Prior to the World Extreme Medicine Conference in Boston we ran, with the very generous assistance of numerous Boston emergency services organisations an amazingly worthwhile pre conference workshop concentrating on the learnings from dealing with mass casualties.
This video explains more;
WARNING SOME GRAPHIC SIMULATED IMAGES
Pre-Trauma Disaster Simulation Workshop from Gloria Tokics on Vimeo.
The awards will be presented at the World Extreme Conference on October 28th 2013 at the Joseph B. Martin Conference Center.
It gives us great please to announce the winners of the EWM Awards for Excellence in Remote Medicine; the winners are…. (drumroll please)….
Company or Organisaiton of the Year
This award is presented to the company or organisation that has made an exceptional impact on extreme medicine: one that has strived to excel and has set new standards in their fields of expertise, whether it is in research, product or leadership.
2013 Winner – The Beth Israel Deaconess Medical Center in Boston for their utter professionalism in reaction to the tragedy of the Boston Bombing
‘Boston’s trauma centers have been widely praised for saving dozens of Marathon bombing victims, treating one person after another who arrived at their doors with limbs torn off or mangled, some patients having lost most of their blood’. Boston Globe
‘When bombs went off at the Boston Marathon on April 15, Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka found himself dealing with the kind of the emergency few drills could ever prepare you for. As bombing victims were brought into his downtown hospital and the city went into lockdown, Halamka and his team began to parse a nightmare situation…. Then it got worse. Suspect Dzhokhar Tsarnaev was bought to Beth Israel… and Halamka, a prominent figure in the bioinformatics world, had to deal with a very unique challenge’
Person of the Year
This years Person of the Years awards will be announced at the prize giving ceremony at Harvard Medical School on the evening of the 30th of October
Product of the Year. A new catagory for 2013. A single product which exemplory in its design and usage.
This years winner is the new generation QuikClot Gauze
‘Every major conflict throughout history produces a medical miracle. This conflict’s miracle is QuikClot’. Dr. Sanjay Gupta, CNN
(embedded with the U.S. Marines 2003) Z-Medica website.‘For the first time in history, we’ve put the ability to quickly stop bleeding from superficial wounds, minor cuts and abrasions into the hands of anyone who can tear open a package and follow a few simple directions. In addition to products for emergency response, we continue to innovate and deliver life saving products – for the soldier, fireman, first responder, law enforcement officer and surgeon. When blood loss is the concern, QuikClot® is the answer’.Z-Medica website.
The EWM awards are geared to keep all of us in the industry motivated and are dedicated to everyone involved in extreme medicine, no matter how great or small their involvement.
The awards recognise the achievements of some of the most inspiring personalities and companies that are associated in one form or another in the growth of the Remote Medicine industry.
Another great article curtesy of Adventure Medics
So, you’re a doctor and you want to go on holiday somewhere exotic? Have you it through before you go? Dr Katie Hawkins, newly married and a recently qualified GP, tells us the tale of her honeymoon trek in remote Nepal. Her story beautifully illustrates some of the problems that can be encountered as an off-duty medic in a remote place. Katie also includes some excellent advice to help you deal with such problems yourself, while giving us the lowdown on the GMC and defence unions’ views on Good Samaritan Acts. Despite her honeymoon, Dr Hawkins remains happily married and is now working for the International Porter Protection Group in Nepal. (Photos: Sam Hawkins)
Imagine this: it’s your honeymoon, and you’ve been dreaming of a big trip – to go away together, to be just the two of you. You love mountains, climbing, walking and adventures. Finally you manage to arrange time off work. You’ve not managed to get time like this since University days, trekking in Nepal. It’s a must, and you’ve earmarked a trek you’ve heard only a few people do. It will be bliss.
There are a few mutterings from friends:
Have you met the people you’re going with?
Don’t worry, we’ve been assured that they’re all super fit and anyway, if we get bored of each other at least we’ve got company.
The day before you leave a kind colleague thrusts some dexamethasone and nifedipine in to your hand and says ‘this might be useful’. Also by chance you ordered the book Pocket First Aid and Wilderness Medicine by Jim Duff and Peter Gormly. This arrives on the morning of your departure.
On arrival, there are the standard problems of missing luggage, retained passports and road blocks. However somehow, later that evening and despite the chaos, you find yourself eating veg thali and sipping on a cool beer. Well here we are.
