Antarctica here we come (again!)

Antarctica; Expedition & Wilderness Antarctic Medical Conference, 10 CME. 2014

14 DAYS/11 NIGHTS – November 28 – December 10, 2014

(depart from U.S. & voyage end date) ABOARD NATIONAL GEOGRAPHIC EXPLORER

EXPEDITION HIGHLIGHTS

  • Spend a week exploring Antarctica aboard our fully equipped, icestrengthened ship.
  • 40+ years of Antarctic expeditions assures you of the best possible experience.
  • Few things compare to a hike, Zodiac cruise or kayak foray amid the icescapes of Antarctica.

Glide around enormous tabular icebergs by Zodiac, walk along beaches covered with thousands of penguins, and kayak amid abundant wildlife. Learn about the Lindblad legacy, dating from 1966, as you travel with Ice Masters, Expedition Leaders and Naturalists who have hundreds of journeys under their parkas. On every expedition, a National Geographic Photographer will give talks and one‐on‐one photo tips in the field, where it counts. An Undersea Specialist captures rarely seen footage of life beneath the icy surface for viewing in the comfort of the ship’s lounge.

Join us aboard the National Geographic Explorer, a state of the art expedition ship. The medical element will be led by Paul Auerbach, MD, MS, FACEP, FAWM, who is the Redlich Family Professor of Surgery in the Division of Emergency Medicine at Stanford University. He is the world’s leading authority on wilderness medicine and is one of the world’s leading authorities on emergency medicine.

A graduate of Duke University and Duke University School of Medicine, as well as the Stanford Graduate School of Business, Dr. Auerbach is editor of the definitive medical textbook Wilderness Medicine, and author of the books Medicine for the Outdoors (named one of the 10 outstanding healthcare titles for 2009 by the Wall Street Journal), Field Guide to Wilderness Medicine, Diving the Rainbow Reefs, and Management Lessons from the E.R. He is a founder and past President of the Wilderness Medical Society, and editor emeritus of the peerreviewed medical journal Wilderness & Environmental Medicine. Dr. Auerbach serves as Chief Medical Officer for Healthline Networks, national medical consultant on hazardous marine animals to the Divers Alert Network (DAN), member of the National Medical Committee for the National Ski Patrol System, and elected member of the Council on Foreign Relations.

**Book by July 31, 2013 for complimentary airfare (based on roundtrip economy group flights Miami/Buenos Aires). New bookings only; subject to availability; not combinable with other offers.

Allegedly one of the world’s most amazing medical expeditions!!

Download the PDF here …. Expedition Medicine Antarctica Itinerary 2014

 

Antarctic Wilderness Medicine ConferenceAntarctic Wilderness Medicine Conference

MSF in Syria: Treating major burns patients

The team working in one of Médecins Sans Frontières/Doctors Without Borders’ (MSF) hospitals in northern Syria has learned to adapt to a changing situation. As the front lines have moved further away, the influx of patients has decreased. But, in the last months, the number of burns victims has grown.   Article © Médecins Sans Frontières/Doctors Without Borders’ (MSF)

During the winter, families rely on rudimentary stoves for heat. Domestic accidents occurr frequently or gunfire causes panic. In these moments, stoves may explode or fuel canisters may catch fire.

“Burns patients arrive several times a week,” explains Dr. Anne-Marie Pegg, an MSF emergency physician. “Their faces and hands are always the most affected.”

Major burns

When a major burn patient arrives in the emergency room, the first step is to treat the pain because the wounds are agonising. The patient is then placed on a drip to replace lost fluids.

The wounds and dead skin must also be cleaned, as they are a source of infection, and then bandaged. This can be done only in the operating room under anesthesia.

The surgeon lays down sterile compresses coated with sulfadiazine, an anti-bacterial cream, so that the dressings can be changed every two or three days without tearing the skin.

The team’s physical therapist often participates in the procedure and may splint the knee, for example, so that it remains extended.

That way, retraction will not occur as the skin scars, leading to loss of mobility that results when the affected part of the body heals in the wrong position.

Treating burns patients

That’s what the team had to do in the case of a six-year old girl with burns across her knee.  Another child was burned on the hands and face. “To treat the burns on the palm of the hand, I placed a little roll in the middle of the palm to maintain the functional position, which is necessary to carry out the activities of daily life,” explains Ricardo, MSF’s physical therapist.

Treating the face was more complicated. A thermoforming mask was required to prevent skin retraction during scarring and preserve facial features.

