped to go and stabilise and retrieve the most critical from the disaster. Unfortunately we had no idea of the scale of the tragedy that morning and I was sent off early to Kismayo to pick up a load of injured but stable soldiers. It was only as we were setting off back to Nairobi that we learned that the regional governor for Kisii had informed the Government’s ‘disaster control centre’. The reason for the delay is unclear. Then this plea for help was escalated to the President himself who officially declared it a disaster.
It still took a while for AMREF FD to be authorised to send a caravan plane out to Kisii, along with a few police helicopters and bring the patients back to Nairobi. Kenya’s Red Cross ambulance service were also heavily involved but they could not cope with the situation on their own. They are a paramedic staffed ambulance provider and are simply not geared up for the safe transfer of severely injured patients. AMREF FD is the only certified air ambulance in East Africa that can do the kind of highly skilled rapid triage, treatment and evacuation of the most critical casualties. I hope that the Kenyan people are starting to recognise this. I do hope that the government can now understand that AMREF FD is a specialist resource that can be used to save lives if they are allowed to be involved early enough.
Personally I found all this out after we had handed over our soldiers in Nairobi and one of our caravans had already headed out for Kisii. Frustrated I had missed the action, I was put on standby in case they needed another team. Our guys had already made it the hospital to find that ‘most of the local population seemed to have taken up residence in the hospital’. People from all over the region rushed there after the accident to look after their relatives or probably just to have a good look at the tragic story. The ambulance was unable to even get to the entrance of the hospital because the main road had become a car park with empty vehicles. Then inside the hospital there was barely room to assess and transfer the patients along the corridors, it was so packed with people. It was a perfect example of why the police are so vital to control the crowds and ensure access and egress from the scenes of major incidents. In the end they managed to get in and triage the 53 patients concluding that only 4 needed to be airlifted to Nairobi. The rest could be safely treated where they were.

As we waited at Wilson by our hanger it became busier and busier. Soon there was a massive crowd of news media, the Red Cross chaps, members of parliament and the Kenyan police. I thought it was a rather big turnout for just four patients. Then someone explained to me that nearly 20 injured patients were being airlifted because the President had declared a disaster. Therefore all the injured must come to the Government hospital in Nairobi.

As the cameras clicked away Charles and I took the first multi trauma case (head and chest injuries) to Kenyatta hospital. I had never been there before and we greeted by even more media. We were soon joined by more and more ambulances dropping off their patients and the already stretched A+E was suddenly swamped. Our staff and the Red Cross paramedics were impressed by how many staff had been diverted to come and take their patients. It’s true, we did not need to hang around. The patients from the incident were all seen very quickly. But I saw how busy the A+E Department was before we arrived and I wonder how the other patients fared while this influx inundated the hospital.
As I returned to Wilson airport, we were asked to head straight out to Kisumu (not far from Kisii) where one of the young girls involved in the crash had been taken. Strangely, we were stood down at the last minute. Apparently new arrangements had been made. I was surprised and assumed that she must have passed away. I was even more surprised when, the next day, Kizito and I were instructed to retrieve the poor girl again. What had happened became clear when we arrived. We were told by the staff at Kisumu that a police helicopter had turned up instead of AMREF FD with just a mattress in the back and no medical personnel. Thankfully the medical staff at Kisumu stood their ground and refused to allow such a critically ill young girl to get airlifted like that. Again I have to emphasise that when there is a resource like AMREF FD, capable of stabilising and safely transporting such a patient, sitting on your doorstep, ready to go at a moment’s notice, then it must be used. Unfortunately another 24 hours had been wasted.
By the time we were at her bedside, her conscious level had deteriorated further. She was now only responding to painful stimuli by inwardly twisting and extending her arms, which is a sign of quite considerable neurological impairment. She was certainly not protecting her own airway so, yet again, Kisito and I set to intubating, sedating and ventilating her and trying to protect her brain as best we could. I think we were reasonably successful as the high spikes in pulse, respiratory rate and blood pressure she was having on the ward, settled with us and she was nice and easy to manage on transfer.
Upon arrival we were met by the CEO of Kenyatta hospital who was extremely grateful for the safe transfer. I think that he clearly understands that now, when the police or Nairobi’s ambulance services can’t handle it, he knows who to call.

