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A Call to Arms for all Extreme Medics!

WEM Marketing DeptExtreme medicineNo Comments, ,

Medics.

Mavericks.

Fighters.

An invisible enemy is at our gates.

And with it, the single greatest global humanitarian crisis in a hundred years. 

History reminds us that those fearless women and men who came before us withstood the spearhead of disease, facing it on the field at greater disadvantage than we do today.

They lacked the resources, knowledge, understanding and communication that we do now.

They fought an invisible enemy, blind and in darkness.

Yet – in that darkness, armed with courage, perseverance and unyielding community they sparked a light.

They fought tirelessly. They fought fearlessly. They fought together.

Light bloomed.

And humanity thrived.

Their monumental efforts armed and prepared us better than we could ever have hoped.

Because not only do we possess that self-same fearlessness, tirelessness and togetherness –

But their battle armed us with resources, knowledge, understanding and the most powerful weapon in our arsenal – our secret weapon – instant communication on a global scale.

And we’ve learned to wield that weapon with unyielding dexterity.

We will harness it, together with our fellow medics around the world, to do our part and help illuminate the path to victory.

WEM’s tactics have, therefore, adapted…

All courses are postponed until further notice.

Those men and women are needed elsewhere right now.

Instead, we will turn our undivided attention to the heroic front-line troops; arming them with freely available online content, including training resources and invaluable tools, provided by leading experts across multiple disciplines that form the ranks of extreme medicine.

Over the weeks, we will stock our WEM Academy and WEMcast armouries with potent video and audio podcasts that focus on mental health, resilience, psychological impacts, human factors, leadership and self-care – each inspired by countless successful expeditions to remote locations, survival in extreme environments and accomplishments during humanitarian crises.

Share your voice.

Sharing real-time situations can have a huge successful result

We understand that not many will have time to do this, but if possible, please share your stories, your encouragement and your expertise – when you can, however you can. Your insights and inside experiences, whether deep behind the lines, treading the trenches or supporting from the rear, will help to rally and bolster the resolve of those who need it now more than ever.

Instructions on how to share will be announced soon.

WEM20 ‘Inspiration Beyond the Ordinary’ will proceed as planned.

While it remains sensible and safe to do so.

Dynamic Earth in Edinburgh will still play host to #WEM20 from 17th – 19th October 2020. We will monitor the situation as it evolves and take necessary action if required. But, right now, we remain steadfast that you will get to benefit from our epic line-up of speakers and workshops – so long as it remains safe.

This pandemic only fortifies the vital importance of the World Extreme Medicine Conference; a place where the experiences shared are never ordinary, and the lessons learned are always extraordinary.

Right now, through communication and collaboration, we can wield the power of humanity to its extreme, protecting our friends, our families and all humankind from threat.

We will bring this war into the light.

And we will defeat it as one.

Mark Hannaford
WEM Founder & Honorary Associate Professor,
University of Exeter Extreme Medicine Program

NEW WEMcast episode: Eoin Walker and Will Duffin on Coronavirus Part 2: COVID-19 Discussions. Perspectives, Protection and Positive Mindsets

NEW WEMCast episode: Eoin Walker and Will Duffin - CoronavirusIn our latest podcast, Eoin (WEM Trauma Lead) and Will (WEM Education Lead and Conference Content Director) consider the potential impact of the Covid-19 pandemic on healthcare services, how this may force us to adapt and innovate, and contemplate the differing impacts this is having on their roles as a Paramedic and a GP.

The pair also discuss how we can apply tips, tricks and lessons learnt from working in remote and extreme environments to the current pressures facing the NHS.

Improvise, Adapt and Overcome – that’s what it’s all about!

Listen, share and let us know your thoughts! > https://bit.ly/2xIVGQd

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Team Rubicon - Paul Taylor

Team Rubicon UK – Hurricane Dorian Response

NickExpedition & Wilderness Medicine, Extreme medicine, Pre-hospital Care, Remote medicineNo Comments, , , ,

“Looking down at the devastated landscape from the window of a small plane I felt those familiar senses of anticipation and responsibility”.  Team Rubicon UK.

Anticipating the effects of a category 5 hurricane on the population of a small Caribbean Island, and the responsibility for another five teammates landing on a remote airstrip which had recently seen a plane emptied of its cargo at gun point.

Hurricane Dorian passed over Abaco Island in the Bahamas on the 1st September 2019 as a category 5 Hurricane with sustained windspeeds of 295 KPH, before passing over the island of Grand Bahama where it stalled, intensifying the magnitude of the devastation. Imagine being in a house by the sea, whilst being battered by winds, with the power to rip the roof of your home clean off, and within the eye of the hurricane, where mini tornadoes or twisters are picking up everything that isn’t bolted down and dispatching items as large as cars randomly across the landscape. If that isn’t enough to contend with, then there is the storm surge (in effect a mini tsunami), which in this instance was a 20-foot wall of water immediately inundating homes and forcing people to escape onto their roof, or be swept away – to either drown or cling for survival to the detritus within the flood waters (I spoke to a man who had clung onto a floating refrigerator for 14 hours).

The Team Rubicon UK team landed at Treasure Cay airstrip to a scene of utter chaos. The local population surrounded our small plane seeking a way off the island as we unloaded our personal equipment and sought some much-needed situational awareness from a Bahamian police officer.

In situations like this I’m often asked, ‘Where do you start?’ and I think back to a mantra I developed during the Nepal earthquake in 2015, when assisting the community at the epicentre of the quake that was that ‘you can’t help everybody but you can help somebody’. This has worked for me thus far and helped me come to terms with the enormity of some of the events I’ve witnessed. It also chimes with the idea of ‘shrink the change’ in that the way to solve a big problem is often a succession of smaller solutions. We were about to become one of those smaller solutions as in return for loading a truck with aid we had hitched a ride on the back and found ourselves driving towards a devastated resort, which had a small clinic where people had sheltered from the hurricane and was now being used as an aid distribution point. A detachment from the Royal Bahamian Defence Force were providing security and as we unloaded the first consignment the team headed back to the airstrip for another load to leave Lizzy (my second in command) and I to work out next steps. No sooner had they left than we rushed to the assistance of a man who had fallen into a diabetic coma. A less immediately apparent consequence of these events is that the affected population often lose everything, which includes medication and details of prescriptions. In this instance the casualty was evacuated by helicopter to Nassau and it was a successful outcome.

