Category Archives: Wilderness medicine

Staying safe in the wilderness

Having spent many years enjoying the wilderness across 6 continents (hold on Oceania, I’m coming), including wintering over in Antarctica and years of service in mountain rescue, and then gaining the perspective afforded to me by having my own serious wilderness accident, I am very mindful of how we balance the risks and rewards of wilderness adventures.  Greg Hill captures the essence of some very simple but powerful advice for staying safe in this brief video.  Watch and reflect!

Transcribed here in my words:

Greg Hill’s 5 Rules for Staying Safe in the Wilderness

  1. Be afraid – be aware of the risks, and cognitive of the risks.
  2. Be prepared – get educated, find mentors, be guided, get good equipment, take the courses, develop your own mountain sense.
  3. Have a great team – find good partners.
  4. Have a plan – prepare for eventualities, have an escape route
  5. Be vigilant – maintain situational awareness, reassess plans fluidly.

Actually, that sounds like a good set of 5 rules for prehospital emergency medicine, anaesthesia, or any other high-stakes game!

MCSA/ICAR/WSAR Mountain Medicine Workshop 2016 Presentations

As promised, open access to my two talks from the Mountain Medicine Workshop hosted at the MCSA in Cape Town, 2 May 2016.  Please feel free to use for reference, or direct questions to me!

Austere & Confined Space Airway Management:

Practical Wilderness Analgesia:

Kilimanjaro Mountain Medicine Expedition 2016 – Photo teaser

A few photographs from the 2016 WildMedix Kilimanjaro Mountain Medicine Expedition, courtesy of our expedition photographer, Chanel Rossouw (@chanel_r).  More to follow!

Snow Hill Island Expedition Postponed

Dear friends and followers,

It is with a very heavy heart that I have to inform you that we will not be departing for Snow Hill Island in the next few days. We’ve been forced to make the difficult (and costly!) decision to postpone the trip by a season or two for safety considerations. This is not an easy call to make, especially with the heavy emotional, financial and time investment we all have made in the expedition, but we believe it is the right course to follow.

As you are no doubt aware, the ice conditions in the Antarctic are at a record high this year, which has made the approach to the Antarctic Peninsula uncertain within our time-frame. This led to the two team members doing penguin research to withdraw or risk losing their research window this year. After a lengthy discussion and much examination of the ice data, the remaining 6 team members decided to continue with the expedition.

It came as a heavy blow when (only 10 days before departure) one of the core team members was also forced to withdraw at the eleventh hour due to a life-threatening illness in his immediate family. Faced with unusually bad ice conditions and a team now dangerously reduced in numbers, we have elected to postpone the expedition. Effectively, this means we will have to try again next October or the year thereafter.

We see this not as a failure, but as a challenge and change in schedule. We are now in a stronger position, having laid the groundwork for all the logistics, gathered vast amounts of data, done endless preparation and provisioning, and ironed out many potential problems with equipment. The knowledge, contacts and systems we have developed will facilitate our next effort.

For our planned physiological research, we see this as an opportunity to expand the conceptual basis. We have already (in the last week) embarked on two projects which were deferred to get the expedition underway, but will actually enhance our fieldwork. Taking a long view, this may be a blessing in disguise. We have already opened some doors (through the Snow Hill preparation) that may accelerate the research far beyond what we envisioned on this expedition…exciting times ahead.

On a personal note, Franelise and I will still be traveling to the Falklands in a few days, where we will sort out, store, and recover some of the expedition gear. We’ll be meeting with role players there and putting the pieces into position for the Snow Hill Island Expedition to come. Thereafter we’re going to disappear into the mountains and fjords of Patagonia for a well-needed break 😉

We are deeply indebted to the individuals and companies that have been so supportive of the expedition, and will be doing our utmost to meet your expectations now and in the future. We take to heart the words of Roald Amundsen: “Obstacles are merely things we overcome”.

