2 day Pre-Hospital Care workshop presented by Extreme Medicine & London Air Ambulance during the two days prior to Extreme Medicine Conference
Back in Costa Rica again and the jungle didn’t fail to provide the perfect environment for the course. As one would expect, it was hot, wet and full of interesting fauna and flora. I never fail to be impressed by the beauty of the jungle, but by god it can be hard sometimes. Its one of the few places I visit that can be so harsh then so comfortable. The moment you start to feel comfortable in the jungle is that Nirvana moment.
It took a while coming this trip because of the heavy rain but we eventually made it. Mike, Ceri, Mark and Martin again excelled themselves and the addition of our new herpetologist bringing snakes into camp was great. The best new addition to the course this year was however the HENNESSEY HAMMOCK, it is without a doubt the best bit of expedition equipment I have come across. 18 people in the jungle in some of wettest conditions I have experienced and everyone was dry, or if they weren’t they didn’t let on. Quite incredible.
Other than the medic feeling a little queasy on the river, everyone escaped injury and illness. Other than the EL developing drucunculiasis that is! but he’s got to have something to winge about. Back next year and I’m looking forward to it already.
2009 dates for Desert Medicine Course; 19th – 25th of April.
Author: Dr Claire Roche
A country famous for its Skeleton coast, an eerie graveyard of numerous shipwrecks which have fallen victim to its rough waters, home to towering sand dunes and of course Africa’s “big five”. Tucked away in South West Africa, Namibia is a country of mystery with a unique landscape and proved to be one of the worlds’ best possible locations in which to learn expedition medicine, desert style.
After undertaking a four day 4×4 self drive safari prior to the course I soon became aware that a lack of understanding of such terrain could have deadly consequences. Described by explorers as “hell on earth” and described in the bible as “the dust of death”, the desert environment can kill in a matter of hours.
A destination popular with European holiday makers and best enjoyed by taking self drive safaris, Namibia’s International airport is a hub of car hire companies. Tourists are pouring onto Namibia’s roads with no journey preparation or experience in handling 4×4 vehicles on off road terrain. This was demonstrated when I crossed paths with a group of four female German exchange students who ventured out to the popular beauty spot of Sossulvei dunes and petrified forest. They had hired the most economical car which was completely unsuitable to gravel roads (which make up the majority of Namibian roads outside of the major cities) and a momentary lapse of concentration resulted in the car sliding out of control, ending up on its’ roof in a field bordering the road. Fortunately no passenger was injured and help passed within the hour but this daily occurrence on Namibian roads has claimed the lives of many tourists and locals. We exchanged stories at a desert lodge as only the previous day I too managed to end up stranded after our 4×4 became lodged in sand whilst visiting the same area. Our only saving grace was that this occurred in a popular area where passers-by stopped to help within half an hour, however if this was to have happened two days previously whilst we had been traversing similar terrain in a desolate area of the skeleton coast I dread to think of the possible implications, especially as the day was drawing in and we had not seen another car in several hours.
Namibia is home to multiple tales of travellers making the mistake of leaving their vehicle to find help and falling victim to temperatures of 50 degrees and limited water availability. Prior to starting the course my experiences made me desperate to feel self sufficient in this unforgiving environment should I ever have the misfortune to be stranded.
Base camp for the course was a 5 hour drive from the capital city of Windhoek to the Brandberg Range, in a region named Damaraland in the north west of Namibia. The first thing I noted was that the term “desert” was an umbrella term for multiple types of terrain. Besides the obvious rolling sand dunes, deserts can be dry, barren and rocky areas or vast, open, dusty plains extending for miles. In this location there was no readily available running water, electricity or mobile phone signal. Just 20 single man tents surrounded by a jaw dropping backdrop of the surrounding desert. From my previous Expedition Medicine experience of Polar and Jungle courses, once again, they had excelled themselves in choice of location for their course. As the sun went down and poured its’ pink heart into the desert floor we sat around natures’ television, warmed our feet and listened to what was planned for the first desert medicine course over the coming week.