Having established a forward operating base our team pushed out on foot to identify affected communities and assess their needs. This information gathering is always the first phase of our operations and once fed into the coordination mechanism it leads to a more effective distribution network. One of our concerns here was for the Haitian population, who were reticent to engage with humanitarians owing to their legal status on the island. They had initially been invited over to work on a government farm in the 1950s but since then a number of shanty towns had developed, which were housing people either living on Abaco illegally or using it as a staging post to the USA. One has only to reflect on the current political situation in Haiti to appreciate why Haitians would flee from their home shores (post-disaster a fishing vessel packed with migrants ran aground off another Bahamian islands and the passengers fled into the relative safety of the expatriate community). We enter into the uncertainty of these events with the humanitarian principles of humanity, impartiality, neutrality and independence as our guiding handrail and aid must be distributed to those most in need. In my experience people sometimes need a literal and metaphorical hand up and to realise they are not alone in confronting the task ahead. Humanity is critical and I have seen something as simple as a hug unlock an emotion that has been stored inside since the disaster struck. Lizzy had one of these moments with a man who had lost his wife and children and was contemplating taking his own life. I hope the humanity of her action averted that course and he has lived on trying to make sense of it all.

During our time in the Bahamas Team Rubicon UK distributed 142 tonnes of humanitarian aid to 68,224 beneficiaries. We have now returned back to the UK and are engaged in ways we can continue to support the people of the Bahamas as they both recover from this disaster and plan for the unfortunate occurrence of yet another.

Paul Taylor, Team Rubicon UK.

Interested in developing a medical career in Disaster & Humanitarian Medicine?

  • The annual WEM Conference features some of the world’s leading speakers and as well as a host of worthwhile and relevant workshops.
  • The University of Exeter Medical School MSc in Extreme Medicine allows for a modular study program as well as offering full-time and part-time study.
  • WEM’s Ethiopia Humanitarian & Expedition Medicine course gives a experiential introduction into what it means to be a humanitarian medic.
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Paediatric Blast Injury Field Manual

Release of the Paediatric Blast Injury Field Manual

NickExpedition & Wilderness Medicine, Extreme medicine, Paediatric Care, Pre-hospital Care, Remote medicine, ResearchNo Comments

A few months ago on the mainstage at #WEM18, Medical Historian Dr Emily Mayhew discussed her work alongside Save the Children, Imperial College London and a host of medical and operational experts in the creation of a new Paediatric Blast Injury Field Manual. 

The Manual, intended to be a comprehensive guide for local medical teams who are forced to operate on and treat children in remote environments and with limited training and resources, is the first of its kind to focus on paediatric blast injury from the point of wounding right through to the discharge of the patient from hospital, and beyond.

Last week witnessed the culmination of this fantastic team effort as the Manual was made available to the public. We caught up with Emily to see what she had to say about the release…

“I first spoke about the plans for our Paediatric Blast Injury Field Manual at WEM’s conference in 2018.  The interest and expert feedback I received from the WEM audience was really important in encouraging us to move forward with our concept of a Field Manual that could be used by all medical staff likely to encounter children injured by explosives – an incredibly challenging patient cohort.  We hope the result will be used by both medics and those who are required to plan for the treatment of severely injured children, in terms of resources, training and equipment.

We’ve produced the Field Manual to support medics with technical information that helps them adapt their existing knowledge to the needs of children and also to provide confidence in what can be a very difficult moment for even the most experienced teams.  We’ve incorporated sections on safeguarding, futility and psycho-social support – for the patients, their families and caregivers, and for the medics themselves who do this work.  

We hope it will be useful.  Please pass it around and come and find me at #WEM19 to share your thoughts”. 

***

Why is this Manual needed? 

It is estimated that today, a fifth of children worldwide live in areas affected by conflict. This equates to approximately 420 million children living in conflict zones (Save the Children define this as an area within 50km of where one or more conflict events took place in a given year). Children living in these zones face an increased risk of injury as a result of explosive weapons, as well as a shortage of equipment and specialist knowledge when treating such injuries.

The Paediatric Blast Injury Field Manual is a durable, easy-to-use tool intended to bridge this gap, providing medical staff with the information needed to help make complex decisions about paediatric care.

 

The Manual is now available to download FREE from the Imperial College website.

Dr Mayhew will be at the World Extreme Medicine Conference in Edinburgh later this year and would love to hear your thoughts – grab your tickets here! 

 

 

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Expedition Medicine: Frequently asked Questions (FAQ’s)

Expedition Medicine: Frequently Asked Questions (FAQ’s)

WEM Marketing DeptExpedition & Wilderness Medicine, Expedition Medicine, Extreme medicineNo Comments, , ,

We asked our remarkable WEM faculty, many of who have a depth of experience, living and working in the most remote corners of the world, achieving notable success in the face of extreme challenge and adversity the most frequently asked questions they get asked regarding the iconic WEM Expedition Medicine Course.

What content do you cover in the Expedition and Wilderness Medicine course?
This comprehensive  foundation course covers a broad range of topics over the course of the 4 days of expedition medicine blending engaging lecture content with hands on practical workshops ending on the last day with a real-time search and rescue simulation. Attending the course will teach you the key skills essential to all expedition medics including:

  • Pre-expedition planning
  • Security on expeditions
  • Climate specific lectures
  • Group management, behaviour and CRM
  • Expedition dentistry
  • Mental health on expeditions
  • Hill skills
  • Wound care

Are these courses just for doctors?
No, expedition medicine opportunities are open to a wide range of medical professionals although doctors, nurses and paramedics are the most common roles advertised for. The good news is this list is growing as the range of practitioner roles within healthcare grows. We have also found that as the expedition world evolves and groups with more complex needs are commonly taking part in expeditions, the range of healthcare providers required can be incredibly varied.

Do I need experience?
No experience required, you’ll find on the course there is a huge mix of people with various degrees of expedition and travel experience. Throughout the course we’ll be discussing what skills are needed to build and make yourself a great expedition medic, but above all a great expedition team member or even leader. All we ask from you to really gain the most from this experience is a positive mindset and a thirst for adventure.

Do we get outside much?
Absolutely, we try and spend half the day outside so we can replicate real-life expedition conditions as much as possible. Typically this is come rain or shine, adverse conditions are all part of what makes expedition medicine so exciting, splinting a leg while dealing with soggy boots, soaking wet waterproofs, mud, driving rain, wind and on uneven ground is great fun…there again it could be lovely sunny t-shirt weather, you never can predict these things in the mountains. It’s uncommon to get enough time to stray too far into the hills so we suggest that people add another day or two to really enjoy the local environment. Plas y Brenin for example has a view of Snowdon from the bar and dining area, with the mountain in view it would be a shame not to set a few hours aside to get up there.