However, it’s not just the two of you. You’re sitting at the table with your trekking group, all in their 60s. You think:
This can’t be right. Well if they’re not young then they must be fit
They are really lovely people and are filled with the same enthusiasm for the mountains that you have. For some of them though, it’s even more than this – this is their adventure of a lifetime! You decide not to be ageist. They seem lovely and you look on the bright side.
However, a few warning shots are fired. One man pipes up that this is his first trekking trip. It seems he hasn’t camped or trekked before. He is also recovering from a broken leg.
Then it emerges that your group also has a woman recently recovered from an episode of vestibular neuronitis, and a man who had a pneumothorax last year. The man with the broken leg is not able to take big steps does not trust it on uneven surfaces. Still you’re all a team now and you get along well. You’re still enthralled by the sights, sounds and smells around you, so you decide to appreciate being here and try not to let it all worry you.
Funnily enough it’s slowly dawning on you that although you’re on your romantic holiday, you’re still a doctor. Well are you? The inevitable conversation at the start of the trek begins, what do you do back home?’ Will you say it? What harm can it do? ‘Okay, I’m a doctor’. ‘Ah, she’s a doctor’, someone says to the trek leader… Help.
You come to the first village and due to their excessive loads, many of the porters have blisters. It seems that the trek leader’s kit has no tape in it, so you offer them some of your Compede. ‘She’s a doctor’ they all say and soon you have 5-10 people coming up to you for help. ‘You should get your local nurse to see to that’ you say to the man with a nasty sore. ‘There isn’t one for miles’. A quick check of the other people, and alarm bells are ringing. Only treat people in an emergency, you think to yourself. Is that right? What should I do? You soon escape the village, having handed over iodine solution and some plasters and realise you need a rethink. ‘I am a doctor, but I’m on holiday’, you tell the trek leader. Phew that should sort it.
Diarrhoea starts spreading around the porters, another comes to you with really painful athletes’ foot. Another porter bashes his head and is sent home (alone?) before you’ve even set eyes on him. Where does my responsibility lie?
Before you left you had a quick briefing. ‘If you get altitude sickness you must go down’. Back in your medical student days you’ve been to altitude with young, fit classmates. You vaguely remember one chap feeling a bit funny and heading down and not getting to the top, but otherwise everyone seemed okay. How would I recognise altitude illness? How fast should I really be ascending? You’ve always known it’s slow but not really thought about the specifics of how to avoid it and how to diagnose it?
You realise soon enough that the group are looking to you for advice:
Should we take Diamox?
How much water should I drink?
Should my hands be this puffy?
How should I manage my nasty cough at altitude?
One of these seems easier to answer than the rest, or does it? Where’s my stethoscope and sats probe? I didn’t think I’d need them on holiday.
Somehow you feel you’re in a role you were not prepared for. You tell the group that you’re interested in mountains but not the expedition doctor. They need to make their own decisions. You will try and help in an emergency but that’s it. However, you feel a sense of impending doom.
You arrive at camp at 4800m. It’s been a fairly long day and you’ve now made it to well above the tree line. You can feel the altitude a bit here, but having trekked up and beyond the previous camps each night, you feel you’re acclimatising well. So you kick off a game of Frisbee with the porters. Beautiful light caressing the peaks, glowing with florescent colours. No wonder people used to think the mountains were Gods. You feel small and insignificant with these towering above you. And then the light is gone. A cold wind and chill sweeps through the valley. Although the mountains are tempting you up them, this is a stark reminder that ‘this is no place for men’.
Back at the tents you realise that one of the group has started to panic. This has been a recurring theme all the way up but you’ve got them to this stage so you feel you’ve done quite well. ‘He’s cold’ they say. Luckily you’ve been reminding yourself how to treat hypothermia by reading the pocket book. Hot drink, bottles in the sleeping bag and huddling in mess tent. He seems better pretty quickly. In the back of your mid you’re thinking is this AMS?
There’s the call of ‘Dinner is ready’. You see a woman emerge from their tent and stumble, trip, wobble. ‘This is how I always walk’, she says. This is true in part but how do you distinguish pre-existing vestibular neuronitis from cerebral oedema? You revert to your now trusty text. No advice there. You decide that it would be difficult. It’s dark and icy. You say:
It’s probably best that you go down
I’ll just have my dinner thanks and I’ll be fine
Can you argue with that? She’s certainly walking a bit better after dinner. You’re not sure what to advise, and should you be advising anyway? She refuses to descend so you make sure her tentmate will keep an eye on her.