We were led by our fantastic guides: Volker, Faan and Korbus, on our first of many desert treks. A ten hour “stroll” in 45 degrees of heat, across plains and gorges. We learnt how to navigate our way using GPS (global positioning system), maps and compasses but the first skill we had to obtain was that of finding water in this apparently bone dry environment. We headed for gorges and began to learn the art of animal tracking. The desert is a maze of animal tracks, the most intriguing to me was that of the desert elephant. An animal that required 12l+ of water per day so if you could find the animals the chances were you could find the water. We were taught water purification techniques and fire lighting. I noticed how morale was boosted in camp when fire was lit as it became dark and the temperature began to drop and also how important fire was to cooking, signalling and keeping warm. The only downside was the unwelcome visitors it attracted such as scorpions, insects and hyenas. The nights spent away from base camp with no tent to protect us I became quite aware that the desert was buzzing with life. As the lights went out the odd call of the barking gecko and the laugh of the hyenas made me feel most vulnerable and somewhat uneasy.
Our first day brought heat related illness to reality as several of the group complained of nausea and headache. Yet to be fully acclimatised, the harsh environment was already having an effect. One member needing to be cooled in the field after developing lightheadedness and tachycardia we were given first-hand experience of minor heat related illness and learnt in the form of lectures about more severe heat related illness. Interestingly we found that measuring temperature is of insignificant value when comparing to the signs and symptoms and is often inaccurate.
Over the week we learned more and more about the flora and fauna of the area and how to treat snake, spider and scorpion bites. To enforce what we learnt we were introduced to a snake handler who brought a variety of snakes and scorpions for us to see and to help demonstrate envenomation. Most snake bites are dry bites and the waiting for symptoms to develop can be distressing. We undertook a practical where venom was taken from a puff adder and added to 5mls of freshly venesected blood. After 20 minutes of being left to stand the blood had still failed to coagulate demonstrating the effects of envenomation.
In desert regions the most common mode of transport is by vehicle and after my experiences prior to the course I had lost all confidence in handling a 4×4 over rough terrain and vowed never to do so again! But the desert medicine course gave me the opportunity to practice extraction of a 4×4 lodged in dense sand or mud using multiple handy tips from our amazing guides who when in their company I felt so safe. We were taught the use of the car if stranded – water in the radiator for drinking, sparks from the battery to generate fire, mirrors for signalling to aircraft and shade from the burning sun. What we learnt was enforced by tales of those who had left their car and fallen to dehydration, heat stroke or the sampling of flora which proved to be toxic.
On our final day all we had been taught was put into practice in a scenario situation.
Divided into groups of ten whilst trekking we came across a familiar patient lying in the scrub having been bitten by a snake. I must say it is a credit to the expedition medicine team of instructors as both groups located their patient, washed the wound, applied a compression bandage and splint, improvised a stretcher, transported the patient 2kms to an arranged rendezvous using GPS and radios, erected shelter and made a small fire in under 20 minutes. The final day was made extra special when we successfully tracked a herd of desert elephant to a water source. To see these amazing majestic animals who had hidden themselves so well all week except for their tracks was in a word, awesome. This was an experience that no game safari could have given me especially when we were “false charged” in an effort to protect their calves. This was the point at which it was time to go back to civilisation, go back to our electricity, showers, iPods and double beds with some profound memories.
Expedition medicine courses join my two loves of travel and medicine. They do not just teach everyday medics medicine relevant to an environment but also how to survive and care for others in these environments. With this knowledge travel to previously hostile, remote destinations becomes safe, possible and enjoyable. There is a great world of travel opportunity and as Winston Churchill aptly said a century to the year ago ” for the formation of opinion, for the stirring and enlivenment of thought and for the discernment of colour and proportion, the gifts of travel, especially travel on foot, are priceless”.
Dr Claire Roche | Junior Registrar in Emergency Medicine | Gold Coast Hospital
The next Expedition medicine course will be in Diving and Marine Medicine, Oman, United Arab Emirates, October 2008.
Visit the Expedition and Wilderness Medicine website for more details
Below Faan Oesthuizen of Kaurimbi Expeditions gives his top tips for defensive four wheel driving.
We are really excited about our new course – following the same schedule as our Lakeland course and with many of the same inspirational faculty we have linked up with Dartmoor’s premier training faculty, the Heatree Centre located near Newton Abbot to provide an additional course in May.
We are hoping that will make the travelling time shorter for some of you and reduce to carbon footprint of the courses, we will of course be working with the Woodland Trust as well to identify one of their projects close by which the proceeds of the course will help support.
Polar Medicine; A Cold Weather Medical Training Course
The setting for this year’s polar medicine training course was Alta, a small settlement, 72 degrees north and well within the arctic circle. A place with a deserted high street where you would be lucky to see one other passer by every 15 minutes, easily explained by a temperature at least ten degrees below freezing and a good foot of snow on the ground.