I’ve got a trip planned; will we be able to discuss it?
Yes, absolutely it’s actively encouraged and part of what are highly experienced faculty are here to help you with! We encourage as much interaction as possible; you can ask questions at any time and workshops session are highly interactive. Our team is with you all week and are always happy to chat about upcoming adventures, we find that breaks and meals are a great time to sit down and chat with the team about your plans.

If you want to open up your medical career and mix adventure into your career then this Expedition Medicine course is for you!

To find out more information about our Expedition Medicine courses or to book your place on what we promise will be an incredibly inspiring few days, please click here.


Other blogs that may be of interest, include:


Interested in diving even deeper?

 

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HEMS Team Nepal

Heli-Rescue operation in Chitwan National Park, Nepal

Nickexpedition, Extreme medicine, Mountain, NepalNo Comments, ,

On April 8th 2019, a rhinoceros charged into a group of 3 tourists and 2 guides in Chitwan National Park, injuring a young Australian tourist. It quickly became evident that surgery would be needed to deal with the injuries, but the remote location (the national park is located 150km southwest of Kathmandu, capital of Nepal), meant that providing medical care would be tricky.

Luckily, a rapidly evolving HEMS team was able to provide assistance and ensure the effective treatment of those involved.

This is the story, as told by Dr Sanjaya Karki:

The rhinoceros injured an 18-year-old Australian male, biting his right thigh and striking him several times over his chest, abdomen and left leg. One of the guides, a 51-year-old male, intervened and he too was struck on his chest by the agitated rhino.

The rhino fled after the intervention, and the guides called local security personnel and local health workers. The injured were carried to safety inside the forest itself and the wounds were tended to. They called Simrik Air, a helicopter operator active in rescue services in Nepal, to request the evacuation of the injured. In light of the severity of injuries, the operator requested that the helicopter emergency medical service team of Nepal Mediciti Hospital assist with the rescue and provide necessary medical help. Nepal Mediciti Hospital and Simrik Air have collaborated for multiple successful medevac and rescue missions throughout the years.

The craft used for this mission was Bell 407GXP, call sign 9N-ALT, piloted by Captain Siddhartha Jung Gurung.

Soon after the information was collected from the dispatch centre, the medical doctor at the pre-hospital care department started to gather the best possible information from the ground. Within just a few minutes, the message was sent to the respected departments and with all the required equipment and gear, the team went up in the helipad.

The helicopter reached the exact location of the injured 25 minuted later. The team got to work immediately, with onboard medics from the HEMS team of Nepal Mediciti Hospital, Dr Abhijit Adhikary and Paramedic Ekadev Neupane stabilising the patients on-site before bringing them safely back to the hospital. The patients needed splinting of injured limbs, pain management and fluid resuscitation. One patient was placed on a mattress and the next was on a scope, and both patients were fitted with a monitor looking for vital signs throughout the journey.

On arrival at the ER, further lab investigations and imaging were completed. The young Australian tourist was diagnosed with a comminuted fracture of shaft of the right femur with multiple deep lacerations. He was admitted and surgeries were carried out in multiple settings. The Nepalese guide was diagnosed with left-sided minimal hemopneumothorax, and was conservatively managed. Both the patients are recovering well in the hospital.

***

Collaborations between helicopter operators and Hospitals, like in this instance, have contributed to better patient outcomes in recent years. In Nepal, the first helicopter was introduced in 1964. Today, the HEMS team in Nepal now have more than 10 helicopter operators and over 30 helicopters. These helicopters are an essential part of pre-hospital care in Nepal as many areas are inaccessible via road and the vast majority of the terrain is mountainous or hilly.

Dr Karki stated that the medical evacuation was a  “glowing example of how HEMS has advanced in Nepal”. 

***

Sequence of events:

11:31 am – Call received from the Helicopter operator Simrik Air.

11:36 am – Call back made to Simrik Air confirming our preparedness.

12:26 pm – Helicopter landed in Nepal Mediciti Helipad and HEMS team dispatched.

12:50 pm – First contact made with the injured on-site.

13:22 pm – Take off after initial stabilisation, pain management, splinting and fluid resuscitation of the patients.

13:55 pm – Patients brought into the ER.

 

***

This incredible tale was highlighted by Dr Sanjaya Karki, former winner of the David Weil Extreme Medicine Award.

 

Other blogs that may be of interest, include: 

Winners of the ‘David Weil Extreme Medicine Award’ (DWEMA) 2014. 

 

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EWM’s Wild Medicine Course Changed our Lives

MCSAfrica, CME, CME Training, cme travel, CME Travel, Conservation Medicine, Desert Medicine, Expedition & Wilderness Medicine, Expedition Doctor, Expedition Medicine, Expedition Nursing, Extreme medicine, International Extreme Medicine' Conference, medical training course, namibia, Pre-hospital Care, Remote medicine, Trauma and Hostile Medicine, Travel, travel doctor, travel medic, Wild Medicine, Wilderness and Environmental Medicine, wilderness medic, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Society, Wilderness Medicine Training, WMS, , , , , , , , , , , , , , , , , , , ,

We know that education opens doors and as the EWM crew are both interested and a bit nosey, we love to hear what our alumni get up to after attending our courses.  Naturally then, we were delighted to hear from Ian P, who told us he and his wife loved the 2013 Wild Medicine course so much, they’re busy packing up in the UK and moving to Namibia…

Not many things you can say that change your life!  Attending the Wild Medicine course was one of those events.  Amazing set of people and a fantastic opportunity to learn about conservation and desert medicine.  

The kind of odd things we learnt…
– Take blood from a cheetah,
– Learn about (and touch – optional) many poisonous snakes,
– Sleep in a desert,  walk 14km through a dry river canyon,
– What are the problem animals with Rabies? (A: Kudu),
– How can carnivores live outside conservation areas & not get killed by farmers &
villagers?
– How to build a vineyard in a desert … what?!.. 

And the thing that changed our lives? Meet the Bushmen and see their need for healthcare!  My wife and I are volunteering at Naankuse to run the Bushmen medical services. The real thing we learned? There are many people out there that can benefit from our skills … 

Oh and by the way Namibia is amazing you get to see loads … but you can also get a 4×4 and do a week or so trip before the course.