In contrast, the man hardly eats anything at dinner. ‘I’ve had lots during the day.’ You advise him to go down as well but he refuses but agrees to share a tent with one of the other guys who will keep an eye on him. By now alarm bells are not just tinkling, they’re ringing loudly. You scribble down some notes before going to sleep; I probably ought to keep some sort of record. However, at the same time you plan a possible escape for the two of you.
At 0030, you have the dreaded feeling of needing a pee. This has been quite normal occurrence over the past few nights. You’re just having the same argument with yourself about leaving your warm sleeping bag, when you hear a kerfuffle outside.
Five porters are carrying the man in his sleeping bag to the shelter. Oh help. This is an emergency. I’ve no choice but to get involved now.
He looks a bit puffier, claims he can’t stand up, can’t see and his headache has returned. What headache? This time it’s 1am, you’re feeling the altitude yourself. Armed with your first aid kit and trusty book, you check his finger nose point test, he cannot walk and his respiratory rate is 40. This is an emergency. We’ve got to get him down. You give him a Diamox whilst the trek leader is ordering soup.
The rivers are bigger at this time of night due to the melt run-off in the day. It’s also icy (-20°) and the porters have flimsy plimsolls on their feet. The leader says they can’t take him down. You try to treat him. You look up the doses for nifedipine and dexamethasone. Soon after you’ve fumbled with boxes and books and plucked up the courage to give him the treatment, a decision is made to attempt descent.
You’re realising now that altitude sickness is unpredictable. Will descent make him better? You hope so, but now, being this involved you decide that you would not forgive yourself if anything was to happen. You’re going down too. The porters and leader prepare a basket with poles across the bottom and strap the man, in his sleeping back, into the basket with a belt. Three able porters then take it in turns to carry the basket, using straps across the fronts of their heads, and down you go.
The streams are bigger, throwing out the melting ice, rubble and dust from the mountains down to the camp below. The porters negotiate these, but also the landslides at top speed. By 5am, still dark, you can hear the familiar sound of the tinkling of Yak bells in the camp below. You’re all down safely. The man is feeling better and the porters are your new heroes.
Your only way out now is over a 4900m pass or 7 days of undulating trekking to back your starting point. The man assures you that now he’s fine and can continue the trek. You are at least certain of one thing: no chance. Fed up with the commotion and feeling sick with the lack of sleep you start strolling back to the previous day’s camp. On your way up you meet the chesty woman, still stumbling, coughing and looks as though she’s aged 20 years. Again??
So now, two casualties, both insisting they can carry on trekking, and you’re pretty sure that they can’t. Luckily the trek leader steps in and is very willing to organise a helicopter. Within two hours it arrives and they are both whisked away. Gone. All that’s left is the fluttering in the breeze of the makeshift ‘H’ made out of loo-roll. A small child is dancing delightedly holding a piece aloft.
From here your trek goes up over a pass and into a still colder and higher valley. From this point, although missing the banter from the others, the pace picks up and there’s more time to spend together and stand in awe amongst the towers, pillars and giants above you.
Twenty-eight days finishes with smiles; a wonderful, memorable holiday to a magical place, the mountains of the gods. Yet there are still questions playing on your mind, most notably: did I do the right thing?
My honeymoon, as well as plenty of others’ tales, raises some of the issues to consider when going on holiday as a doctor. Although advice and guidance may differ depending on which country you travel to, I have attempted to offer some tips below.
Know when you might/need to help in an emergency
The GMC Good medical Practice Guide states that ‘In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care.’ Good Medical Practice applies to all doctors, whether they have a licence to practice or registration only.
In other words, you are in it, whether you like it or not.
Make sure you are aware of what your indemnity covers you for prior to departure.
The latest responses from the three leading UK defence unions from email and telephone advice (Feb 2013) are as follows:
MDU / The MDU is primarily a UK indemnifier. We are not set up to handle claims arising from overseas. For this reason we advise our members to seek indemnity in their destination country for work abroad. There are some circumstances where indemnity might be granted for overseas work but this is on a discretionary basis, We are unable to offer this for the USA, Canada, Australia, Zimbabwe, Hong Kong, Bermuda, Israel, Nigeria.
