Improvising in the extremes: Learn how [Podcast]

17 January 2023

‘Improvise, adapt and overcome’ is the old adage in survival circles. But exactly what role does improvisation have in the coal-face practice of extreme medicine?

What Exactly is Improvisation Medicine?

“In 2016 my wife and I worked on a paediatric unit of a small regional hospital in Myanmar for 6 months. The store cupboard was filled to bursting with expensive kit that had been donated by various NGO’s and charities. Much of it was gathering dust as there was no way of procuring spare parts or maintenance. However, I was in awe of how the local staff were able to keep things going. They found ways to bodge bits together with superglue, tape and zip ties. They fashioned a crude bubble CPAP machine from off-cuts of tubing and made spacers from empty coke bottles. The ingenuity was endless and inspiring.” 

Dr Will Duffin, Joint Medical Director, World Extreme Medicine.

Improvisation: the ability to create a workaround to whatever the wilderness throws at you, is fundamental within extreme medicine. It’s both a playbook ‘of different tricks, hacks and techniques that you accumulate over the years and it’s also a mindset – a way of seeing the world.

Medics who improvise are those who are unflappable. They don’t languish in the problem – I can’t do this because I don’t have that, frustration, blame, anger… Nope. None of that! They quickly accept where they are and seek solutions.

To use a wonderful phrase, learned from our friends at NASA – ‘they work the problem. They use whatever resources are at their disposal to craft functional rather than ideal solutions to novel problems. It’s about having what Bruce Lee liked to call a mind like water. That is, a mind so agile and fluid it can bend itself into the shape of any problem.

‘Start where you are. Use what you have. Do what you can’

Arthur Ashe, American Tennis Player.

Improvisation is very much a practice that we must deliberately cultivate, and low resource medical settings are the perfect opportunity to do this.

Learn How to Improvise: Useful Resources

Listen to the World Extreme Medicine Podcast

On the latest World Extreme Medicine Podcast Dr Will Duffin is joined by Dr Iserson who discusses his book: ‘Improvised Medicine’.

Sharing expert insight into how you can open your mind to ways of solving problems in a crisis and providing options for you (and your patients) when alternatives seem limited or non-existent. It’s the perfect place to start.

Read Improvised Medicine by Kenneth V Iserson

If there is one book that’s earned its place front and centre on the wilderness medicine bookshelf: Improvised Medicine by Kenneth V Iserson.

It’s a massive and curious compendium of improvised techniques that the author has gathered from his own experience as a medical director of search and rescue, alongside working in remote humanitarian environments on every content. At first, the tiny font and sheer ‘meatiness’ of this tome may put you off, but this belies a comprehensive and valuable resource.

Dr Iserson’s techniques include how to manually measure clotting times in snake envenomation, how to do tracheal intubation using a bent spoon, how to repurpose your stethoscope into a hearing aid for your deaf patient and how to position two X-ray films to create a 3-dimensional image. Much of it has been tested in the field by either the author or his wide network of equally intrepid colleagues.

Practical Learning Opportunities

Keen to put your learning into practice?

Improvised techniques also feature heavily in all World Extreme Medicine courses. You’ll learn how to carry casualties using climbing rope, webbing, or your bare hands, how to splint limbs using bits of wood or walking poles, how to stop the bleeding using a buff or some old rags and how to deploy your own ingenuity most effectively in any extreme environment.

Join a World Extreme Medicine training course to learn improvised medicine

Remember – ‘Medics who improvise are those who are unflappable.’ 

Dr Will Duffin, Joint Medical Director, World Extreme Medicine.

Have you needed to improvise in a limited resource setting, or can you share any top tips on how to do so? If so, we’d love to hear about it, feel free to share your thoughts in the comments section below. 

The 4-Day Expedition That Will Redefine You as a Medical Professional

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