A Course in Polar Medicine, New Zealand
Author: Petronella Watson
University of Otago, Wellington, Mein St, PO Box 7343, Wellington South 6021, New Zealand.
Correspondence to Petronella Watson, [email protected]
“the Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence.”
Ethics approval: NA.
In July 2011, Queenstown welcomed the course participants with a bitter winter storm: minus 14 degrees, a heavy snow fall, flight cancellations and road closures. This was the second big snow fall of the winter and we were thankful to arrive safely at the Lodge set high on the Pisa range to enjoy good food and great company. Course convener Dr Simon Dalton and the other staff (Dr Sean Hudson, Dr Dick Price and Mr Simon Murfin) welcomed participants to the course, and kicked things off with an introductory lecture on polar medicine and standard operating procedures.
After an early night everyone was ready to acquire the practical skills required for life in this cold environment. We started off with an introduction to snowmobiles – the mechanics, recovering stuck machines, riding and rescue techniques. After a while confidence and doughnuts, grew dramatically, until our arms were exhausted. Then we moved onto the care and use of dogs as a means of transport. Local enthusiasts introduced us to their packs and discussed general care and handling (not to mention some of the dog sledding journeys and races which they had competed in). We each took the dogs for a run by ourselves, gaining an appreciation for the affinity so many polar explorers, scientists and locals have for the enthusiastic Husky and Malamute.
In the evening we had an informative and inspiring talk on hypothermia, cold water immersion and frostbite – tales from the reaches of Everest’s summit to Scott Base and lonely polar research boats. The session covered recognition and management of these important conditions as well as their underlying pathophysiology and an overview of the limitations imposed by the wilderness environment. We then proceeded to hear much more about Dr Dick Price’s amazing life and career; from hair-raising mountain rescues to idyllic igloo building with his son.
Another beautiful dawn brought with it cross country skiing and an overview of the history and development of skiing as a sport and means of transport. Great practice for what was to come! Another half day was spent on navigation techniques in the often confusing white cold landscape. We also had introductions to the principles and practice of fire lighting and snow caving. Evening lectures covered altitude related illness and pre-expedition planning.
Wednesday brought preparation for our own fast approaching overnight expedition. We covered some practical scenarios, wilderness resuscitation, avalanche safety as well as transceivers and communications. The afternoon brought tutorials in stoves, shelter building and a briefing for our trip. We rounded off the day with a movie on Shackleton’s amazing Antarctic adventure and later that evening guest speaker Marcus Waters described some of his expeditions kayaking in the Antarctic Circle and skiing across the Greenland ice sheet – a real eye opener to the realities of Polar travel.
As the sun rose again and the skies changed from black to purple and pink to blue, we picked up our skis, fully prepared for an overnight expedition out into the wilderness. The morning was spent passing through iconic Pisa Range valleys, and quite a few spills and tumbles. We eventually made it to the selected spot for a late lunch and then shelter building. The afternoon was spent jumping, shoveling and carrying until quinsy’s, igloos and snow caves were fitted out with all our kit. After soup, pasta and chocolate for dinner, Dick set off some celebratory fireworks and a surprisingly comfortable, warm sleep was had.
Yet another fresh clear day followed, and after jumping on our snow cave (just as one delights in destroying a sand castle, except with notably more effort) we packed our bags and skied back to the lodge. At the lodge, there was a rush for the showers, but by lunch time everyone was enthusiastically chatting about their snow cave experience.
As we glumly packed our bags, and pulled out the expedition handbook for reading on the bus back to Queenstown, we reflected on the week. Certainly for most people the course taught much about survival in cold and remote areas. Another important aspect of the week was the camaraderie generated between participants. I’m sure the newly struck friendships will continue for many years to come.
Further information on Expedition & Wilderness Medicine UK’s CME approved courses for medical professionals may be found here
Polar Medicine; A Cold Weather Medical Training Course
The setting for this year’s polar medicine training course was Alta, a small settlement, 72 degrees north and well within the arctic circle. A place with a deserted high street where you would be lucky to see one other passer by every 15 minutes, easily explained by a temperature at least ten degrees below freezing and a good foot of snow on the ground.