MPS / As a truly Global organisation, MPS provides indemnity and support to healthcare professionals in over 40 countries, We can offer access to indemnity for our UK-based members who undertake medical work abroad, including those who work as an expedition medic. The rate charged for this will vary largely on the location, nature of work to be undertaken, earnings of the doctor and the time period over which the indemnity is to be provided. Existing members will benefit from reduced subscription costs. MPS is unable to indemnify health professionals working in some countries, including the USA or Canada. If the act is a ‘good Samaritan act’, the MPS will aim to assist no matter where in the world the care is being provided or action is brought.
MDDUS / Doctors are only covered to go on expeditions provided that they are going on a voluntary basis with a UK registered charity. We require written notification from the charity confirming details of the expedition, and we only cover claims raised within the UK jurisdiction. If the doctor is being paid as the expedition medic and /or the doctor is not going with a UK registered charity, the doctor will not be covered. All members do have worldwide cover through MDDUS membership for Good Samaritan acts in emergency situations.
Think carefully about what you take in your first aid kit.
When you make up a first aid kit to go abroad, you must make decisions based on whether you are providing for yourself, for you and the group, or for everyone including porters and locals. If you are also providing for your group and locals, your treatment is no longer a ‘Good Samaritan act’. You would need to contact your defence union to make sure that you have the correct indemnity for this.
Jim Duff and Peter Gormly’s book provides a handy resource to help in emergencies. Ultimately, what you decide to take is your own personal decision but there are plenty of resources out there. For example, Adventure Medic’s own Resources Section.
If you prescribe for others on the trip think carefully about why you are doing this, especially at altitude. The GMC states:
Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship’. If you prescribe for yourself or someone close to you, you must make a clear record at the same time or as soon as possible afterwards. The record should include your relationship to the patient (where relevant) and the reason it was necessary for you to prescribe.
Tell your own or the patient’s general practitioner (and others treating you or the patient, where relevant) what medicines you have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody close to you) they object.
You must not prescribe or collude in the provision of medicines or treatment with the intention of improperly enhancing an individual’s performance in sport. This does not preclude the provision of any care or treatment where your intention is to protect or improve the patient’s health.
If you are prescribing a medicine for somebody overseas which is being dispensed overseas, you should check whether you need to be registered with the country in which you are prescribing.
If you do have mountain medicine experience, be wary of stating you are a ‘specialist’ as you will be judged against your peers.
When going in a group, make sure you do your best to vet your companions carefully. You may be able to meet before-hand, speak over the phone or email. This will at least give you some idea of what you are letting yourself in for. I found this out the hard way, as problems within the group had been denied by the agency but only revealed themselves on our arrival. Some companies have medical vetting procedures and some don’t. It would be worth asking your company about this, even if you are only going on holiday somewhere remote.
Be wary of companies that offer that you can act as Expedition Doctor and get a 10% reduction. This may be tempting but make the decision carefully. Check whether they would provide first aid kits/medications and what they would include. Check your indemnity. The extra cost may actually be considerably more than the 10% reduction.
Even if you are not medically qualified, if you employ local porters or guides, you are responsible for their health. They should be treated in the same way as any other member of the group. See the IPPG ‘Guidelines on Ethical Trekking’ for more on this subject.
The decision as to whether or not to treat local people en route is difficult. Unless the problem is an emergency it is usually best to refer the problem to local health care workers. Treatment may be appropriate if i) the problem is an emergency, ii) you can provide a full course of treatment, iii) you will be around in the area to give the patient adequate follow up.
In the case of chronic illness it may be appropriate to provide a letter for the patient to take to their nearest health care facility.
If a medical problem arises, keep detailed notes of what happened. This is important medico-legally, even if acting as a Good Samaritan. The GMC states ‘you must keep clear accurate and legible records, reporting relevant clinical findings, the decisions made, and any other drugs prescribed or other investigations or treatment’ and ‘make the records at the same time as the event you are recording or as soon as possible afterwards’.
Beware of buying medications abroad. It is common that medication ‘is not what it says on the tin’. Also be aware of internet sales as in >59% cases medicines from illegal sites have been found to be counterfeit.
The home office website has some useful advice on where you can take opiates. Make sure you speak to them and also the country of origin prior to travelling, as well as taking all prescriptions with you. It is not advisable to take any opiate through United Arab Emirates countries or Saudi Arabia (5, 6).
Consider the option of not telling anyone you’re a doctor. If you really are going on holiday, and fancy a break, there is always the option of not telling anyone you’re a doctor, but remember in the event of an emergency, GMC guidance says that you must step in. In such an event, it may then be hard to explain to your companions why a part-time musician/novelist/barmaid has suddenly morphed into a full-time, business-like clinician.