About; AMREF’s vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty. We believe in the inherent power within African communities – that the power for lasting transformation of Africa’s health lies within its communities.

Interested in working in remote medicine?  Courses of interest

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Latest Dispatches from Kenya with EWM Medic Matt Edwards

Adventures with AMREF Flying Doctors

The Calm Before the Storm – Part 1

Matt Edwards Blog  working in remote medicine

The past week at AMREF has been one of strange contrasts. There were no flights at all for three days and it was making the staff twitchy. It just doesn’t feel right to have nothing going on. In actual fact there was quite a bit going on at AMREF FD headquarters, just no flying. We had the official launch of the new Beechcraft King Air air ambulance on Monday. It was an impressive event with the dignitaries and guests sitting in the hanger alongside the beautiful new plane. Proudly I watched as my  film was being shown on repeat in the background. Dr Bettina Vadera, a representative from AMREF and the visiting MP all made speeches with a compare from Nairobi radio. She did a fantastic job of helping market the Maisha cover plan which is new insurance policy which is affordable to a large proportion of Kenyans and they then can get rescued from wherever they are in East Africa.  But after the banners and tables were cleared we sat around twiddling our thumbs for the rest of Monday and then Tuesday. Then suddenly on Wednesday morning, we had three medevac flights come in simultaneously. During the next two days AMREF FD would take on 9 flights, many of them extremely sick patients.
As I entered the office I was directed to the waiting caravan plane to do our checks as we had to fly out to Lewa where an 8 year old girl had fallen from her horse and was unconscious. There really is nothing like paediatric trauma to brush off the morning cobwebs. Far more effective than coffee. As I was busy agonising over whether I should be using the (A+4)x2 or the (Ax3)+7 calculation for her weight and the plane was about to start off, we were suddenly stood down. The girl was being brought straight to Wilson in a small plane with the parents and I was needed on another urgent flight into Tanzania. But we had to stay on site to receive the little girl from Lewa at Wilson to resuscitate as required and pop her in our ambulance to take her straight to hospital.

One of our locum doctors was on his way in to help out but was a little way off in the infamous Nairobi traffic. The tiny Cessna plane arrived from Lewa and taxied to us. The little girl had improved on the journey and was now wriggling away from stimulus. It was a good sign; lots of little kids respond like that after a significant head injury. I see mostly insignificant head injuries in children back home, and often I have to physically catch them from the play-area in the waiting room to assess them. We packaged her up while calming the parents and sent her off to the hospital for a scan of her head to exclude a neurosurgical issue. I am told she awoke fully on the way to the hospital and is doing fine.

So as we popped her in the ambulance the King Air was brought around and had been loaded ready for us to head into Tanzania. A young girl of 15 had been involved in a nasty car accident and was critically ill. She had been unrestrained in the back seat of her father’s car as they hit a pot hole, breaking the axel and the car rolled several times. The father was fine but his daughter had been ejected though the front window and was lay unconscious on the road. Once they got to the local hospital, we were contacted. As far as they could tell she only had a head injury (always a dangerous assumption) and she was still unconscious. All they could do was wait for us and give her strong medication to suck fluid out of the cells in her brain and halt the swelling going on inside.

It took about an hour to get to this gold-mining town in Kahama, Tanzania and on the way, while being bumped around by the thermals coming off the baked ground, we did our standard checks and discussed our plan. Given that we were expecting to be escorted to the patients bedside, we thought we would have a little time to assess and plan in the relatively safe and sheltered environment of the hospital. As we taxied around at the dusty runway, I noticed an ambulance sitting just outside the gates on the other side of the airstrip. I wandered off in the baking heat to have a pee (I am always totally convinced I am going to get bitten by a snake when I do this) and Kisito the flight nurse explained to the airstrip’s official that the ambulance needed clearance to enter. It seems no matter where you go in the world you will find irritating ‘jobsworths’. It’s just that in Africa they tend to back up their obstinate behaviour with an AK-47. Kisito gave up and beckoned the ambulance to bring some people to help us hump the equipment the 500m over to the gate. I lifted a few pieces of equipment out of the aircraft and then noticed he had started running towards them.