“I covered the child’s face with sterile compresses and used a thermoforming plate to make a mold, emphasising the injured areas.

“Then I made a plaster mask, which was my positive. I hollowed out the plaster around the eyelids, nostrils and the corners of the mouth,” added Ricardo.

The next step involved setting another thermoforming plate over the positive to obtain the mask, which was placed, in turn, over the face – under anesthesia, of course.

The mask is then adjusted as the scarring process proceeds. “When the swelling lessens, you have to hollow out around the cheeks, dimples and the chin in order to reshape the facial features.”

Nutritional needs

Treating major burns patients also requires following very strict rules of hygiene as these patients are at great risk of infection. Their nutritional needs are also twice the normal amount.

“Their diet must include a lot of protein,” Dr. Pegg says. “If the children want cake, we are happy to give it to them. They can eat everything they want. Eating properly is key to healing.”

But that’s not always enough. The surgeon may have to perform skin grafts and healing is a lengthy process. Even when a major burn patient leaves the hospital, he or she must return approximately every three days to have the dressings changed and for physical therapy.

But winter is coming to an end. The MSF team treated 85 major burn patients between January and March. And maybe that number will decline.

 

Off interest

EWM’s Facebook group smashes the 20,000 ‘likes’ barrier

Wow! 20,000 followers on Facebook!! – our supporters out there must like what we do as much as we love doing it which is great and we will continue to innovate, improve our courses and present the latest in remote medicine so that we not only keep what we are presenting fresh but also continue to keep it cutting edge and exciting for ourselves as that the reason we started all this over a decade ago!!

If you havent already found our Facebook page you can do so by following this link…. https://www.facebook.com/ExpeditionMedicine, its really a very useful area presenting the latest in remote medicine jobs, interesting links and discussion, discounts on courses and leavened with a dose of legendary EWM humour!!

To celebrate we are offering some once-in-a-EWM-lifetime  (or at least until we get the next milestone that we feel like throwing our hats into the air for!) discounts which will last for a total limited of 20 hours so early afternoon tomorrow GMT cus that how we rock our marketing world here – we love the share the joy!   Visit the Facebook page and ‘like’ is to get the get the very best news and views!

*only applies to new bookings and is limited in number.

Expedition & Wilderness Medicine Facebook Page

Use these codes at checkout on the EWM website

Use these codes on the Extreme Medicine Conference website

Doctor needed to support community development programme in India for 3 months this summer

Raleigh International is a youth and sustainable development charity that brings together people of all ages, backgrounds and Raleigh Internationalnationalities to contribute to sustainable development projects overseas. Raleigh is recruiting a Doctor to provide medical support to their International Citizen Service (ICS) programme this summer.

International Citizen Service is a unique opportunity for you to work with communities in developing countries, making a real difference to the lives of people overseas, and more locally in the UK. Funded by the Department for International Development (DfID), Indian and UK volunteers work together to develop an understanding of international development, to have a positive development impact on rural communities and to engage as active global citizens post-programme.

The role

The Fieldbase Medic role in India is responsible for providing support to the ICS programme. The role consists of working independently to look after the general health of all volunteers and supporting the operational decisions relating to managing emergencies that may occur alongside a team of non-medical fieldbase staff. Medical support for this role will be provided by Raleigh’s Medical Coordinator who is based at our head office in London.

At the start of the programme you will stock and prepare medical kits for all project sites and vehicles, complete medical interviews with each volunteer in order to understand the health needs of the programme, and give comprehensive first aid instructions to all volunteers. You will work closely with Raleigh’s staff and volunteers in preparing health related training and educational materials for use in the rural communities on project. You are also responsible for preparing regular medical reports to inform the Raleigh Medical Coordinator in London about the on-going medical health status of volunteers.

The FB Medic will predominantly work from fieldbase. At regular intervals during the programme the FB Medic will deploy on a mobile clinic to visit all ICS project teams in rural communities.

Essential skillsindia (c) Mark Hannaford

  • Doctor with minimum of 3 years experience post-qualification
  • Medical skills that are transferable to remote static environments
  • Ability to teach first aid and promote health and safety on programme
  • Able to prioritise/triage
  • Good communication skills
  • Ability to work as part of a multi disciplinary team

Programme Dates: 9th June – 8th September 2013

Salary: Stipend of £1950. Flights, vaccinations and living expenses (food and accommodation) whilst on programme will also be provided.

Application Deadline: Friday 10th May (applications will be reviewed on a first come first come basis so please apply as soon as possible).

