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The International World Extreme Medicine Conference and Expo 2013 will host some of the very best speakers from around the world, who are amongst the leading figures in remote extreme medicine fields, including expedition and wilderness, pre-hospital, disaster, and relief medicine. Alongside the daily lecture series will be exhibitions from focused industry leaders, showcasing products and services to meet your extreme medicine needs.
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Dr Luanne Freer, leader of Expedition & Wilderness Medicines Mountain Medicine CME & FAWM course in Nepal and speaker at the 2013 Extreme Medicine Conference at Harvard Medical School, is featured in Outside Magazine…
THURSDAY, MAY 17, 2012
LUANNE FREER: BEHIND THE SCENES IN EVEREST’S EMERGENCY ROOM
This is shaping up to be one of the deadliest seasons on record, with 10 deaths so far and too many helicopter evacuations to count. Here’s a sneak peak at the doctors on the front lines of the world’s highest clinic.
Not surprisingly, this has been one of the busiest seasons on record at the Everest Emergency Room, the clinic at Base Camp that Dr. Luanne Freer founded 10 years ago. In late April, when Schaffer first spoke with Freer and her staff, they had already seen over 200 people. Since then, the number of patients has risen to roughly 500, many of whom were seriously injured or sick—there have been so many helicopter evacuations this year that they’ve lost track. There are multiple flights each day, both medical and non-medical, that Freer’s staff doesn’t necessarily hear about. In the aftermath of this latest disaster, there were seven evacuations from Camp II (and up to 6,700-meters) alone.
“We’re happy to see climbers,” says Freer, “but in the end, the thing that makes our hearts warm is seeing the little cooks and the Sherpas.”This year has been especially busy for the ER staff, which also includes Dr. Rachel Anderson, 33, of Manchester, England, and the organization’s first Nepalese doc, Ashish Lohani, 27. Within the first three weeks of the season—when we spoke—the ER had already seen 220 patients and overseen roughly a dozen helicopter rescues, more evacuations than in all of 2011. They’ve also seen some rare maladies, including two cases of deep vein thrombosis, an ischemic foot (no oxygen supply, though not frostbite related), a 33-year-old who had a stroke in the ER, and a trekker who’d suppressed her altitude headaches with narcotics and ended up with cerebral edema by the time she reached Base Camp.
In the 10 years that the clinic has been in operation, the biggest change is probably the new ubiquity of helicopters. Freer explained that climbers have always had rescue insurance, but it used to be that helicopters were incredibly scarce in Nepal. In some years, the only option for rescue was a military-owned, Russian-built Mi-8.
“Now we have these big machines,” says Freer, “and heli companies that are competing for the business.” Freer admits that she does sometimes feel under pressure to authorize helicopter evacuations in questionable cases and that she’s sometimes overridden by a climber’s personal physician back home.
“We have an ethical issue,” she says “You have to be reasonable. There was a guy down in Pheriche who wanted to call a helicopter because he had a sinus infection—you have to put your foot down somewhere.”
What Ails You
Here, Freer and Anderson explain the top five reasons people darken their tent flap
1. Khumbu Cough, aka high altitude cough: It’s a little bit controversial in the medical climbing community. There are some people who feel like it’s sub-clinical high-altitude pulmonary edema. “They’re not hypoxic yet, they’re not leaking yet, but it’s pulmonary pressure that causes it,” says Freer. “I’m not in that camp. I believe it’s the extremely dry air—relative humidity is four-five percent here—combined with the cold and it just cracks the bronchial tree.”
2. Viral Respiratory Infection, aka the common cold: Somebody who has a bacterial infection usually has a fever, though you can still get a fever with viral infections. Coughing up a lot of green stuff is usually a sign of bacterial infections. When you listen to the chest, you can hear it. Our bodies have a harder time fighting off illness at high altitude, and we’ve got a really impatient community here. “They want to be fixed in 24 hours with a tablet,” says Anderson. “They’ll say ‘I’m going up tomorrow, gimme the best thing you’ve got.’ And unfortunately, we have to tell them: You’ve got a cold. What would you do at home if you had a cold? We’re sensitive to it, but it gets frustrating.”
3. Gastritis: ”It’s more prevalent among the native population,” says Freer. We’re not talking about infection, this is inflammation of the stomach lining that causes pain—acid reflux. With hypoxia from the altitude, the stomach lining doesn’t get as much oxygen, either. It can be more serious up here. When you’re doing really hard work, your body has to decide where the oxygen goes. “The muscles and brain always win out,” says Anderson, “and the gut loses.”
4. Infectious Gastritis: The stomach bug. A simple matter of not washing your hands, and not properly treating water and food. Antibiotics are effective against these.
5. Altitude Issues: Periodic breathing, insomnia, acute mountain sickness (AMS), high-altitude pulmonary and cerebral edema (HAPE and HACE). “We know from big studies that at the altitude of Lobuche (16,210 feet), 50 percent of people will develop AMS—headache, dizziness, loss of appetite,” says Freer. What’s different up here is that people are self-selected. Most people who are going to get sick get sick at lower elevations and never make it to Base Camp. And climbers tend to be pretty well tested at altitude. It’s a group that’s self-selected for success.
Expedition & Wilderness Medicine courses of interest…
With the Extreme Medicine Conference due to kick off tomorrow we are pleased to have the Android app ready for you…
For those of you who missed to iPhone app please use this link
We have written the book and now we have made the film…
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To support the Extreme Medicine Conference at the Royal Society of Medicine in London EWM is happy to announce the launch of its supporting iphone app – download your copy here
The Wilderness Medicine Society has granted the Extreme Medicine Conference 32.25 credits towards the Fellowship of Wilderness Medicine if all 4 days of the conference are attended
The Academy of Wilderness Medicine is a modular system of adult education that organizes the broad range of information in the discipline of Wilderness Medicine. It delivers them in a professionally packaged, standardized fashion according to modern concepts of medical education using objectives as the basis for learning experiences and outcomes evaluation where appropriate.
The most visible of the Academy’s modular programs, and the one that promises to be the most popular, is the Fellowship program (Fellow of the Academy of Wilderness Medicine TM or FAWM). This initiative offers a means to identify those who have achieved a demanding set of requirements validating their training and experience in Wilderness Medicine for the assurances of patients, clients, and the public at large. Society members enroll in the Academy and, by completing lessons from a pre-established Wilderness Medicine curriculum as well as receiving credit for specefic, indentiable experience; accumulate credit toward becoming a Fellow.
Any current member of the Wilderness Medical Society who successfully completes the requirements will have the distinction of being a registered member of the Academy of Wilderness Medicine and entitled to use the designation Fellow of the Academy of Wilderness Medicine (FAWM) and may reference it on resumes, business cards, and advertisements.