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How far and to what extent can we treat injuries on an expedition?

12 December 2019

How far can we treat injuries on an expedition?
To what extent can we treat injuries on an expedition?

Interesting questions, and ones that our expert faculty are constantly asked when on one of our training courses and workshops. It’s the ‘million dollar question’, and the answers often given will of course vary depending on the injury, your environment and the resources you have to hand.

But, one way to think about this is by using the anagram ‘Don’t Eat All Of A Cow’ or for the vegetarian/vegans out there ‘Don’t Eat Any Of A Cow’ (DEAOAC) as used by leading expedition dentist and WEM faculty Burjor Langdana. He uses this anagram to discuss injuries on expeditions and more specifically when asked “How far and to what extent can we treat dental issues / facial trauma on an expedition? We do not have much dental or maxillofacial experience”, but ‘DEAOAC’ can actually have a wider application across all medicine.

D – Develop
Develop your toolbox by attending courses, lectures and workshops. Absorb as many practical tips and as much knowledge as possible of anything and everything – it all adds to your skillset.

E – Exercise
Exercise and practice at every opportunity, as by gaining more experience you’ll be able to develop new or previously dormant skills. It’s also a great idea to get friendly with the MaxFax department (or other relevant team) at your local hospital and also your local dentist to gather further insights and experience.

A – Assess
Assess the situation that faces you on the expedition and think carefully about what you are facing and how best to deal with the situation using the limited resources you have. The main objective is to get the patient in a stable enough condition, so they are able to travel and seek further medical attention, whether that be with you or via MediVac.

O – Options
There will be treatment options available which you should discuss with your patient, colleagues and the rest of the team. This will keep everyone in the loop, help you think aloud your plan of action and it also lets the patient know what is happening and why. By communicating clearly and effectively it puts you in control of the situation and should keep the patient and those treating them calm enough so as not to panic.

A – Accept
In a quite possibly remote and austere location with limited resource, now is the time to accept and fully understand your own limits of what you can and can’t do.

C – Comfort
Now is the time to stay within your comfort zone. How much you stretch yourself will depend on various factors, including the situation, the expedition environment you are in and the seriousness of the injury. Call on the help of others around you and have confidence in your own ability – get the basics right first!

Burjor says: “It’s actually a decreasing circle. Pre-expedition you may have developed a huge toolbox attending various training programmes and acquiring new skills. However, from this you may be able to practice and develop only a few skills, and out of those few skills, there will be even less that you regard as ‘within my limits’. Out of these, there will be fewer still that will ‘fit within your comfort zone’, and this zone will vary according to the environment, your fitness level, speed and the possibility of MediVac. You may be tempted to stretch (or not) your comfort zone depending on these factors.

The interesting point Burjor is making, is the bigger the toolbox you start off with, the deeper your comfort zone will be in the stressful environment of an expedition. If you are fully prepared, have enhanced your learning and used every opportunity to observe, experience and practise those skills, you will feel more confident in your own ability to face any challenges that come up on an expedition. With this confidence you’ll be able to proficiently assess, stabilise, manage and treat your patient, which will lead to an improved patient outcome.

For further specific expedition dentistry resources and information from Burjor and his team, you can visit

Interested in developing a medical career in Extreme Medicine?

  • WEM’s exciting selection of expedition, wilderness and remote medicine courses offers you a fully immersive training experience into what it means to be an expedition medic.
  • 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.

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