For the full role description and application details, click here.  Raleigh International are especially interested in hearing from applicants connected to Expedition & Wilderness Medicine, please mention our name when applying.

Of interest

New US based Trauma Course Launched…

In response to the tragedy of the Boston Bombing  and also working in tanden with the Extreme Medicine Conference*

This course is an intensive 2 day Pre-Hospital Trauma and Medical Emergency course for medical practitioners who may not have regular exposure to witnessing and managing acute medical emergencies and/or trauma injuries day to day, and who are interested in improving and refining their skill base whether it be for use as a first responder, in a remote medical surgery setting or in a pre hospital setting.  Taught by present or former HEM’s medics.

Accredited for 15.25 CME points

* Extreme Medicine ’13 Conference Attendees receive a 15% discount on booking this course.

Outline

The weekend will consist of small group interactive workshops, (max 10), with practical sessions and moulages (clinical scenarios using a manikin and all relevant medical equipment) and lectures. The learning is interactive, experiential and dynamic.

The topics and practical workshops covered over the weekend will include basic trauma care such as simple fracture reduction, basic splinting, ring blocks, suturing, wound dressings, burns, minor injuries; major trauma care such as detailed primary survey, airway management (including use of iGELS), chest injury management, haemorrhage control including pelvic and long bone fracture management, permissive hypotensive fluid management, head injuries; and assessment and management of medical emergencies such as the treatment of the severe asthmatic, anaphylaxis, seizures, myocardial infarction, sepsis, heat illness – all in the pre-hospital and remote environment setting (i.e. learning how to optimise care prior to a patient getting access to hospital).

This will be delivered by experienced pre-hospital Emergency and Anaesthetic practitioners.

Course Accreditation

In association with the Wilderness Medical Society we are able to offer the ability to earn 15.25 CME and credits towards the Wilderness Medicine Fellowship Program to gain the FAWM.

‘This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Expedition Medicine. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians.
The Wilderness Medical Society designates this educational activity for a maximum of 15.25 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity.’

(Accommodation not included)  A special course rate has been negotiated with the  Longwood Hotel – just quote this reference when booking ‘EXTR1027′.  click here

Of interest

Urgent care medic needed in New Zealand

Registered medical practitioner required to work at accredited Urgent Care Clinics situated on the mountain at either Whakapapap or Turoa, Mt Rump for 2013 winter ski season.

A & E and Orthopaedic experience essential. Ideally you would have at least three years post-grad

 

What’s involved

Deliver acute medical care in accordance with the Turoa and Whakapapa Urgent Care Clinics Manuals

Assist with the provision of medical facilities in keeping with stated company goals

Assist with the medical training of Safety Services staff

Perform any duties as requested by the Clinical Director and Practice Manager as required to enhance the performance of the company and assist in achieving company goals.

Actively foster a service-focused culture within the company

Requirements

Ability to build effective working relationships with a wide range of people.

Respond in a positive and proactive manner to feedback from supervisors/ managers.

Maintain an approachable and co-operative persona with co-workers and customers, both internal and external.

Commitment to a strong customer service ethic.

Punctual and reliable.

High energy levels.

For more information or to apply send a CV and covering letter explaining why you are well suited for the role to Angela at aguy@mtruapehu.com. Please mentioned ‘Expedition Medicine’ when enquiring.

Of interest

MSF in action in the Congo, Early Bird tickets sales for Harvard Extreme Medicine and more…

Expedition & Wilderness Medicine

Expedition & Wilderness Medicine

MSF in action in the Congo, Early Bird tickets sales for Harvard Extreme Medicine and more…

Médecins Sans Frontières in action

Médecins Sans Frontières (MSF) Surgeon David Lauter reports from the DRC

It’s late in the evening and I’m on call overnight again. After a busy day in the operating room (OR) there hasn’t been much activity since 9pm. I ate a late dinner (late for me that is; the French and the Congolese here both like to take dinner at 8pm) with R, one of the Congolese nurse anesthetists here. She has worked for MSF for several years, spending a month at a time in Rutshuru between time at home in Goma with her husband and two daughters…

Read the full article here…  Article © msf.org

Of interest - Pre Hospital Trauma 2 day course.

Wilderness Medicine Course

Expedition Medicine course at the National Mountain Centre, Wales

20 May 2013 to 23 May 2013
Join the eclectic and diverse EWM team at the next iconic course on the slopes of Snowdon.  Great fun, great learning and superb networking…

16.3% as ‘very good’, 82% rated the course as ‘excellent’, and 1.7% as ‘good’

Course staff were fantastic, well organised, enthusiastic, informative and delivered the lectures with technical ability. Best course I’ve been on.’