Duff, Jim; Gormly P. First Aid and Wilderness Medicine. Tenth ed. Cicerone Press; 2007. GMC. Good Medical Practice. Point number 11. P. 11. 13th Nov 2006. GMC. Good practice in prescribing and managing medicines and devices. GMC. 31 Jan 2013. World Health Organisation. Medicines: spurious/falsely-labelled/falsified/counterfeit (SFFC) medicines. WHO May 2012. Home Office: licensing for drugs. Accessed 31/1/2013. Home Office: list of UK based Embassies. Accessed 31/1/13.
Of interest
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The final polish has now been applied to an amazing an speakers program – you can view it here and if you are one of the few people without a ticket yet they can be purchased here…
The International World Extreme Medicine Conference and Expo 2013 will host some of the very best speakers from around the world, who are amongst the leading figures in remote extreme medicine fields, including expedition and wilderness, pre-hospital, disaster, and relief medicine. Alongside the daily lecture series will be exhibitions from focused industry leaders, showcasing products and services to meet your extreme medicine needs.
**’This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Expedition Medicine. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians.
The Wilderness Medical Society designates this educational activity for a maximum of 33.25 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity’.
EXTREME MEDICINE 2013 CONFERENCE
The final polish has now been applied to an amazing an speakers program – you can view it here and if you are one of the few people without a ticket yet they can be purchased here…
The International World Extreme Medicine Conference and Expo 2013 will host some of the very best speakers from around the world, who are amongst the leading figures in remote extreme medicine fields, including expedition and wilderness, pre-hospital, disaster, and relief medicine. Alongside the daily lecture series will be exhibitions from focused industry leaders, showcasing products and services to meet your extreme medicine needs.
**’This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Expedition Medicine. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians.
The Wilderness Medical Society designates this educational activity for a maximum of 33.25 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity’.
EXTREME MEDICINE 2013 CONFERENCE
03 December 2014 to 22 December 2014
Dr Freer is the Medical Director of Yellowstone National Park, ex President of the Wilderness Medical Society and subject of the documentary ‘Everest ER’which features her work running the field hospital at Everest Base Camp. You will also travel with an Expedition Leader, a team of naturalists, an undersea specialist, divemasters, a National Geographic photographer and a Lindblad-National Geographic certified photo instructor, who are amazing experts in their own right, and consequently offer a superb environment from which to explore this incredible region.
Aboard the luxurious, 102-guest National Geographic Orion
Highlights
Traveling aboard the new National Geographic Orion, encounter spectacular volcanic landscapes in Bora Bora and uplifted atolls of Makatea and Henderson Island. Snorkel and dive some of the most remote and pristine reef systems in the world. Hear the tales of the Mutiny of the Bounty and the Kon‐Tiki, and experience the lively culture of the islands. End the voyage among the evocative statues of Easter Island.
You will be booking your trip directly with Lindblad Expeditions but doing sounder our conference name in order to gain access to our special lecture program. The conference content is CME accredited for 10 hours by the Wilderness Medical Society and will include the following topic headings:
The cost of the conference is based on two people sharing a standard cabin but if you want to upgrade your cabin, travel singly or book separate travel arrangements then Lindblad Expeditions will be more than happy to make these arrangements for you. Most meals, landings and activities are included in the price but the arrangements will be governed by Lindblad Expedition’s terms and conditions.
How to book: Please email Liz Estes for a reservation form. Should you require further information regarding the itinerary, flights and travel arrangements or specific requirements regarding your stay on the National Geographic Orion, your point of contact is Liz at 888-773-9007, if ringing from outside the US on 001-212-261-9000 or email [email protected] We recommend you make your flight arrangements through Lindblad especially if travelling from the US to tie in with local ground arrangements.
To find find out more information
https://www.facebook.com/events/173939846140822/
Pre Conference workshop for Extreme Medicine Conference, Harvard Medical School boston.extrememedicineexpo.com
2 Medical Officers’s need by Col John Blashford-Snell for his expedition to Peru 2014JBS is leading an expedition to support the Peruvian conservationists and to give aid to the indigenous communities. This is likely to be medical and dental treatment, the provision of reading glasses for older villagers and school books for the children. At the same time biological and engineering advice will be given to the park officials and volunteers will monitor the wildlife
The expedition is approved by the Scientific Exploration Society and will probably be 1-21 July 2014 and involve around 20 self funded volunteers. The expedition subscription is likely to be £2900 per person excluding the international air fare. They will travel by vehicle and on foot and use pack horses and mules. He is especially keen to involve doctors, dentists, nurses, biologists and engineers who speak some Spanish. Persons to assist with the community aid are also being sought.
