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Expecting the unexpected, being an expedition doctor by Dr Alex Rowe

26 September 2016

Expecting the unexpected, writes WEM Medical Director Dr Alex RoweExtreme Medicine

In life one thing is certain you will encounter situations that you could not anticipate no matter how much you plan.  In expedition medicine one of the challenges is dealing with these when away from the security of a well staffed and secure environment, in fact you could say that meeting these challenges is part of what makes it so interesting.

Imagine you are travelling with an expedition group as their doctor. You are travelling to Nepal to undertake a Himalayan high altitude trek everything is planned meticulously. You’ve undertaken medical kit sourcing, researched the local area and formulated evacuation plans, revised management of high altitude conditions, spoken to local guides and are happy that you have all the emergency communications systems you need.

You are driving along the mountain pass and there is a sudden, loud bang and the coach in front of yours swerves, breaking through a rickety crash barrier, careering down the bank into a small river where the coach rolls onto its side. The inside of the coach is chaos with debris everywhere and you can hear the screams as you survey the scene. You also know the nearest hospital is three hours’ drive away.

Your mind switches into processing mode to analyse this chaotic scene, formulate a plan, delegate then get on with the job- it’s what we’ve always done and somehow our minds find a powerful focus in the most dramatic situations. Key to this is organising the response to achieve the best outcome for the most people.  Decision making is at the core of how we practice medicine and we base these decisions on previous experience, prior learning, teams we have worked with, great leaders and a certain X factor originating from common sense and lateral thinking.

Another aspect of medical training is the emphasis on the role of the team and in general most doctors are capable of functioning as valuable team members because we are taught the importance of listening, empathy and compassion when we are looking after our patients and how to treat them as human beings, rather than just numbers with problems and solutions. As our medical personalities evolve, our human personalities are also shaped.

I started my medical career in anaesthetics and emergency medicine before going into general practice and the longer I practice medicine, the more I understand the importance of communication and consultation skills. I also work as a pre hospital care doctor where empathy, compassion and communication has never been more important as we manage major trauma. We are taught that we can even ease pain purely with compassion, kindness and talking to our patient. Drugs help of course!

So how does this fit into Expedition and Extreme Medicine? Groups of people are fascinating to watch and interact with. Put those people into more challenging environments and out of their comfort zones, and suddenly true colours are revealed as the sub conscious primitive brain takes over and starts to govern what is shown to the outside world. As an expedition medic, we are in the same challenging environment, yet how do we control ourselves when we are undertaking the same challenges as the people involved, then switching into doctor mode when we are as tired, hungry and possibly as scared as the rest of the group.  Conventional medical training can give us the foundation to operate in this challenging environment.

I have been working with a great team developing the Human Factors Module for the Extreme Medicine Post Graduate Programme. Human factors are what allow us to perform and do our job when others are struggling. Self-awareness, situational awareness and group awareness allow us to process the global picture when groups are under pressure, and should enable us to stand back from the scene and make functional and rational decisions. We are not alone though and it is a skill to recognise and utilise the group members who can work with us. Task and environment specific skills such as management of altitude illness will always be vital, however it’s the softer skills that help us stand out, perform as accepted leaders and take control when stuff starts hitting the fan.

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