Big Project Cover and the Curious World of Media Medicine

3 January 2024


Dr. Will Duffin – Joint Medical Director & GP

Will is a jobbing Devon based GP, educator and adventure addict. He has provided medical cover for dozens of very different expeditions and projects; including commercial high-altitude treks in The Himalayas and The Andes, a luxury Trans-Siberian private train, a reality TV show in the South Pacific and he has worked with UNICEF out in forgotten corners of Myanmar.

World Extreme Medicine is no stranger to big project cover, having worked with the likes of Paramount Pictures, Bear Grylls and the BBC, each project bringing a new set of medical challenges. WEM also provides on-site emergency and primary care for the major US TV production ‘Survivor’ in the South Pacific. This involves caring for up to 500 local and international crew, villagers and even the odd backpacker alongside the show’s contestants. Dr Joe Rowles, Dr Laura MacArthur and I recently returned from filming Seasons 45 and 46 of the show, working alongside a dedicated team of other docs, nurses and paramedics. We saw a fascinating case mix, from gangrene, severe pneumonia, ciguatera poisoning and decompression sickness, through to kidney stones and shark bites.

This article is split into three instalments. In part 1 I’ll reflect on some of the more unusual aspects of working in the curious world of ‘media medicine’. Part 2 is all about how our medical team trains to stay sharp when on location and in Part 3 Joe and Laura are talking all about how we’ve been using the latest technology in the world of Pre Hopsital Ultrasound (POCUS).

You must be ready for anything at any time!

The location for the show ‘Survivor‘ is a true tropical island paradise, – until it isn’t! There will be spells when not a lot happens medically, but situations can evolve quickly. We’ve dealt with cardiac arrests, sepsis, shark bites and have learned to always be on our guard. The environment itself can also quickly become hostile, we’ve had to hunker down during category 4 cyclones, and sweat it out through punishing heat and humidity.

TV Productions are close knit communities.

Some productions are comprised of ‘flash teams’ that come together at very short notice, which requires accelerated team bonding. ‘Survivor’ is in fact the longest running reality show in history, so we’re part of an established ‘family’, most of whom have been working together for over two decades. It’s vital that the med team integrates well with the rest of the crew. Living and working on a tiny Island with friends and colleagues who become your patients also requires everyone to be mindful of their profile in the production. Other crew rightly have high expectations of how medics behave both outside as well as inside of work time.

It’s private healthcare, not the NHS.

This is a mindset shift. In the public system of the NHS we do a lot of gatekeeping and health care rationing. As a media medic you’re there to provide a service to a client (the production). Often this has a much broader scope than the role back home – you are the patients Emergency Physician, General Practitioner, Local Pharmacist and Counsellor all rolled into one. It’s not just all about the big stuff. We have no qualms about issuing Strepsils for sore throats, band aids for the most minor of cuts and we take the time to sit down and chat things through when people just feel a bit homesick. It’s a luxury to be able to provide a comprehensive service.

You need a ‘can do’ attitude.

We are there to be advocates for safety and wellbeing but not to put unnecessary spanners in the works. Large film productions operate on tight schedules, and we’ve learned to work collaboratively with producers to find solutions. When medical or safety concerns arise, constructive dialogue enables the right adjustments to be made that still promote business continuity and allow the production to achieve its creative objectives. Producers are seeking to push the limits and capture that emotion on camera, this is what makes good TV and gets ratings. But in my experience, producers also care deeply about the welfare of the cast and crew and prepared to work with the medical and safety team to achieve this.

Reality show contestants are still real people.

Before doing this job, I had this pre-conception that all reality TV show contestants must be fame hungry, vacuous narcissists, but I was wrong! They are wily competitors, super fans of the show and are there to play the game. Beneath this, of course, they are also regular human beings just like everyone else. As one of the shoot doctors alongside my colleague Project Lead, Dr Joe Rowles, I have the privilege of seeing each contestant 1:1 nearly every day of the production. It’s vital for us to monitor their health and wellbeing given the stress their bodies are under during the game. The challenges are physically demanding and the contestants are competing under survival conditions. They are invariably hungry, sleep-deprived and dirty. What makes this so special as the medic is you feel as though you’re there with them through what is an undeniably intense and life-altering experience. The contestants I’ve worked with have shown nothing but warmth and appreciation for the medics that look after them.

It’s where real medicine meets storytelling!

I’ve never felt more alone than being on a remote beach in the pitch darkness with a sick contestant and the only onlookers being a wall of ten shoulder-mounted cameras. The first few times I was called on set to treat a contestant ‘on camera’, it was like being a rabbit in headlights. There’s no script, you must think on your feet by quickly assessing what’s in front of you to deliver safe care, whilst simultaneously explaining to the show’s host -Jeff Probst- what’s happening. This helps to both coordinate care and inform the viewer.

Jeff gave me some really useful coaching on how to work with him to help create the narrative arc. In my test run (with ‘dummy’ contestants called the ‘Dream Team’) I hurried onto the set, did a quick exam, then explained glibly she probably had a broken collar bone and that would be the end of her game. Job done? ‘’No, no, no!’’ Jeff exclaimed in our debrief, ‘’dude, you gotta build the suspense!’’ I’ve learned to take my time, allowing the story to emerge in stages, guided by Jeff. It’s all about verbalising your thought processes and avoiding too much jargon. There’s no need to create any of the drama – it’s all there already. Of course, if the contestant is ‘big sick’, then the medical care always comes first and Jeff doesn’t expect me to make much eye contact with him until I get some bandwidth back.

In some shows the medics are heavily ‘produced’ and told to fit into a desired persona. This isn’t the case on Survivor, where I’m just expected just to be myself. My ‘concerned face?’ Yep, that’s all me, I’m genuinely bricking it!

In the next blog I’ll explain how our medical team use In-Situ Wilderness Simulation Training to stay sharp and prepared.

Check out part two here.

→ If you’d like to learn how you can find interesting opportunities like this, join our careers panels at this year’s World Extreme Medicine conference

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