It took me a little while to work out what the problem was through the heat haze. Then I could make out a little group of people hurriedly carrying a small body on a stretcher. ‘Oh bugg*r’ I thought and quickly followed Kisito.
A rapid sequence induction on a critical patient in the pre-hospital environment can be one of the most stressful situations you can encounter as a doctor. But it needs to be calm, clear and systematic with good communication between the intubator and the assistant. So many things can go wrong; the powerful drugs you use to render the patient amnesic and unaware of the whole process, to reduce the stress response to having the breathing tube put down their throat and to paralyse their muscles, can easily put them into cardiac arrest. And if you can’t get the tube down and can’t breathe for them then they will asphyxiate. In a critically ill patient the time you have to get a breath into the patient can be only seconds before the oxygen in their blood is used up. The pre-hospital environment makes this procedure even more difficult especially in injured patients with potentially broken necks, damaged lungs and occult internal blood loss.
From one look at this girl, you did not need to be a doctor to see she was in a bad way. She was unresponsive with a partially obstructed airway, breathing extremely fast with a pulse rate of 170. Her blood pressure was actually slightly elevated, as young people often do before it starts dropping. Her head was bandaged and she had signs of a facial fracture. Kisito and I did not need to spend long deciding what we needed to do. In the shade under the wing of the aircraft we beavered about. Soon Kisito had established a large IV line and was getting one of the crowd (of course there was a crowd) to squeeze a bag of fluid into her, while I drew up the necessary drugs. Soon we had her assessed, oxygenated and her pulse rate was sensible. I was prepared for it all going horribly wrong but the tube passed simply and she did not respond adversely to the medication. We continued to optimise her chances of neurological recovery as best we could on our way back to Nairobi but I’m afraid the prognosis for such injuries is not very good.
Just as we were handing over in Nairobi we were instructed to return urgently as we were needed in Kisumu next to Lake Victoria. A normally sprightly elderly man had had a heart attack the day before and was not doing well. We had had a non-urgent enquiry about a transfer for him to have cardiac catheterisation earlier in the day. The clot busting and cardiac support drugs he had been given had seemed to be working. But then as his heart started to fail and the pressure started backing up, he had started to drown in his own fluid. This is not an uncommon occurrence for us in the emergency department and we deal with ‘crashing pulmonary oedema’ pretty regularly. Nitrates and ‘non-invasive assisted ventilation’ works pretty well. Obviously this was not available in Kisumu hospital. They also couldn’t do an echocardiogram because the machine is owned by one of the other physicians and apparently it can only be used on his patients.
Our radio room informed us that the patient was deteriorating and we needed to get a move on.

Unfortunately the relatives could only afford a flight with our caravan. We could have been there in 20 minutes in a jet. Two hours and a bumpy road journey later we were at the patient’s side to discover the doctors had intubated him despite the advice of the guys in the radio-room. They had intubated and sedated him but had no capacity to give him positive pressure ventilation. So he was basically in a worse state than if he had been left to his own devices. He was sedated, driving down his own appropriate urge to breathe rapidly and the tube was merely providing an extra long windpipe, like a rather thin snorkel, just making the work of breathing more difficult with the froth from his chest bubbling out the end periodically. I’ve never seen this done to a patient before. Without the benefit of assisted ventilation I simply don’t understand what they were hoping to achieve.

For the second time in the day Kisito and I exchanged glances, sighed and got to work. Thirty minutes later we had this chap settled on the vent and his chest was already improving. We had to contend with his heart doing some weird things as we ascended but with a little tweaking and strong cardiac drugs we had them solved by the time we handed him over back in Nairobi to go have his angiogram.

As I settled down to a well-earned sleep that night, little did I know that, across the other side of the country, something terrible had just happened. The storm was about to get worse…

Stay tuned for the next signal….

About; AMREF’s vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty. We believe in the inherent power within African communities – that the power for lasting transformation of Africa’s health lies within its communities.

Interested in working in remote medicine?  Courses of interest

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News from the world of Remote Medicine

Remote Medicine Jobs, working in Africa and lots lots more in this summer bumper edition of Expedition & Wilderness Medicine news
Expedition & Wilderness Medicine: remote medicine courses

News from the world of  Remote Medicine

Working for Amref in Africa Dr Matt Edwards Reports New Trauma Workshop in response to Boston Bombings, Polar Medicine in New Zealand and lots more!