 

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Needed: Medical Professionals to support Fundraising Marathon

MCSAfrica, CME, CME Training, cme travel, Extreme medicine, Jobs in Expedition Medicine, marathon, Wilderness Medicine, , , , , , , , , , , , ,

 

street child logoSTREET CHILD are looking for assorted medics and also a Medical Director* to provide cover for this fundraising event in the world’s 10th poorest country and help improve the lives of vulnerable children in West Africa.

**** POSITION NOW FILLED *****

The Street Child of Sierra Leone Marathon 2014 is an ambitious project and we need medical help to stage it.   It’s more than just a run.  We invite runners to join Street Child in Makeni, Sierra Leone to see and assist with the work we do in country, and to get involved with the local community.  All of this takes place in a developing country with a basic medical infrastructure.

The race covers tough but beautiful terrain, invariably with high temperatures and humidity.  The route is classed as a category “black” marathon – a marathon where serious consideration should be taken to safety provision.  For this reason medical support is vital.  Over the last 2 years, under the guidance of the Medical Director, groups of medical professionals from across the world have travelled to Sierra Leone to help out.  When joined by local medics and nurses, mining corporation paramedics and medical students, this team have provided essential cover to the marathon.  More importantly, previous teams can testify that they have have had an amazing adventure, providing a great talking point for grand rounds on their return!

Most of the action for the medical team takes place on race day, where teams set up makeshift medical stations around the course, providing first line medical care to the runners.  This is co-ordinated from Medical HQ, the headquarters for ongoing treatment, and communication centre to each of the medical stations.

Sierra Leone is very much a developing country – supplies and equipment are limited and expertise is varied.  This is a challenge, but one worth taking on.  Outside of race day, the medical team will be involved in procuring equipment, medical briefings to international runners, and manning clinics offered to local runners on registration day.  Another important job for the team is spending time chatting to the runners before the race, providing reassurance and advice, usually over a local beer!

We would like people who like the sound of this event to travel out to Sierra Leone for between 1 and 2 weeks to help us organise the 2014 Sierra Leone Marathon.  We do ask that you fund your own trip (flights and accommodation only, all transport and meals will be free) but in return we will give you your own ‘experience of a lifetime’ seeing and assisting with Street Child projects in urban and rural Sierra Leone, taking part in a week of festivities in Makeni and you still get to finish on a high joining our West African beach party and 2 night beach hut retreat!

Dates are pretty flexible, the marathon is on Sunday 25th May so an 8 day trip could fly Wed 21st May and return Wed 28th May 2014.  Direct 6 hour flights from London are available from Gambia Bird Airlines and BA.

For more information, photos and videos please look at www.sierraleonemarathon.com and www.facebook.com/sierraleonemarathon.

To enquire or apply please send your details to [email protected]

 *For applications to the role of Medical Director, the role will be to provide leadership and direction to the medical team.  A return flight from London will also be provided.  Minimum dates Mon 19th – Wed 28th May 14.

Of Interest

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Dr Luanne Free Mountain Medicine leader featured in Smithsonian article

MCSAcute mountain sickness, CME, CME Training, Dr Luanne Freer, Everest, Everest Base Camp, Everest Base Camp Mountain Medicine CME, Expedition & Wilderness Medicine, Expedition and Wilderness Medicine Facualty, Expedition Doctor, Expedition Medicine, Extreme medicine, Khumbu Valley, medical training course, mountain medicine, Nepal, travel doctor, Wilderness Medicine, , , , , , , , ,

Dr Luanne Freer, leader of this years Nepal CME accredited Wilderness Mountain Medicine course in Nepal, has been written up in a brillant article on the illustrouis Smithsonian website in an article entitled ‘Inside the ER at Mt. Everest’ by Molly Loomis.

A middle-aged woman squats motionless on the side of the trail, sheltering her head from the falling snow with a tattered grain sack.

Wilderness Medicine

Find out more about Mountain Medicine in Nepal

Luanne Freer, an emergency room doctor from Bozeman, Montana, whose athletic build and energetic demeanor belie her 53 years, sets down her backpack and places her hand on the woman’s shoulder. “Sanche cha?” she asks. Are you OK?

The woman motions to her head, then her belly and points up-valley. Ashish Lohani, a Nepali doctor studying high-altitude medicine, translates.

“She has a terrible headache and is feeling nauseous,” he says. The woman, from the Rai lowlands south of the Khumbu Valley, was herding her yaks on the popular Island Peak (20,305 feet), and had been running ragged for days. Her headache and nausea indicate the onset of Acute Mountain Sickness, a mild form of altitude illness that can progress to High Altitude Cerebral Edema (HACE), a swelling of the brain that can turn deadly if left untreated. After assessing her for HACE by having her walk in a straight line and testing her oxygen saturation levels, the doctors instruct her to continue descending to the nearest town, Namche Bazaar, less than two miles away.

Freer, Lohani and I are trekking through Nepal’s Khumbu Valley, home to several of the world’s highest peaks, including Mount Everest. We are still days from our destination of Mount Everest Base Camp and Everest ER, the medical clinic that Freer established nine years ago, but already Freer’s work has begun. More than once as she has hiked up to the base camp, Freer has encountered a lowland Nepali, such as the Rai woman, on the side of the trail ill from altitude. Thankfully, this yak herder is in better condition than most. A few weeks earlier, just before any of the clinics had opened for the spring season, two porters had succumbed to altitude-related illnesses.

Each year over 30,000 people visit the Khumbu to gaze upon the icy slopes of its famed peaks, traverse its magical rhododendron forests and experience Sherpa hospitality by the warmth of a yak dung stove. Some visitors trek between teahouses, traveling with just a light backpack while a porter carries their overnight belongings. Others are climbers, traveling with a support staff that will aid them as they attempt famous peaks such as Everest (29,029 feet), Lhotse (27,940 feet) and Nuptse (25,790 feet). Many of these climbers, trekkers and even their support staff will fall ill to altitude-induced ailments, such as the famed Khumbu cough, or gastro-intestinal bugs that are compounded by altitude.

A short trip with a group of fellow doctors to the Khumbu in 1999 left Freer desperate for the chance to return to the area and learn more from the local people she had met. So in 2002 Freer volunteered for the Himalayan Rescue Association’s Periche clinic—a remote stone outpost accessed by a five-day hike up to 14,600 feet. Established in 1973, Periche is located at an elevation where, historically, altitude-related problems begin to manifest in travelers who have come up too far too fast.