Blast from the past

ross-hofmeyr

I stumbled across this article online to day, which I didn’t know was available other than in the print version of Junior Doctor magazine years ago.  It’s a nice vignette for people thinking about working as a polar expedition doctor.  Brings back warm memories of SANAE IV, and heightens the longing to get back down south.  One month to go before we depart for the Snow Hill Island Expedition

Have a look at the article on JuniorDoctor.com here:  Extreme Medicine – The Antarctic Doctor

New aeromedical presentations available

I’ve uploaded another two talks onto the ‘Presentations’ page.  These are lectures I gave recently as part of the ILS Aviation Health Care Practitioner’s course at the Red Cross Air Mercy Service here in Cape Town.  The should be considered introductory, and there is a lot of (verbal) content not in the presentations, but the framework may be of interest.  I’m getting more familiar with using Prezi and liking it more every time.  Click the arrows to advance or rewind through my sequence.  FYI – You can click, drag and zoom freely at any time, and return to the sequence by clicking on the arrows again.  Enjoy!

 

Locum MO position on Tristan da Cunha

An interesting position has emerged – Tristan da Cunha Island is looking for a locum medical officer for a limited period of time. See the info below:

“The usual contract is 12-24 months. There is however now an unusual
opportunity. They are struggling to find a replacement doctor. So
much so that they may be willing to break it up in periods of a few
months each (depending on the schedule of the supply ship – see
attached schedule) till the end of September. At the moment there are
two windows of opportunity: 26 May to 18 July and 18 July to 2
October. Perhaps the latter may still be broken up as well but the
ship’s schedule is not known yet.

There are some interesting You Tube video clips here.

As can be expected there will be the occasional medical emergency
(MI, heart failure, etc). Obstetrics is also a required skill – a
baby will be due in June. However, on the rare occasion you need to
be able and willing to give an anaesthetic / spinal and then do the
surgery yourself (eg c-section, appendectomy etc). There are 5 nurses
that can give a hand.”

You’d need to be at least and MO with relevant qualifications and experience – contact me if genuinely interested.

Good overview on field management of femur fracture

The Expedition Medicine team (www.expeditionmedicine.co.uk) have put together a nice review of field management of femur fracture, written by their medical director, Dr Amy Hughes.  In particular, it has a good step-by-step pictorial guide for applying the Kendrick Traction Device (KTD), one of my favourite pieces of kit.

The degree of haemorrhagic compromise caused by even a simple closed femur fracture shouldn’t be understated:  Expecting 1500ml of loss into the compartment, this by definition puts the patient into at least Class 2 shock.  While it is good to see wilderness/expedition medics au fair with hypotensive resuscitation,  we must not lose sight of the fact that maintaining adequate perfusion trumps the fear of dilutional coagulopathy and ‘clot-popping’, especially in the face of delayed/lengthy evacuation.  It’s a fine balance, especially in the wilderness.

I’d also ike to see the analgesia section expanded a little – in particular, the use of femoral block and the addition of ketamine to the armamentarium – but as that’s one of my personal soap boxes and fields of interest I’ll cut them a little slack 😉

The other great things to see in print are the promotion of simple cephalosporin antibiotic prophylaxis (not the shocking top-end drugs being advised from our US tactical compatriots) and encouragement to use adequate irrigation (utilising Wilderness And Tactical Environmental Rinse, aka WATER, *grin*).  Cue one of my favourite quotes:  “The solution to the pollution is dilution!”

Kudo’s on a good blog, folks.

WildMedix course getting a daily detailed review…

It is to be assume d that I believe that WildMedix is providing unique, challenging and useful training.  However, it is very good to get an unbiased view from the outside looking in!  Gaynor Schoeman – aka “Flygirl” – won a free course as a sponsored prize in the last Overberg Paragliding Club “Gatskop” competition, and when she expressed an interest in the Wilderness First Aid course we decided to upgrade her prize.  She seems to be loving it, even if it involves being at the sharp end.  Read her ongoing review here, complete with pictures of some of the action.  I have cuts and bruises 😉