RACGP features Dr John Apps

RACGP features Dr John Apps, Course Director Polar Medicine, New Zealand.

Dr John Apps’ career in wilderness medicine has taken him on some extraordinary adventures. He now passes on his skills to other doctors.
There aren’t many people in the world who can run a marathon, let alone one at nearly 5000 metres elevation through the Himalayas. Rarer yet is a doctor who can keep up with the runners and tend to them in harsh conditions if anything goes wrong. John Apps is such a doctor. Overseeing the medical services for the Everest Marathon is all in a day’s work for the British-born adventure doctor and part-time GP.  Read the full article here…

To find out more details about Polar Medicine NZ 21-26 July 2013 please follow this link …. Polar Medicine CME 

Register for your place.  Email Catherine Harding

Extreme Medicine Conference at Harvard Medical School

Harvard Extreme Medicine Conference

EarlyBird Ticket sales ends soon

With the tragedy of the Boston Bombings fresh in our minds it seems a lit bit odd to mentioning that early bird tickets sales end of this month but the importance of pre hospital care and disaster management is clear.

Make sure you secure the best tickets for this conference by booking now….

boston.extrememedicineexpo.com

Thank you for reading our news!

If you require any further information on any of our courses or how you can get invovled please contact us.

Email admin@expeditionmedicine.co.uk or
Call us on +44 (0)1234 766778

 

Extreme Medicine Conference Twitter Hash Tag #extremeexpo

This years Extreme Medicine Conference hosted this year at Harvard Medical School has its own Twitter hashtag #extremeexpo so that you can keep up to date with all news about the conference, its speakers and developments in the world of extrem

Extreme Medicine Conference Twitter hashtag

e medicine…

#extremeexpo

Please follow us and forward other twitter sites of interest

 

The Royal Australian College of General Practitioners features EWM

The Royal Australian College of General Practitioners magazine features our very own John Apps and the Polar Medicine course in New Zealand – see
pages 14-15review of dr john apps and polar medicine course

Medicine in the wilderness by Nick Johns-wickberg – see the full article here

Dr John Apps’ career in wilderness medicine has taken him on some extraordinary adventures. He now passes on his skills to other doctors.

There aren’t many people in the world who can run a marathon, let alone one at nearly 5000 metres elevation through the Himalayas. Rarer yet is a doctor who can keep up with the runners and tend to them in harsh conditions if anything goes wrong. John Apps is such a doctor. Overseeing the medical services for the Everest Marathon is all in a day’s work for the British-born adventure doctor and part-time GP.

‘I stationed a number of doctors on the descent route and my job was to jog behind the slowest person,’ Apps said. ‘There’s a lot of up and down, there’s a lot of rough ground, a lot of yaks to avoid.’

Apps’ work throws a wide range of challenges his way – yaks included. Overseeing the marathon isn’t easy, but Apps said the hardest part of that job is convincing the ultra-competitive runners to take it easy while acclimatising to the high altitude. He has also provided medical support for an extreme marathon in Antarctica, where the flatness of the course is offset by the fact that, as he puts it,

 ‘it’s just blooming cold’.

‘You’re hauling in all these huge lungfuls of air at minus 15°C and it does take it out of people,’.

Read the rest of this entry »

Médecins Sans Frontières (MSF) Surgeon David Lauter reports from the DRC

Médecins Sans Frontières in action…

Article © msf.org

It’s late in the evening and I’m on call overnight again. After a busy day in the operating room (OR) there hasn’t been much activity since 9pm. I ate a late dinner (late for me that is; the French and the Congolese here both like to take dinner at 8pm) with R, one of the Congolese nurse anesthetists here. She has worked for MSF for several years, spending a month at a time in Rutshuru between time at home in Goma with her husband and two daughters.

Among the cases toward the end of the afternoon were two men in their early 20’s with gunshot wounds, one in the arm, the other in the leg. They had been seen at another smaller hospital where their wounds were bandaged and splinted, then transferred to Rutshuru for definitive care. Ideally we would have x-rayed the injured extremities immediately but the x-ray machine was down for the day so they came to the OR for debridement [the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue] and wash-out of their wounds without x-rays.