Extreme Medicine Conference speakers

Extreme Medicine ’13

Featured speaker: Dr Micheal Barret, Aerospace Medical Association and the American Association for the Advancement of Science.Specializing in aerospace medicine, Barratt served as a flight surgeon for NASA before his selection as an astronaut, and has played a role in developing NASA’s space medicine programs for both the Shuttle-Mir Program and International Space Station. His first spaceflight was a long-duration mission to the International Space Station, as a Flight Engineer in the Expedition 19 and 20 crew. In March 2011, Barratt completed his second spaceflight as a crew member of STS-133.

Polar Medicine New Zealand

Next Course

Polar Medicine, New Zealand: A Winter Extreme Climate Expedition Medicine Course in the South Island of New Zealand close to Wanaka and Queenstown – 6 days of Mountain and Polar Expedition Medicine. As featured in the Royal Australian College of General Practitioners magazine

21 July 2013 to 26 July 2013
Last few places left email Catherine to reserve your place

Diving and Marine Medicine in the Maldives

‘A must do course!’

The feedback couldn’t’t be any clearer!. 6 days based on liveaboard vessel the ‘Ari Queen’ diving at some of the world’s most treasured locations and earning 20.25 CME and credits towards the Wilderness Medicine Fellowship Program to gain the FAWM!  Sound too good to be true?  Well that what other delegates think and why we are promoting the last few places – make sure you get yours by contacting Catherine at her email here.

Trauma and Pre Hospital Care

Pre Conference Trauma Workshop

28 October 2013 to 31 October 2013

In response to the tragic Boston Bombing and the fact that we have some of the preeminent experts in pre hospital care on site we are running a TRAUMA workshop on the weekend prior to the conference.  The final details are being ironed out but we hope to have these with you very soon.  For those of you who have booked on the conference you can prebook your place on this workshop at a conference discount of 15% by following this link….

Remote Medicine cheese model

Working as a flying doc in Africa

EWM Facualty Dr Matt Edwards reports!  I have been shown the Swiss cheese model for error or disaster many times in my career. But I wonder if there is a Swiss cheese model for success? So instead of the multiple holes lining up to allow an environment for disaster, all the right holes line up allowing you to sail through against all the odds and come out the other side with a truly excellent result. If there is not such a model, I would like to propose it now and give you an example that happened just the other day.  To read more click here.

Adventure Medic

AdventureMed

The new and shiny Adventure Medic website is now live atwww.theadventuremedic.com – featuring the best of adventure, expedition and wilderness medicine. Fresh articles include Space Medicine, the Flying Doctors and some stunning photos, lots on input from EWM faculty members and lots more besides…

Thank you for reading our news!

If you require any further information on any of our courses or how you can get invovled please contact us.

Email admin@expeditionmedicine.co.uk or
Call us on +44 (0)1234 766778

 

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Dr Matt Edwards philosophies from Africa

Dr Matt Edwards, facualty member of Expedition & Wilderness Medicine writes about this time as flying doctor with AMREF in Africa

Source: Matt Edwards Blog | AMREF – http://www.flydoc.org/

The inverse Swiss cheese model of Success!

I have been shown the Swiss cheese model for error or disaster many times in my career. But I wonder if there is a Swiss cheese model for success? So instead of the multiple holes lining up to allow an environment for disaster, all the right holes line up allowing you to sail through against all the odds and come out the other side with a truly excellent result. If there is not such a model, I would like to propose it now and give you an example that happened just the other day.

I have written little about the staff and expertise that goes on behind the scenes allowing AMREF FD to do its job. They made those first layers of Swiss cheese line up, just in time.

Coming from a first world country and working at AMREF you become very acutely aware of the different medical capabilities in the third world and how incredibly remote (geographically and logistically) some of these places are. And that’s coming from someone who has worked in Antarctica! If taken ill in one of these places you had better cross your fingers and hope your own body can sort it out. While out here I have often thought about one of my medical school colleagues, who tragically succumbed to a severe illness in the bush of Africa on her elective. I wonder if she would still be with us if AMREF FD had been there and able to pick her up in time

We received word of a young man travelling in a remote area of Ethiopia who had become extremely sick. They thought it was probably malaria but could not confirm. He had had a pretty classic malarial course with a few days of very high fevers, rigors and then started to develop dark urine and jaundiced skin. He seemed to improve on a dose of artemether (administered by another member of the group he was with) and then during the night became drowsy, confused and convulsed. He had not regained consciousness since. The doctors in the small clinic there had neither the supply of medication, nor the facilities to treat such a severe illness. Their experience of severe malaria like that in their local population is that it is invariably fatal. They just expect to watch people pass away.

