Train Hard, Fight Easy: the Benefits of In-Situ Wilderness Simulation Training

11 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.

WEM has been busy again this year providing 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 and I recently returned from filming Seasons 45 and 46 of the show, working alongside a dedicated team of other doctors, 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.

But working in these settings isn’t always non-stop action, there is usually plenty of down time too, and it’s important we take opportunities to train as a team and keep our skills sharp.

Something I’ve always found very worthwhile is in-situ team simulation training. This involves finding a quiet moment in the day, coming up with a few scenarios, and exploding the kit bags in search of some useful learning.

I’ve found it can often be hard to line up the rotas and steward the energy within a group to get a sim up and running. It’s an easy thing to fall by the wayside, however there are a number of key benefits. If you’re yet to be convinced, here are just three of them:

  1. There’s good evidence that Simulation improves our ability to manage emergencies.(Ruesseler, 2010) It’s likely to have a direct and positive effect on the quality of care we’re giving.
  1. Simulation helps you to bond as a team,it helps you to understand each other’s unique skillsets, communication styles and ways of working. It can be an incredibly rich skill-share where ED docs learn from HEMS paramedics and vice versa.
  1. Then there’s the opportunity to ‘battle test’ of your equipment and processes. Talking things through is one thing, but it’s only when you actually explode your kit on the floor that you discover that certain connectors aren’t compatible, that your IV bag doesn’t have any flushes or sharps bins, or that your patient monitor is completely out of batteries! A surprising number of ‘little things’ always emerge that can be ironed out before a real event, when those little things become big things.

We have access to a helicopter, so we’re able to run sims that involved the full patient pathway, from the assessment and initial management of cases of polytrauma and heat stroke through to packaging and transporting a casualty for a helicopter medivac.

These exercises are a great test of our processes and systems. We’re forced to consider our ‘what if’s’: how we’d prevent and manage patient vomiting or agitation in the aircraft, or even full cardiac arrest including in-air defibrillation. We are also forced to consider our comms protocols, how we would pre-alert the local hospital and who would interface with the insurance company and other members of the expedition team. I’m a fan of physically getting out and handling the specific kit you will use (without necessarily opening the packaging) as it builds muscle memory and familiarity that grants you ‘cognitive ease’ in the real thing.

We’ve found that a key ingredient to success is avoiding the tendency to overcomplicate the clinical scenario. The scenario is not really the endpoint, but more of a vehicle to explore and test your processes around it. It also helps to have a high degree of ‘psychological safety’. Fundamentally, simulation in these settings seems to work best when presented as a low-stakes learning exercise within an environment where everyone’s contributions are welcomed. It doesn’t have to be super high-fidelity. Work with what you’ve got and don’t let the stress of planning something overly elaborate get in the way of getting your first sim over the line.

The final key ingredient is taking the time to debrief afterwards. Talk through how things went in a non-threatening way and then actually use those insights to improve. 

At World Extreme Medicine, all our courses are built around casualty simulations and our Expedition and Wilderness Courses include a full multi-casualty Search And Rescue (SAR) exercise, which is always really popular with our delegates! You can book a course here.

You can learn all about how to package and transport casualties in litters over tough terrain, combined with rope skills, in one of our many hands-on outdoor scenarios at this year’s World Extreme Medicine Conference.



  1. Ruesseler M et al. Simulation Training Improves ability to manage medical emergencies. Emergency Medical Journal 2010;27:734-738.
  1. Davis, D and Warrington, S J. Simulation Training and Skill Assessment in Emergency Medicine: Stat Pearls Online. Jan 2023.

→ 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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