Email Anne Gilby at [email protected] or phone 01747 854456 for more details – they are particulary interested in hearing from candidates from ‘Expedition & Wilderness Medicine’ so please do mention our name.
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Our Mountain Medicine course heads for Nepal led by Everest ER founder Dr Luanne Freer, head medic for Antarctic Logistics and Expeditions Dr Martin Rhodes and world authority of frostbite and cold weather injuries vascular surgeon Prof Chris Imray.
Progress updates here and on the Expedition & Wilderness Facebook group
Updates; most recent on top
Join us next year in Nepal on the next Mountain Medicine course
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A brand new course is added to the growing stable of iconic Expedition & Wilderness Medicine courses
Join us on a 6 day CME accredited Wilderness Medicine and Glacier Safety Skills course set in stunning southern Iceland led by Dr Freer who is the Medical Director of Yellowstone National Park, ex President of the Wilderness Medical Society and subject of the documentary ‘Everest ER’ which features her work running the field hospital at Everest Base Camp.
The course is based in southern Iceland in the Thorsmörk area and teaches not only the principles of wilderness medicine presented by one its acknowledged experts but also glacier safety and travelling on ice.
The outline program;
Day 1 – Reykjavik – Country hotel Fljótshlið. You will be picked up from outside the City Centre Hotel* in Reykjavik @ 10.00 am. Then we will then drive you for couple of hours to your hotel base in the backcountry for the next few days. Introduction for the weeks activities and plans. Evening lecture.
Day 2 – Altitude illness – Canyoning – hard ice skills – bites and stings. Canyoning is only 15 min away from the base Hotel Fljótshlíð, beautiful canyon and we will use dry suites to enter the water. An ideal location to learn about tough evacuation from accident.
We will then drive after lunch to the glacier Sólheimajökull and do hard ice skills, topics covered will include glaciology, anchors, basic use of ice tools, amateur iceclimb and crevasse rescue technics. Then we arrive at the base camp around 19.00 have dinner and lecture in the evening.
Day 3 – Wilderness wound management – Roping up for glacier travels – tindfjöll trek – wild animals attacks. We will start the morning with a lecture then put into practice some of our learnings by practicing roping up for glacier travels. Super jeeps will then take us to the base of the volcano Tindfjöll (900m). We will trek to the volcanoes summit, it´s approx 6 km in total but takes around 5-6 hours depending on the conditions. It’s a rugged glacier terrain with a steep walk to reach the top, great practice location for applying our newly learnt mountaineering skills. When we get back approx 18.00 we have time for lecture after the dinner.
Day 4 – Backcountry medical kits – Mýrdalsjökull IceCap traverse – staying at fimmvörðuháls hut (or camp) – Backcountry water disinfection. This is the physical day, we will do an amazing Icecap traverse which is approx 24 km to the Þórsmörk mountain reserve hut . This day is weather and conditions dependent. The route profile will start at about 900 meters ascending to 1350 meters and descending again to 1000 meters.
Day 5 – The interpersonal Features of group travel – trek to Thorsmörk mountain reserve – wilderness ophthalmology – dinner and farewell – overnight at Þórsmörk mountain reserve hut or camp.. The Walk from the hut takes approx 5 hours and we would go passed the two craters that opened up in 2010. There are really nice colors in the new mountain and might still have steam coming up from it. From there we walk down to Thorsmörk valley witch is one of the most beautiful walks in the country, amazing scenery when you go into the Glacier valley.
Day 6 – Management of fractures & dislocations – Thorsmörk hike 2 hours – Expedition Medicine – Moving to Reykjavik in the afternoon. Course ends at City Centre Hotel at 18.00 approx.
An early bird discount of £50 is available to end of the November 2013. Terms & Conditions apply. Not combinable with any other promotions and valid only on new bookings
Book early with this code to get £50 off! ‘ICE14-Eb-50’
Other courses of interest
The ‘David Weil Extreme Medicine Award’ (DWEMA) and is by invitation only however, nominations of worthy candidates are welcome for the 2014 Extreme Medicine Conference which will take place at the Royal Society of Medicine in London 26 – 29 October 2014.