Base camp was a 40 km drive along icy roads to a picturesque mountain lodge by the name of Ongajoksetra. At the higher altitude the temperature was that much lower and if a wind was blowing, temperatures as low as minus fifty could be achieved. We were introduced to the Scandinavian team who would teach us methods of navigation across such tough terrain in harsh conditions and also to the Expedition Medicine team who would teach us polar medicine in a series of lectures and practical sessions both in the classroom and in the field. One more group I must not forget to mention is the team of fifty sled dogs who would provide another mode of transport across the snow.
My first day involved skidooing up a mountain demonstrating the importance of protective clothing, navigation aids and preparation for travel in severe blizzards with visibility of approximately two metres, sudden drops in temperature and rapid weather changes. I realised that without our trustworthy guide, Espen Ottem, we could become hopelessly lost in such conditions where you would be unable to survive more than a couple of hours at most. Our dog sledding guide, Pre-Thore was the perfect example of this as he told us of the time where inadequate preparation resulted in frostbite, blackening of his fingertips but fortunately no amputation. This story made me somewhat paranoid about the daily pain and numbness in my hands and feet when outside in the cold for prolonged periods. A “buddy system” was paramount to preventing frostnip. Simply by having that small exposed area of skin, pointed out to you to cover up
Dr Leslie Thomson, a consultant anaesthetist who had first – hand experience of polar medicine after spending several years in Antarctica taking part in the British Antarctic Survey gave an excellent lecture on hypothermia, bringing home how hypothermia is not just a condition seen near the poles but also in the Saturday night party goer who collapses under the stars, the homeless and the elderly. We were taught how to treat by various re-warming methods and when to commence C.P.R in the hypothermic patient sending home the message of not pronouncing death until warm and dead in certain individuals. This information was demonstrated by the story of Dr Anna Bagenholm , a 29 year old doctor who fell into icy water whilst skiing in Northern Sweden, immersed for approximately an hour, her body temperature was 13.7 degrees centigrade. C.P.R continued for three and a half hours alongside re-warming techniques such as bypass, bladder / stomach / peritoneal lavage and warm intravenous fluids. She survived to become the person with the lowest body temperature ever to survive.
Expedition and Wilderness Medicine obviously feel that first- hand experience is the best way of teaching and as a result each member of the group had to undergo cold water immersion. Prior to undertaking this challenge we were kindly taught about the cardiac arrhythmias that can be induced by the shock of entering the water, the short term cold water gasp reflex increasing the chance of aspiration and swimmers failure! One by one we stepped up to an ice hole in our thermal underwear and in the more daring members of the group a little less! to swim across icy water. I can confidently say that was the coldest I had ever been. As if several knives had been plunged into my body, breath taking and inducing chest pain, I swam across water of ridiculously low temperature to attempt getting out of the hole using my ski poles
Of our nights spent in the field we were taught how to construct snow holes. Five hours later our own little home with two double beds, stove, cupboards and shelves for our candles was constructed. It was as comfortable as it could be on a mountain side with winds blowing outside dropping the temperature to twenty below. I was amazed that the snow hole was so warm at five degrees compared to the outside however a slight air of nervousness was in the back of my mind as my avalanche detector slowly flashed in the corner and a rope attached to a spade inside connected our holes to other holes in case of us having to be dug out. The course perfectly demonstrated how to survive in such conditions
In summary the course prepared 25 everyday doctors to be able to traverse the polar landscape, recognise and competently treat local cold injury and hypothermia as well as to be safe expedition medics capable of caring for their groups and evacuating when required. To spend a week in such a location gave me the upmost respect for those who live in these regions and cross the landscape as part of everyday life, as well as a great respect for the land. In a day and age of global warming and melting of the polar ice caps it becomes paramount to look after our environment, to take only photographs and to leave only footprints.
Dr Claire Roche, Clinical Fellow in Emergency Medicine Countess of Chester Hospital. See the BMJ article.
The next expedition medicine course will be in Desert Medicine Course which will be held in Namibia, August 17th -23rd 2008.
To see the full range of Expedition and Wilderness Medicine Training Courses see here.