When a distress emergency call like this comes into AMREF a number of things need to happen before we can get going. One of the first things is getting confirmation from the insurance that they will pay and the patient is covered for what we propose to do. Then we need to get the guys at Phoenix to work out how to get us there. That requires knowledge of the airspace, the airstrips in the region and, crucially in this case, their opening hours. Our operations team need to get immigration to agree to let the patient into the country and get clearance for our aircraft to enter the countries airspace and land.

In this particular case, the challenge was that the call came through about lunchtime and the airstrip we were flying to could not support night flights. Lalibela is a site of considerable beauty and cultural heritage in Ethiopia attracting a large amount of pilgrims and tourists alike, so the runway is tarmac and well maintained, allowing us to get there is a jet. But immigration dictates we cannot go straight there; we use first stop in the capital Addis Ababa to process the paperwork. Only in extremely rare circumstances is that wavered in any country, not just Ethiopia. (For example, because of a prior agreement, we can fly straight to any airstrip in Tanzania without going to Dar Es Salaam). So given that it’s two hours from Nairobi to Addis Ababa, then about 30 mins until we can set off to Lalibela which takes 45minutes and shuts at 18:00, we were looking at a cut-off time of 14:30. If we missed it we would have to wait until morning. The medical report strongly suggested that the patient would not survive such a delay.

As our Operations staff battled with Ethiopian immigration and badgered to gain clearance for the flight, our radio room in desperation tried to charter a flight in Ethiopia to go get the patient and bring him to Addis (which is open 24 hrs) then we could pick him up there, but we couldn’t get a doctor or nurse to do the escort. At 13:45 it was looking like this young man’s life was slipping through our fingers. All we could do as the medical team was sit with our equipment, ready to go and hoping the operations team could pull it off in time. It just seemed crazy to me that this red tape can’t be sorted out while we are on our way or even once we had picked him up, but that just isn’t the way it works.

At 14:10 we got the call the clearance had been granted, the insurance had confirmed they were happy, the patient’s travel documents had been found and we started up the jet. It was still going to be tight. It was entirely dependent on the immigration officials at Addis Ababa. Airport officials here seem to behave a little like ‘Rheopectic liquids’ i.e. they become ‘slower and thicker over time when shaken, agitated, or otherwise stressed’. Utter deference to their lofty status and prostrated begging normally works better for the fluid dynamics of the situation.

In Addis we were able to speak to the doctor treating this chap. He was worried. Really worried. He said his respiratory pattern was changing indicating he was not long for this world. This news came as the pilot did his calculations and worked out we would have about 30 minutes on ground. We told the doctor to him to get him to the airstrip, we couldn’t come to him. He was reluctant but it was the only way.

The flight into Lalibela was about 45 minutes. As Clement the flight nurse and I drew up drugs and set up the ventilator I caught glimpses out the window of an incredible landscape. If the only pictures of Ethiopia you have ever seen have been from Oxfam adverts, the country has been rather misrepresented. This particular region is breath-taking, with vast undulating valleys, deep canyons and lush green cultivated fields. From that elevation I missed any of the famous temples carved out of the ground and canyon walls but I could see the scattered village buildings resembling little mushroom plantations. Soon we were banking hard around a valley rim and on finals into Lalibela.

The patient had been brought to the airstrip and he looked worse than I imagined. His travelling companions were obviously incredibly worried and glad to see us. Like any of these situations a little crowd of locals had gathered to watch. It’s annoying and intrusive but you get used to it. There simply is no point telling them it isn’t a spectator sport. Because it is really. You just have to get on with it and they can be useful on occasions as another pair of hands to help lift things.

Clement and I set to our resuscitation (being given our absolute max time of 45 minutes) and the pilots were incredibly helpful and just became members of the medical team. When rushed in a situation like this where there is no one to bail you out like in hospital, it is even more critical you keep your head, calm down and go through your checklists. Communication is key and despite not having worked with Clement for long (he is one of our newest flight nurses) we gelled and did a bloody good job if I do say so myself. Within our allotted 45 minutes we had more IV lines in him with improving oxygenation, a blood pressure, and had established him on the ventilator without any complications. We settled him into the plane with all our pumps, drips and machines and were taking off from the beautiful Lalibela just as the light was fading.