For three months, Freer worked in Periche treating foreigners, locals and even animals in cases ranging from the simple—blisters and warts—to the serious, instructing another doctor in Kunde, a remote village a day’s walk away, via radio how to perform spinal anesthesia on a woman in labor. Both the woman and the baby survived.

Find out more about the  Nepal CME accredited Wilderness Mountain Medicine course in Nepal attendance of this course will count toward a FAWN degree.
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International 'World Extreme Medicine Conference & Expo' – London 2012

MCSCME, CME Training, Expedition & Wilderness Medicine, Expedition Doctor, Expedition Medicine, Extreme medicine, International 'World Extreme Medicine Conference & Expo', Wilderness and Environmental Medicine, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Society, , , , ,

International Extreme Medicine EXPO-  Expedition & Wilderness | Tactical | Disaster Medicine

‘Taking Medicine To The Extremes’

A major new International ‘World Extreme Medicine conference and EXPO’ series with the first inaugural event in London  April 2012 followed by Salt Lake City in September 2012 with the very best speakers from around the world, leading figures from the world of expedition and wilderness travel, displays from focused industry leaders and also awards. All CME accredited on a modular basis to allow you select just a day or to attend the entire medical expo. 

Over the last ten years the care of casualties in a remote environment has come a long way. This has been driven by conflict, the apparent exponential rise in natural disasters and our capacity to respond on an international scale and not least by the evolving interest in the field of expedition and wilderness medicine. The conference concept was generated out of a desire to amalgamate the associated specialties in this field and to share the skills and knowledge we have acquired. It will run over 4 days and involve some of the major specialists in their field of remote and austure medicine.  

Developed specifically with medical professionals in mind the International ‘World Extreme Medicine EXPO’ will also be of interest to other medical specialists and students for which there will be a discounted rate.

To pre-register your interest for ‘Extreme Medicine’ email us here.

Extreme Medicine Conference and Expo

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Treatment of Cholera in Active Malaria Zone

MCSCME Travel, expedition, Expedition & Wilderness Medicine, Expedition Doctor, Expedition Medicine, Extreme medicine, Jungle medicine, medical training course, Pre-hospital Care, Remote medicine, Travel, travel doctor, travel medic, Wilderness and Environmental Medicine, wilderness medic, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Training, , ,

The treatment of cholera in an active malaria zone is a difficult matter.  This is especially true with lessons being learned in Haiti and their recent cholera outbreak.  I am specifically referring to the combination of Chloroquine (antimalarial) and the antibiotic class Macrolides (used in treatment of cholera).  A post that I made back in 2009 has new recent relevance and I wanted to repost that here:

Azithromycin, Chloroquine and Arrythmias:

Travel medicine frequently uses medicines that are taken under special circumstances and for short periods of time, like a trip.  Many travelers carry an antidiarrheal antibiotic on their trip and a common choice is azithromycin.  This can potentially be a problem when they are also traveling in a malaria area and using chloroquine for prevention.  Two very commonly used medicines chloroquine (antimalarial) and azithromycin(macrolide antibiotic used for respiratory infections and diarrhea) both have wonderful safety profiles, individually.  However when taken together, there is discussion of the chance of a heart arrhythmia, specifically prolonging the QT interval.  In fact, my software I use for prescribing cites this as a combination to avoid.

 

There are several important articles that can be used to look at this problem and evaluate the risks.  One very good paper looks at medications that prolong this QT interval:

These authors list azithromycin as a “very improbable” medication, although other macrolides are listed as higher risk.  Chloroquine is listed as an “Unknown” medication, with respect to prolongation of QT interval.  This article was based on expert opinions.

  • “Azithromycin/Chloroquine combination does not increase cardiac instability despite an increase in monophasic action potential duration in the anesthesized guinea pig” by Fossa, et al.

This study looked directly at this problem, in animal models.  Their research showed no increase in arrhythmia risk.

  • “Lack of a pharmacokinetic interaction between azithromycin and chloroquine” by Cook, et al.

A wonderful article that is actually helping to look at using this drug combination to treat resistant forms of malaria.  More about this combination and treating malaria here.  Their study did show an increase in the QT interval in both groups of those who received chloroquine alone and those who received the combination of chloroquine and azithromycin.  This QT interval increase was maximum on day number three and returned to baseline by the end of the study.

Most of the information I am finding looks reassuring for safely using this combination, in healthy individuals.  Those with a history of arrhythmia should use this combination with caution and discuss this problem with their doctor, before they take these two medicines within a close amount of time.

Contributer: Dr Erik McLaughlin |  www.adventuredoc.net

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Pre-hospital Expedition Medicine Series – Pelvic Injury

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Pre-hospital Expedition Medicine Series

Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar and HEMS paramedic Dave Marshall, both part of the Kent Helicopter Emergency Medical Team, continue their series examining pre-hospital expedition trauma care and associated kit.

In the second article in the series, Dave Marshall gives an overview of managing pelvic fractures pre-hospitally and in an expedition environment, and introduces the use of the pelvic splint.

Edited by Dr Amy Hughes.

Pre hospital and Expedition management of pelvic trauma and use of the pelvic splint

Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential. Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Pelvic Sam Splint is essential.

Mechanism of Injury

Pelvic fractures often result in extensive disruption of the bony structures and associated ligaments of the pelvis and are potentially life-threatening injuries. The fractures associated with the greatest morbidity and mortality involve significant forces such as motor vehicle crashes, motorcyclist crash, pedestrian versus car, falls from height and crush injuries. Early suspicion, identification and management of a pelvic fracture at the prehospital stage is essential to reduce the risk of death as a result of hypovolaemia, (1). It is especially important to be able to identify, treat and minimize risk of further damage when in a remote area miles from the nearest medical facility.

Understanding the mechanism of injury is vital in being able to predict the potential for significant injury to the pelvis and its underlying structures, even in the absence of clinical signs. It is, therefore, essential that time is taken to evaluate the mechanisms involved in any accident resulting from significant force or where there is pain or injury to the spine, abdomen, pelvis or femurs.

In motor vehicle accidents – a not uncommon event on expeditions – learning how to ‘read’ the wreckage to help identify possible pelvic injury, in conjunction with clinical suspicion, can significantly aid diagnoses.

The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis.

The intrusion into fuel tank shows the imprint of the riders pelvis. This would often result in significant fracture to the pelvis – often multiple, often ‘’open book’’ pelvis.