To nominate please contact Mark Hannaford, Managing Director, Expedition & Wilderness Medicine; [email protected]
The Extreme Medicine Conference which this year is taking place at the end of this month at Harvard Medical School funding to two medics to attend under a sponsorship arrangement has been provided.
The sponsorship scheme was set up to enable worthy medical candidates, who otherwise might not be able to afford, to attend the conference. The learning’s would then be applied to medicine provided in extreme, front line, disaster & relief environments and in turn relieve suffering and advance medical care in the situations where typically treatment would be lacking. The award also serves to promote new qualified individuals who show great promise in the area of disaster, humanitarian and remote medicine.
David is a Hong Kong/ London based entrepreneur who is passionate about using his resources to make positive social change and has supported EWM for a number of years and he has offered to cover the following expenses;
This years winners are;
Dr Anushavan Virabyan
Dr. Anushavan Virabyan is the Vice Chairman for Disaster and Emergency Medicine at Yerevan State University in Armenia. He is a practicing Cardiologist and Emergency Physician with more than 35 years’ experience. He completed his medical training in 1979 and has specialized in pre-hospital medicine during his career. Dr. Virabyan is married with two children and is fluent in Armenian, Russian, and English. He currently lives in Yerevan Armenia.
He was announced as the best emergency physician in 2013 by the Ministry of Health of Armenia.
Dr. Virabyan became an Emergency Physician at No. 5 Ambulance sub-station, Yerevan Armenia in 1979 and rapidly rose to become a Cardio-Reanimatologist in 1981, and then Chief of that station in 1991. He remains in that position today. The Yerevan city ambulance service responds to nearly 600 ambulance calls per day in and around that capital city. Ambulance station No. 5 is one of the largest stations in the city.
In 1994 Dr. Virabyan became Director of the Emergency and Disaster Medicine Regional Training Center, a jointly sponsored program between the University of Massachusetts Medical School, Boston University School of Medicine, the American International Health Alliance (AIHA), and the Armenian Ministry of Health. This center served as the first and the model for a system of centers that grew to number 16 throughout the former Soviet Union. Under Dr. Virabyan’s direction the center grew to serve all of Armenia in Emergency Medical Services (EMS), Emergency Medicine, and Disaster Medicine training. As the first and model center for the AIHA network of training centers, Dr. Virabyan’s center received numerous awards and accolades for cutting-edge Emergency and Disaster training. From 1994-2002, the center trained nearly 10,000 students and hosted a number of international conferences and training sessions. Under the leadership of Dr. Virabyan, the Yerevan center became the flagship center of the American International Health Alliance network, and was featured prominently in its advertisements and website.
Dr. Anushavan Virabyan continues to serve Armenia as one of its leaders in the medical field, and a pioneer in the fields of Emergency and Disaster Medicine. He has written over 20 published papers and continues to teach young medical students and residents. He was recently appointed Vice President of the Armenian Ambulance Association and helps to drive policy through that position. Armenian history will show that through Dr. Anushavan Virabyan’s forward thinking and advanced training programs, he pioneered the establishment of the fields of Emergency Medicine and Disaster Medicine, revolutionizing the way Emergency care is provided in that country.
Sam Moody
Sam was born in London and lived in Essex, enjoying a life in Music during school and college there. He made the decision to enter medicine late and now studies at the University of Manchester, after completing a foundation year for widening access. He is currently fourth year.
Last year he took a year out and intercalated, gaining a BSc in Tropical Disease Biology from the Liverpool School of Tropical Medicine. Although his research focus was on the laboratory growth of filarial parasites, it was there he found a way to begin accessing the sphere of humanitarian medicine, and could begin to further his interest in the structure of humanitarian response and disaster/tropical medicine. He is currently helping to organise a conference on Health in Humanitarian Settings at the LSTM, and is beginning research with members of the HCRI in Manchester. He hopes to enter the world of humanitarianism after FY1/FY2 years.
The ‘David Weil Extreme Medicine Award’ (DWEMA) and is by invitation only however, nominations of worthy candidates are welcome for the 2014 Extreme Medicine Conference which will take place at the Royal Society of Medicine in London 26 – 29 October 2014.
To nominate please contact Mark Hannaford, Managing Director, Expedition & Wilderness Medicine; [email protected]
The Extreme Medicine Conference which this year is taking place at the end of this month at Harvard Medical School funding to two medics to attend under a sponsorship arrangement has been provided.