With all our kit we were able to invasively monitor his progress as we treated and correct his various issues. As he improved he started to require more sedation to help him cope with the ventilator which is a promising sign that his brain was coming back on line. By the time we arrived in the hospital in Nairobi we performed a blood gas test which showed he had massively improved and was even breathing for himself. I am told he is now stable and improving in intensive care and the doctors are very positive about his prognosis. Discussing the case, we all agree that had it not been for the actions of our dedicated operations team busting through that red-tape and our pilots ‘pushing the envelope’, the story would have been very different. But for this lucky young man, all the holes in the Swiss cheese lined up just in time.

Of interest – relevant Expedition and Wilderness Medicine Courses & Conferences
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Treating Common Wilderness Injuries

It seems that each year expeditions and adventurous activities in challenging wilderness are becoming more and more popular. The simple fact is, many adventurous people like to explore new kinds of terrain, and wilderness environments offer as many thrills and positive experiences as they do challenges and dangers. Still, the prevalence of danger in such environments is the reason that rescue organizations and medical professionals near or within popular wilderness destinations must be well-trained.

No matter how well-trained a nearby professional may be, however, there are many common hazards that can arise in wilderness exploration for which you yourself may be responsible. Certain injuries and inconveniences are quite common, and can become serious issues if you are not properly prepared to handle them. So with that in mind, here are a few common hazards and injuries, and a few words on how you can handle them safely and appropriately.

Skin Lacerations

Certainly one of the most common minor injuries among people trekking through various wilderness environments, skin lacerations can become serious if handled improperly. Skin lacerations should be rinsed with clean water, and any foreign objects or loose dead tissue should be removed from the cut before a bandage is applied. Ideally, you should also carry an antibiotic ointment such as Neosporin to apply to the wound before dressing.

Preemptive measure are also significant. In this case, that might mean ensuring that you have an up-to-date tetanus shot before taking off on an expedition.

Eye Irritation

Eye irritation can occur as a result of numerous different factors that are common in wilderness expeditions. Dry climates result in dry eyes, dusty areas can result in small particles irritating your eyes directly, and heavy rain or swimming can sting or pressure your eyes into discomfort. The simple solution after the fact is to have moisturizing eyedrops on hand for the sake of comfort.

Additionally, however, you may want to consider your eyewear as a preemptive measure. Glasses can often be inconvenient on wilderness treks, but some Acuvue contact lenses are designed specifically to keep your eyes moist and comfortable. Additionally, contacts free you up to wear sunglasses, which is recommended for comfort and UV protection when spending extensive time outdoors.

Twisted Ankles

Another very popular injury when trekking through wilderness is a twisted ankle, and unfortunately this is one that’s difficult to overcome on-the-go. Generally, a badly twisted ankle means its time to abandon your adventure at the soonest opportunity so that you can properly address and rest the injury.

When out in the wild, your treatment options will be limited. Most significantly, you likely won’t have access to ice. However, do your best to wrap the ankle for stability and compression, try to rest it as much as possible, and when not moving, position yourself so that the ankle is elevated. Proper treatment involves the “RICE” method – rest, ice, compress, elevate – so try to do all you can until you reach shelter.

Dehydration

One of the most common issues with any extensive outdoor exercise, dehydration is not an “injury” so much as a gradually developing condition. Dry or sticky mouth, coupled with fatigue, headaches, or of course intense thirst, can be a sign that your body is not properly hydrated. In the event that you feel these symptoms, find a cool area to rest and hydrate, and remove extra clothing to help your body to cool off.

Once again, the best treatment is preventative. When spending extensive time outdoors, try to hydrate periodically whether or not you feel particularly thirsty. Keeping a schedule of hydration will help to prevent eventual discomfort.

Of interest

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EWM Facualty Dr Matt Edwards report on his day hob with AMREF

Dr Matt Edwards, part of the Expedition & Wilderness Medicine’s faculty team has taken up a post with AMREF Flying Doctors based in Kenya see Matts Blog in full….