Base camp was a 40 km drive along icy roads to a picturesque mountain lodge by the name of Ongajoksetra. At the higher altitude the temperature was that much lower and if a wind was blowing, temperatures as low as minus fifty could be achieved. We were introduced to the Scandinavian team who would teach us methods of navigation across such tough terrain in harsh conditions and also to the Expedition Medicine team who would teach us polar medicine in a series of lectures and practical sessions both in the classroom and in the field. One more group I must not forget to mention is the team of fifty sled dogs who would provide another mode of transport across the snow.
My first day involved skidooing up a mountain demonstrating the importance of protective clothing, navigation aids and preparation for travel in severe blizzards with visibility of approximately two metres, sudden drops in temperature and rapid weather changes. I realised that without our trustworthy guide, Espen Ottem, we could become hopelessly lost in such conditions where you would be unable to survive more than a couple of hours at most. Our dog sledding guide, Pre-Thore was the perfect example of this as he told us of the time where inadequate preparation resulted in frostbite, blackening of his fingertips but fortunately no amputation. This story made me somewhat paranoid about the daily pain and numbness in my hands and feet when outside in the cold for prolonged periods. A “buddy system” was paramount to preventing frostnip. Simply by having that small exposed area of skin, pointed out to you to cover up
Dr Leslie Thomson, a consultant anaesthetist who had first – hand experience of polar medicine after spending several years in Antarctica taking part in the British Antarctic Survey gave an excellent lecture on hypothermia, bringing home how hypothermia is not just a condition seen near the poles but also in the Saturday night party goer who collapses under the stars, the homeless and the elderly. We were taught how to treat by various re-warming methods and when to commence C.P.R in the hypothermic patient sending home the message of not pronouncing death until warm and dead in certain individuals. This information was demonstrated by the story of Dr Anna Bagenholm , a 29 year old doctor who fell into icy water whilst skiing in Northern Sweden, immersed for approximately an hour, her body temperature was 13.7 degrees centigrade. C.P.R continued for three and a half hours alongside re-warming techniques such as bypass, bladder / stomach / peritoneal lavage and warm intravenous fluids. She survived to become the person with the lowest body temperature ever to survive.
Expedition and Wilderness Medicine obviously feel that first- hand experience is the best way of teaching and as a result each member of the group had to undergo cold water immersion. Prior to undertaking this challenge we were kindly taught about the cardiac arrhythmias that can be induced by the shock of entering the water, the short term cold water gasp reflex increasing the chance of aspiration and swimmers failure! One by one we stepped up to an ice hole in our thermal underwear and in the more daring members of the group a little less! to swim across icy water. I can confidently say that was the coldest I had ever been. As if several knives had been plunged into my body, breath taking and inducing chest pain, I swam across water of ridiculously low temperature to attempt getting out of the hole using my ski poles
Of our nights spent in the field we were taught how to construct snow holes. Five hours later our own little home with two double beds, stove, cupboards and shelves for our candles was constructed. It was as comfortable as it could be on a mountain side with winds blowing outside dropping the temperature to twenty below. I was amazed that the snow hole was so warm at five degrees compared to the outside however a slight air of nervousness was in the back of my mind as my avalanche detector slowly flashed in the corner and a rope attached to a spade inside connected our holes to other holes in case of us having to be dug out. The course perfectly demonstrated how to survive in such conditions
In summary the course prepared 25 everyday doctors to be able to traverse the polar landscape, recognise and competently treat local cold injury and hypothermia as well as to be safe expedition medics capable of caring for their groups and evacuating when required. To spend a week in such a location gave me the upmost respect for those who live in these regions and cross the landscape as part of everyday life, as well as a great respect for the land. In a day and age of global warming and melting of the polar ice caps it becomes paramount to look after our environment, to take only photographs and to leave only footprints.
Dr Claire Roche, Clinical Fellow in Emergency Medicine Countess of Chester Hospital. See the BMJ article.
The next expedition medicine course will be in Desert Medicine Course which will be held in Namibia, August 17th -23rd 2008.
To see the full range of Expedition and Wilderness Medicine Training Courses see here.
We are happy to announce the dates for our autumn Expedition Medicine course in the Lake District for the 9-12 September 2008 to be held at our training centre at the Barrow House Youth Hostel, Borrowdale, Keswick, Cumbria.
Find out more about the course at the UK expedition medicine training page here