Anatomical structure of the pelvis 

The pelvic ring is often likened to a polo mint in that it is almost impossible to have a significant break in one place and not another. The most common area to be damaged in trauma is the pubic rami, acetabulum and the sacroiliac joint. There is extensive vasculature through and around the pelvic ring, most notably the iliac vessels. For imagery see > http://visualsunlimited.photoshelter.com/image/I0000kUOn3NJHcZU.

The greatest risk of a pelvic fracture is catastrophic haemorrhage and gentle handling of the patient in the initial and subsequent stages could literally be the difference between life and death. Whole blood clotting time is approximately 10 minutes, (depending on the environment). Expedition medics should be familiar with the ‘first clot best clot’ theory. In other words, a patient sustaining a traumatic injury resulting in haemorrhage will begin to form a clot using their own clotting factors. If this clot is disrupted they could easily bleed to death. A full fluid resuscitation will not be practical in the field as most expeditions carry a maximum of 2 litres of crystaloid. However it should be noted that overloading the patient with fluid can be equally harmful, and small boluses should be given to maintain a central pulse and cerebral perfusion. This is known as permissive hypotension and will be discussed in more detail in a future article. Disruption of this first clot in the prehospital setting could be fatal, and without access to blood and clotting agents the patient may die. Trauma will result in the patient becoming acidotic, hypothermic, and coagulopathic. (3)

This coagulopathy cannot be easily reversed pre-hospitally, each factor contributes to the decline in the others. (see above diagram). Any disruption to the first clot will have devastating consequences. Ultimately, the patient requires definitive haemorrhage control, (surgery, angiography and embolisation), and replacement of blood and clotting agents.

The glass pelvis:  Think of the pelvis as being made of very fragile glass, and you can see the clot in the form of a cartoon jelly inside. The jelly is very delicate and unless movement is gentle and kept to a minimum, it will ‘wobble’ to the point of destruction very easily. The same applies to the blood clot! Early recognition of the potential for a pelvic injury, gentle handling and prompt stabilisation is vital to improve the outcome of a patient injured on an expedition.

Clinical Features of a pelvic injury:

  • Management of pelvic fractures and clot preservation:
    Asymmetry of the pelvis – do not spring the pelvis. Visual alignment and gentle palpation of the Anterior Superior Iliac Spine may help demonstrate pelvic injury, but often the pelvis visually appears normal, thus mechanism of injury is vital in determining injury
  • Shortening/rotation of the leg/s
  • Inguinal pain
  • Localised swelling/contusion
  • Hematuria/urinary incontinence
  • Bleeding PR/PV – PR examination not recommended to determine pelvic injury.
  • MECHANISM, MECHANISM, MECHANISM! (albeit not a clinical feature!) – there may be no obvious clinical abnormality despite significant injury. Thus clinical suspicion is essential.

As we have already discussed, a patient with a suspected pelvic fracture must be handled very carefully. Whether in a medical facility or the most extreme expedition environment, the same principles apply to prevent worsening the injury and preserving the clot.

Log rolling the patient should be avoided at all costs!

The medical kit available on expeditions will be minimal. Stretchers may have to be improvised and transportation limited. However, all medical kits should have some sort of pelvic binder which should be applied carefully and correctly at the earliest opportunity,

Application of the pelvic SAM splint.

The casualty will inevitably have to be placed in the supine position, to evacuate them on whichever device is available. This can be achieved by a coordinated team approach utilising other members of the expedition.

One person should be at the head end of the patient maintaining in manual inline immobilisation, (MILS), and they will give clear commands to the team when moving the casualty, (“ready, brace, roll”). A pelvic binder such as the one shown can be applied using a minimal 10-15% roll, (enough to get a bum cheek off the ground!)  

Once in position the device can be tightened just enough to maintain anatomical alignment. Do not over tighten as this could cause significant further damage!

Log rolling patients.

Whilst sometimes useful in a controlled hospital environment following appropriate imaging, should be avoided in the pre hospital field. In simple risk versus benefit terms it could have catastrophic consequences. By using the hands available and correctly briefing the team about the amount of movement required (one cheek off!), it should be possible to optimise the care of the casualty prior to evacuating them to definitive care.

Improvised methods of pelvic splinting on expeditions

Much of the challenge of expedition medicine is improvisation. The medical kit you take out with you may not have SAM splints in them. Providing a support can be placed across the greater trochanter, then any sort of material could be used – for example clothing, a sheet, or a canvass of some kind.

Fluids

The approach to fluid management in trauma has changed. Two litres of fluid is not necessarily required for management of pelvic injury. Titrate fluid according to the presence of pulses or cerebration (alertness). The presence of a radial pulse, and even in certain circumstances (without associated head injury) presence of a femoral pulse signifies the blood pressure is sufficient to perfuse the necessary organs and promote clot preservation. Further details of permissive hypotension will follow in another article.

Analgesia

Essential – this depends on what is available. Intravenous opiates or a fentanyl lolly is ideal for analgesia, after the use of paracetamol or a NSAID.

Other injuries

Pelvic injuries are often present in conjunction with other significant injuries – spinal, femur, urological or abdominal as examples. Whether or not other injuries have been excluded, spinal precautions are essential in conjunction with good management of the pelvis.

References

  1. Lee C, Porter K. The prehospital management of pelvic fractures, Emergency Medical Journal 2007;24:130-133
  2. Maya A, Matinowitz U, Kluger Y. Coagulopathy in the critically injured patient, Yearbook of Intensive Care and Emergency Medicine 2006, Part 5,232-243
  3. Crawford C, Pelvic Fracture in Emergency Medicine, available at: http://emedicine.medscape.com/article/825869-overview
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Some feedback just makes us smile!

MCSArctic Medicine, CME Training, cme travel, CME Travel, Expedition & Wilderness Medicine, Expedition Doctor, Extreme medicine, medical training course, polar medicine, Pre-hospital Care, Remote medicine, travel doctor, travel medic, Wilderness and Environmental Medicine, wilderness medic, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Society, WMS, , , , ,

Feedback on our recent Polar Medicine training course in Norway has clearly affected some of the course delegates by creating a need for ‘biggles-speak’…

PapaFoxtrot calling Red Leaders AlphaHotel, AlphaCharlie, DeltaBravo, Bravo and Delta

Congrats on recent Operation Polar Bear

Wizard week

No prangs

Best ever

Location stunning

Bunks and chow excellent 

Red Leaders all SPLENDID

Hope all returned to base safely

Please pass on to all members of Polar Bear as don’t have call signs

Do you read me ?