The sponsorship scheme was set up to enable worthy medical candidates, who otherwise might not be able to afford, to attend the conference. The learning’s would then be applied to medicine provided in extreme, front line, disaster & relief environments and in turn relieve suffering and advance medical care in the situations where typically treatment would be lacking. The award also serves to promote new qualified individuals who show great promise in the area of disaster, humanitarian and remote medicine.
David is a Hong Kong/ London based entrepreneur who is passionate about using his resources to make positive social change and has supported EWM for a number of years and he has offered to cover the following expenses;
This years winners are;
Dr Anushavan Virabyan
Dr. Anushavan Virabyan is the Vice Chairman for Disaster and Emergency Medicine at Yerevan State University in Armenia. He is a practicing Cardiologist and Emergency Physician with more than 35 years’ experience. He completed his medical training in 1979 and has specialized in pre-hospital medicine during his career. Dr. Virabyan is married with two children and is fluent in Armenian, Russian, and English. He currently lives in Yerevan Armenia.
He was announced as the best emergency physician in 2013 by the Ministry of Health of Armenia.
Dr. Virabyan became an Emergency Physician at No. 5 Ambulance sub-station, Yerevan Armenia in 1979 and rapidly rose to become a Cardio-Reanimatologist in 1981, and then Chief of that station in 1991. He remains in that position today. The Yerevan city ambulance service responds to nearly 600 ambulance calls per day in and around that capital city. Ambulance station No. 5 is one of the largest stations in the city.
In 1994 Dr. Virabyan became Director of the Emergency and Disaster Medicine Regional Training Center, a jointly sponsored program between the University of Massachusetts Medical School, Boston University School of Medicine, the American International Health Alliance (AIHA), and the Armenian Ministry of Health. This center served as the first and the model for a system of centers that grew to number 16 throughout the former Soviet Union. Under Dr. Virabyan’s direction the center grew to serve all of Armenia in Emergency Medical Services (EMS), Emergency Medicine, and Disaster Medicine training. As the first and model center for the AIHA network of training centers, Dr. Virabyan’s center received numerous awards and accolades for cutting-edge Emergency and Disaster training. From 1994-2002, the center trained nearly 10,000 students and hosted a number of international conferences and training sessions. Under the leadership of Dr. Virabyan, the Yerevan center became the flagship center of the American International Health Alliance network, and was featured prominently in its advertisements and website.
Dr. Anushavan Virabyan continues to serve Armenia as one of its leaders in the medical field, and a pioneer in the fields of Emergency and Disaster Medicine. He has written over 20 published papers and continues to teach young medical students and residents. He was recently appointed Vice President of the Armenian Ambulance Association and helps to drive policy through that position. Armenian history will show that through Dr. Anushavan Virabyan’s forward thinking and advanced training programs, he pioneered the establishment of the fields of Emergency Medicine and Disaster Medicine, revolutionizing the way Emergency care is provided in that country.
Sam Moody
Sam was born in London and lived in Essex, enjoying a life in Music during school and college there. He made the decision to enter medicine late and now studies at the University of Manchester, after completing a foundation year for widening access. He is currently fourth year.
Last year he took a year out and intercalated, gaining a BSc in Tropical Disease Biology from the Liverpool School of Tropical Medicine. Although his research focus was on the laboratory growth of filarial parasites, it was there he found a way to begin accessing the sphere of humanitarian medicine, and could begin to further his interest in the structure of humanitarian response and disaster/tropical medicine. He is currently helping to organise a conference on Health in Humanitarian Settings at the LSTM, and is beginning research with members of the HCRI in Manchester. He hopes to enter the world of humanitarianism after FY1/FY2 years.
With the most extreme of medicine conference fast approaching we have been inudated with requests for group tickets – which offer superb value and these are now available at the base of the order form
4 FOR THE PRICE OF 3
Conference app now available for iPhone
The conference will deliver 4 days of CME-accredited knowledge, insight and innovation in the field of remote medicine and sub-disciplines: expedition and wilderness medicine, pre-hospital medicine, and disaster and relief medicine. Delivering these messages will be speakers who are the global leaders in remote extreme medicine, ideally placed to provide expert knowledge transfer to delegates.
Developed specifically with medical professionals in mind, the International ‘World Extreme Medicine’ conference and EXPO will also be of interest to other medical specialists (nurses and paramedics) and as well as for students all with discounted rates