It’s been awhile since I’ve treated someone with a gunshot wound though I saw my share during residency on the trauma service. There’s a significant difference between wounds from a handgun and a military rifle. The speed of a bullet as it leaves the barrel of a typical 9mm handgun is 300 meters/sec compared to 900 meters/sec for a military rifle. The force behind the bullet is in direct proportion to the speed of the bullet squared. This means that if a bullet from a Kalashnikov rifle is traveling 3 times faster than a bullet from a Glock 9mm handgun, it carries 9 times the impact. Compared to gunshot wounds at home, the ones in Rutshuru come with bigger holes and more tissue destruction. The protocol here for treating gunshot wounds is based on the recommendations of the International Committee of the Red Cross. It involves two operations, the first being debridement of all infected and dead material with leaving the skin edges of the wounds open, thus avoiding secondary infections that threaten life and limb.

The man with the leg wound had two holes in his upper leg. His smaller hole was the size of a US quarter, coming in the back of the leg at the mid hamstring and his larger hole was the size of my fist, coming out in the front just above his knee a bit to the outside. After induction of anesthesia, we removed his splint, pulled the compresses that had been packed into the wounds and surveyed the damage. There was a large cavity with torn muscle and bone fragments between the two holes. Almost all the bleeding had stopped. I could feel an abnormally rough texture to his femur bone but his leg felt structurally stable. I was comfortable that the main artery in his leg, the superficial femoral artery, was intact because it travels around the other side of the femur away from the damaged area, plus I had felt a good pulse in his foot before we started.

Using a scalpel I cut the bruised, dead skin from around both wounds so that I could better see into the cavity. I removed fragments of cloth and bone and cut away fat and torn, bruised muscle until I was satisfied that anything that would act as a source for bacteria to grow in had been removed. I rinsed out the cavity with saline and Betadine, put a loose dressing on both sides so that any infection could wick out and wrapped the wound. With the help of the nurses in the OR, we put his leg in a plaster splint to immobilize it until he can get an x-ray tomorrow.

The next patient clearly had an open fracture of the upper arm because even with the arm immobilized in a splint, it didn’t look quite anatomically correct. I felt a strong pulse at his wrist, indicating no major arterial damage. It was harder to be certain about the three major nerves (the median, ulnar and radial nerves) that travel through the upper arm. There is a quick examination to see if they are working but it can be difficult to rely on when your patient is in pain, has received narcotics and you don’t share a common language. After induction of anesthesia and the removal of his splint and dressing I could see he had a 2 inch diameter hole through his mid upper arm. By pulling on his arm I could see straight through to the other side. Needless to say, the exposure of his cavity was good. His humerus was broken with the two ends staring at each other 180 degrees apart and a visible gap. Without an x-ray it was impossible to tell how much of the bone, if any, was missing. I debrided skin and fat, cut away pieces of bruised and non-viable muscle with attached bone fragments and washed out the wound. There weren’t that many bone fragments so either he hadn’t lost much bone (good) or a big chunk had already been blown out (bad) or I had done an inadequate debridement and left dead bone fragments (worse). I looked in the cavity to see if I could identify the ends of a transected major nerve but didn’t see any. If I had seen one, I would tag it with a blue suture to help find it at the next operation when it would be repaired. Having completed the debridement, I washed out the wound with saline and Betadine, checked to be sure there wasn’t any more bleeding, placed a dressing followed by a plaster splint and we were finished.

Like all our patients with gunshot wounds, these two will come back to the OR in four or five days for re-evaluation. For smaller wounds without bone injuries or secondary infections, we close the skin at the time of the second operation (called delayed primary closure or DPC if you want to talk like a trauma surgeon). For larger wounds, we wait until they are ready for a skin graft. For patients with open fractures who need an external fixature (our second patient will definitely need one to salvage his arm), it is placed at the time of the second surgery. Some readers may be interested in looking at the ICRC publication “War Surgery” (just google search “war surgery ICRC” and you will find a downloadable pdf) which talks authoritatively about the treatment of high velocity gunshot wounds (some photos are not for the squeamish). As well, it provides a readable (at least I thought it was readable, but then I’m a surgeon) overview of the tremendous variety of injuries that occur during war and natural disaster and the complexities of treating these injuries.

When I left home to come to Rutshuru, there was a renewed and vigorous debate in the US about the restriction of military style rifles for personal ownership that began after the recent tragedy in Newtown, CT. The subject is a political hot potato involving powerful lobbies, heartbreaking tragedies and passionate arguments on both sides. Regardless of where one stands on those issues, there is one indisputable fact; bigger guns make bigger holes. If you ever get shot, hope it’s with a handgun and not an assault rifle.

Work for MSFhttp://www.msf.org.uk/work-us

Of interest