Over

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Keele Medical School interviews Dr Amy Hughes, Medical Director at WEM

MCSCME Training, CME Travel, Everest, Everest Base Camp, Everest Base Camp Mountain Medicine CME, expedition, Expedition & Wilderness Medicine, Expedition Doctor, Extreme medicine, Himalayas, Khumbu Valley, medical training course, mountain medicine, Nepal, Pre-hospital Care, Remote medicine, travel doctor, travel medic, Wilderness and Environmental Medicine, wilderness medic, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Society, Wilderness Medicine Training, WMS, , , , ,

Dr Amy Hughes medical career has been far from ordinary and she talks about how she has ended up as medical lead at WEM.

Dr Hughes co-leads with Dr Luanne Freer our CME accredited Mountain Medicine course on the Everest Base Camp trail in Nepal.

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Acute mountain sickness – a review by Dr Sean Hudson

MCSAcute mountain sickness, CME, CME Training, cme travel, CME Travel, Dr Sean Hudson, Everest, Everest Base Camp, Everest Base Camp Mountain Medicine CME, expedition, Expedition & Wilderness Medicine, Expedition Doctor, Extreme medicine, Himalayas, Kathmandu, Khumbu Valley, medical training course, mountain medicine, Nepal, Pre-hospital Care, Remote medicine, travel doctor, travel medic, Wilderness and Environmental Medicine, wilderness medic, Wilderness Medicine, Wilderness Medicine Society, Wilderness Medicine Training, WMS, , , , , , , ,

Management of AMS

Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT)

High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. The researchers sought to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.

Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).

Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).

Fascinatingly the authors demonstrated that Ibuprofen and acetazolamide are similarly effective in preventing HAH. This adds another medication to the useful arsenal to use in the treatment of AMS and in particular is especially useful when you have a patient who can’t take acetazolamide (diabetics or sulphur allergies) .

Learn more about Altitude Medicine by joining Expedition and Wilderness Medicine’s CME accredited Mountain Medicine course in Nepal headed up by Everest ER founder Dr Luanne Freer

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Pre-hospital Expedition Medicine Series

MCSCME Training, Expedition & Wilderness Medicine, Expedition Doctor, Extreme medicine, medical training course, mountain medicine, Pre-hospital Care, travel doctor, travel medic, wilderness medic, Wilderness medical training, Wilderness Medicine, Wilderness Medicine Training, , , , , ,

Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar with Kent Helicopter Emergency Medical Team gives a brief overview of managing femur fractures in an expedition environment, in the first article in a series examining  pre-hospital expedition trauma care and associated kit..

Management of a mid-shaft fractured femur in the field and use of the Kendrick Traction Device

Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential.  Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Kendrick Traction Device is vital.

Mechanism of injury

Fractured femurs form only a small percentage of common injuries on expeditions but can be associated with significant morbidity and mortality. Early effective management is vital in view of the risk of significant blood loss, pain, long term complications and compartment syndrome. In assessing and managing femur injuries, it is also very important to exclude associated injuries such as chest, axial skeleton, pelvis and head. This article will focus only on mid shaft femur injuries, further discussion on management of multi-trauma will be examined in another article.

A high energy force is often needed to fracture the femur in a young, fit individual unless they have a pre- existing medical condition predisposing them to reduced bone density (osteoporosis, malignancy, malnutrition, muscle atrophy, previous fracture). Road Traffic Collision are the one of the most common risks to participants on an expedition and a common mechanism for high energy transfer resulting in fractures of the femur – especially dashboard injuries. Other mechanisms of injury include falls from height, pedestrian versus vehicle and direct trauma to the leg. As mentioned above, associated injury need to be considered and managed appropriately, especially pelvic injuries.

Mid shaft femur fractures

These fractures are almost always the result of high energy trauma, the mechanisms of which have been mentioned above. As the femur is very vascular, injury can result in significant blood lost and a requirement for haemorrhage control and clot preservation pre-hospitally until definitive care can be reached is paramount. The pattern of femur injury often results from the direction of force applied. For example, a perpendicular force results in a transverse fracture pattern, an axial force may damage the knee or hip and rotational forces may cause spiral or oblique fracture patterns (1) . Again, understanding the mechanism of the injury is fundamental in determining the resultant pathology. Further complications from mid-shaft femur fractures include deep vein thrombosis, fat emboli, nerve palsies and rarely compartment syndrome.

Clinical Features

Pain is the initial most significant feature. The leg may be shortened and rotated and/or visually deformed with swelling and fullness to the thigh. If the injury is compound (or open) then there will be a wound over the fracture site communicating with the bone / bony fragments. The person will be unable to weight bear. A neurovascular assessment should always be done, with distal pulses felt (often worth marking the pulse with an ink cross) and distal perfusion monitored both after the initial injury, following any intervention and throughout the course of the casevac.

Management

It is vitally important to ensure there are no other traumatic injuries, and an ATLS management approach to the patient should be made.

The ultimate aim of management of a femur fracture is to return the limb to its normal anatomical position. This not only helps reduce pain by bringing the bony fragments into alignment and reducing muscle spasm and soft tissue involvement, it also reduces bleeding, improves clot preservation and helps improve distal perfusion. In the pre-hospital expedition environment resources are limited but if there are no formal traction devices available, improvised devices can easily be used.

Expedition Medicine

Traction is needed on the limb to help bring the proximal and distal ends of the fracture back into alignment, reduce bleeding and pain.

 

Steps to management of mid shaft femur fractures on an expedition

ANALGESIA – depending on what you have available:

  1. Paracetamol
  2. NSAIDs
  3. Morphine.

IRRIGATION

  1. If the injury is a compound fracture (open) or has a wound associated with it, it must be irrigated. This does not have to be done with sterile water – water from drinking bottles or taps can be suitable for preventing wound infection (2, 3) . The wound must be irrigated thoroughly to reduce the risk of infection. It is likely that it will be some length of time before the injury is dealt with in definitive care and re-irrigated. This applies to any wounds sustained to the patient. A dressing can be applied to the area. Irrigation can be undertaken at the same time as traction is being applied.