Having recovered from travelling the length and breadth of the the continent last week, I’ve been doing a few shorter retrievals into the wild expanses of Kenya’s neighbor to the south – Tanzania. I’ve done a few medevacs from there in the last month but haven’t written much about it. But as I seemed to be spending more and more time buzzing around it’s vast landscapes in the co-pilot seat of a Cessna caravan, I thought I’d expand on my experiences there.

I was first called out to a young man stuck in the middle of the game reserve of Katavi, the other side of Tanzania and close to Lake Tanganyika, with resistant malaria. Now if I’ve learnt to respect one thing out here it’s malaria. I suppose I am exposed to a pretty severe case-mix to be fair. If the local treatment isn’t working or they are in a collapsed state we get involved. Some of these guys are impressively sick and I suppose, now I reflect on it, I think what is actually affecting me about this is the number of young people with critical illness I’m seeing on this placement. Working in the UK I’m so used to critically unwell elderly patients but I’ve just not been asked to manage many elderly patients here. Well apart from the minister in Musoma and the jogging octogenarian rose farmer who had broken his hip in Kampala but they don’t count as really ill. They could both beat your average middle aged Brit in a race, even with a fractured neck of femur.

I was lucky enough to be allowed to sit in the co-pilot seat for the trip there. It was a long journey in the caravan but you simply couldn’t get bored with that view. We flew past the famous Ngorongoro crater into the wide open plains of the Serengeti. I was told on the way that the crater is an incredible, almost ‘locked-in’ ecosystem of a huge variety of animals. Even though Sir Arthur Conan Doyle’s Lost World was based in South America, it’s tempting to believe the crater could have been an inspiration for the tale. It is truly vast and few animals, especially the lions, seem to see the need to cross the rim. As we made our way into the Serengeti plains I could not stop humming Toto’s rock ballad ‘Africa’ – it drove me mad.

 My second mission over the weekend was to attend to an unfortunate gentleman tourist who had collapsed and had had a ‘cardiac arrest’ with ROSC (Return Of Spontaneous Circulation) while at a remote retreat in Grumeti, just over the Kenyan border and within the Serengeti Park. Again you don’t need to be a doctor to realise that having a cardiac arrest in a place like that is likely to have a poor outcome. I’ve heard of AMREF arriving to a situation in which the poor bystanders have been doing CPR for a few hours, only to tell them that any continuation would be futile. However if someone gets a pulse back after a short period of basic life support in the field then we could really do some good with post-arrest care (if we get there quickly enough).We had to fly fairly high over the Serengeti National Park and so any animals were tiny specks down on the ground but you could see the impressive migration trails made by the herds. From above you could get a scale of how many thousands of these beasts must march along these tracks every year. It must be incredible to see. I wonder if somehow I will get a chance. It can be put on my ‘bucket list’ for the future if not.

Soon we were landing in Tabora for a fuel stop and then continued south west towards Lake Tanganyika. The landscape became relatively featureless and it reminded me of flying in Antarctica. The huge marshlands of the Katavi National Park came into view – the home of a huge number of hippos and billions of bloody tsetse flies unfortunately. At least when you went to see Antarctic wildlife you didn’t have to cope with their irritating, disease-spreading, insect entourage.

We managed to find the secluded airstrip and did a dummy run to clear it of about five impala. No wonder cheetahs struggle to catch those things – they move incredibly fast. At most of the Tanzanian airstrips we have to get rid of a number of large animals standing in the way. Not something most pilots normally need to worry about. There are certain interesting considerations to this animal clearing such as; if you are going to land between two herd animals, bail out and climb. If it is just one, it will run away so you can land. The instinct to herd is so strong when they are threatened, that they will run together. So if the plane is landing between them, the likelihood is that one of them will run into the path of the plane and that would be sub-optimal for a landing.

Our patient was not too bad so was quickly popped into the plane and connected up to some fluids etc. I am told he has been treated for recurrent malaria and is recovering well.