TRACTION

  1. The leg needs to be put under traction. Whilst kit is being assembled, the leg can be held in traction by any member of the team. The foot and ankle can be held, and the leg pulled out to anatomical alignment and held in position. This is immensely painful for the patient, and thus adequate analgesia is essential. Once the leg is under traction, pain is often reduced.
  2. Kendrick Traction Device Use: The Kendrick Splint is an excellent lightweight piece of kit used widely in pre-hospital care and expedition medicine. It is easy to use, effective and relatively cheap. The pictures below demonstrate correct use of the splint:

The Kendrick Traction Device (KTD). Lightweight and very effective. Approx weight 0.5kgThere is also a boot hitch strap (see final images)

Step 1:

Place upper thigh strap high into groin with the pole holes on the outside of the leg. This strap must sit as high as possible. Measure out the length of the pole against the leg. The bottom of the pole should extend approximately one section length below the foot. The pole can be shortened and lengthened in a similar manner to a tent pole.NOTE : Manual inline traction of the limb should be undertaken as soon as possible and throughout the KTD application

Step 2:

Example of manual in-line traction of the limb.Prior to the ankle strap being positioned, the yellow Velcro strap can be applied just above the knee. This may need tightening after traction has been applied.

Step 3:

Apply ankle strap. The padded part of the strap sits behind the ankle. Tighten using the green strap. The yellow strap fits over the pole end (black part) and traction can be applied gently by tightening the red strap. Traction should be applied until the leg is comfortably under traction and in anatomical alignment. Check distal perfusion.

Step 4:

Whilst pulling the red strap, a small amount of counter traction needs to be applied to the KTD

Step 5:

Apply the two other Velcro straps…..the red strap at the top of the thigh, the green on the lower leg. Manual in-line traction can now be released.

Step 6: Boot hitch

The KTD comes with the option of a boot hitch which can sit over a walking boot if the decision is made not to remove the shoe. The boot hitch strap is laid under the ankle, the white label on the inside of the strap lying closest to the boot.

Step 7: Boot Hitch

The hook is done up over the boot

Step 8: Boot hitch

The same process as per the ankle strap can then occur, although there are only two straps – the yellow attaches over the end of the pole, the red strap is used for tractioning the splint with a small amount of counter-traction.

Other splints:

i.      Sager traction splint – this is bulkier to carry as part of an expedition medical kit but is effective and allows traction of both femurs simultaneously.

ii.      Improvised splints

Walking pole or sturdy wooden stick braced and secured to either side of fractured limb (the outside length up to the pelvis, the inside length up to groin) and extending a good 15cm below the ankle. A cross pole positioned across distal end of the poles below the ankle and tied into place. A figure of eight strapping around the ankle, extending down over the cross pole and tightened on itself thus pulling traction down the length of the leg. Alternatively, the figure of eight strapping can be tied to the cross bar and a small piece of wood or metal can be used on the length of strapping between the foot and the cross bar to twist the strapping and tighten the traction on the limb. Important to ensure traction is comfortable and foot remains perfused with a good distal pulse.

The injured leg splinted against the non-injured leg using a walking pole or sturdy stick and strapping (crepe bandage, clothing, rope). This doesn’t allow for traction but may be the only option available to provide some comfort to the patient prior to evacuation.

IV FLUIDS

Providing the patient is cerebrating and has a good radial pulse, intravenous fluids are not required unless there are significant signs of haemorrhagic  shock. Permissive hypotension is not discussed in this article and further reading is advised regarding the changes and advances in fluid management in trauma. Do not run 2 litres of fluid into the patient!!

IV Antibiotics for compound (open) fracture and Tetanus prophylaxis

Open fractures are tetanus prone wounds, and most participants on expeditions should be up to date with there tetanus vaccinations. However, it is vital to check with the participant when their last booster was and documenting it for handover when definitive care is reached. If a patient is not vaccinated, of if they are unsure, the vaccine should be administered. The current UK guidelines state that a patient is considered Tetanus immune if they have received five doses of vaccine in their lifetime (3).

Intravenous antibiotics should certainly be considered in the expedition environment. A Cochrane systematic review of the use of antibiotics in open fractures as an adjunct to irrigation and further care found that administering antibiotics did reduce the incidence of early wound infections (3, 4) . Depending on what you carry, a first generation cephalosporin can be used.

References

  1. F. Gaynor Evans; Herbert E Pedersen, H.R Lissner; The role of tensile strength in the mechanism of femoral fractures; Journal of Bone and Joint Surgery, 1951; 33; 485 – 501
  2. Fernandez R, Griffiths R 2008; Water for wound cleansing. Cochrane Database of Systemic Reviews, Issue 1, CD003861
  3. Barnard AR, Allison K; The Classification and principles of management of wounds in trauma. Trauma 2009; 11; 163-176
  4. Gosselin RA, Roberts I, Gillespie WJ; Antibiotics for preventing infection in open limb fractures; Cochrane Database of Systematic  Reviews 2004, issue 1, Art No CD 003764

 

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Wilderness Medical Society approves Desert Medicine course in Namibia for 20.5 CME

MCSCME Training, CME Travel, Desert Medicine, expedition, Expedition & Wilderness Medicine, Expedition Doctor, Extreme medicine, Media Crew Expedition Medical Support, medical training course, namibia, Wilderness and Environmental Medicine, Wilderness Medicine, Wilderness Medicine Society, Wilderness Medicine Training, WMS, , , , ,

Feedback from delegates in our unique Desert Medicine medical training course in Namibia is feedback enough but the Wilderness Medical Society has also awarded it 20.5 CME points.

‘I had a fantastic time and feel like I learnt a lot. I will definitely be signing up for more courses and recommending the courses to people I know!’    Desert course participant.

Developed for medical professionals or advanced medics working in hot or arid climates. The Desert Medicine Course aims to introduce participants to the skills required to be a valuable member of a desert expeditionary team, and to care for and treat injuries and illness likely to occur in this fascinating environment.

Our Desert Medicine Course is based in Damaraland, an area bounded to the south by the spectacular Namib Desert, to the east by the Kalahari, Ovamboland to the North and the world famous Skeleton Coast to the west. Located near the famous Doros Crater, a massive volcanic crater formed over 140 million years ago. Our training area is a stunning region,  remote from civilisation, inhabited by an array of desert adapted flora and fauna and with some of the most remarkable night skies in the world. As a result of the recent changes in wildlife management in Namibia, the Doros Crater has been chosen as the region in which the endangered white rhinos are being released. It is a very exciting location inhabited by elephants, hyena, giraffe, rhinos, cheetahs and occasionally lions. It is almost unique in Namibia and for this reason we have endeavoured and been allowed to gain access to this virtually uninhabited area. Its the perfect location for our desert course. 

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