This was a shorter journey and the route was thronged with wildebeest (with a couple happily grazing on the airstrip). When we arrived on the beautifully secluded airstrip we found our patient, who was alive, cheerful and looked pretty chipper! We examined the circumstances surrounding this cardiac arrest and it was very short, while he was witnessed drifting off to sleep. It is possible that someone’s heart can stop due to an abnormal heart rhythm briefly and then it reverts to normal when someone starts thumping on their chest. It’s possible. If that was the case, then he is one lucky guy. For our years and years of research into the outcomes of out-of-hospital cardiac arrest, we know that the only people who have a reasonable chance of walking out of hospital with an intact brain are those who are witnessed to collapse and have good early bystander CPR. Just look at the survival outcomes they acheived in Las Vegas! (Valenzuela, NEJM 2000) The situation is slightly different in the middle of the Serengeti I’m afraid. There are many different explanations to what happened to this chap, including the fact he might have just been asleep, but the key fact was that someone was at his side and and started life saving actions immediately. I can only hope that, in the event of  a sudden collapse for myself or my loved ones, someone close-by acts as promptly.

Who are AMREF?

In 1956, three doctors – Michael Wood, Archibald McIndoe and Tom Rees – drew up a groundbreaking plan to provide medical assistance to remote regions of East Africa, where they had all worked for many years as reconstructive surgeons.

Spurred by what they had seen of the combined effects of poverty, tropical disease and a lack of adequate health services in East Africa, their collective vision was born in the foothills Mt Kilimanjaro.

At that time, there was one doctor to every 30,000 people in East Africa – in Britain it was 1:1,000. Medical facilities were sparse, with rough terrain and often impassable roads making access to medical care difficult for people in rural and remote areas. As this was where the majority of the population lived, Archie, Tom and Michael saw an air-based service as the only way to get health care to remote communities.

AMREF Flying Doctors provides air evacuation services in medical emergencies across East Africa, as well as air ambulance transfers between medical facilities.

We are Africa’s leading provider of air ambulance services and operate across many East African countries including Uganda, Kenya and Tanzania and, when clearance can be obtained, most neighbouring countries including the Democratic Republic of Congo, Eritrea, Somalia, Ethiopia, Rwanda and Burundi. Subject to flight clearances, AMREF Flying Doctors will carry out evacuations from anywhere on the African continent.

In addition, patients can be repatriated via an AMREF Flying Doctors aircraft to Europe, Asia and North America or a medical escort can be provided on commercial carriers.   AMREF Flying Doctors operates 24 hours a day, 365 days a year. As a vital link between remote areas and AMREF’s Control Centre at Wilson Airport in Nairobi, AMREF has established a radio network that comprises over 100 HF radio stations across East Africa, making it the largest two-way radio network in Africa.

As well as emergency evacuations, AMREF Flying Doctors provides a medial outreach programme, taking essential health care to some of the most impoverished and remote areas of Africa.   AMREF Flying Doctors, part of the African Medical and Research Foundation, is based in Nairobi, Kenya and has been delivering health care to some of the most remote areas of east Africa since its formation in 1957 by Sir Michael Wood.

AMREF Flying Doctors is committed to providing world-class medical services to the people of Africa.

Of interest

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Expedition Medic needed – Iceland

BES are urgently seeking an Expedition Medic to join this year’s Dangoor Next Generation Programme; Project New Horizons Iceland.

Dates: 11th August – 1st September 2013

Job Description: Please see our leader page or follow this link for a medics information page... or download PDF here Leader Job Description – Doctor

Application Process: CV’s to be emailed to outreach@britishexploring.org or call the office to discuss further.  BES actively recruits from Expedition Medicine course delegates so please mention ‘Expedition Medicine’ when applying

The Dangoor Next Generation Programme 2013 Expedition will be a three week adventure amidst the spectacular volcanic moonscape of north-east Iceland.

After touching down in Reykjavik, the Adventurers will transfer to their base camp at Svartarkot, where they will spend two days training and acclimatising to their new surroundings with a trek to the mighty Aldeyjarfoss waterfall. The team will then split into smaller groups, taking part in four different adventurous activities in four-day long phases.

Adventurers will trek across lava fields to ascend Askja Volcano, explore the mountains surrounding base camp, trek to Lake Mývatn to see its famous bird life and craters, and practice their navigation skills Geo-caching.

The teams will then re-group at base camp to review their achievements and break camp before setting off on the return journey.

 

Contact

Jo Gibbs, Outreach Assistant, British Exploring Society

At the Royal Geographical Building

1 Kensington Gore, London SW7 2AR

Tel: 020 7591 3173  Fax:020 7591 3140

outreach@britishexploring.org

www.britishexploring.org

Of interest

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