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Take a look at our latest newsletter to find out more about the amazingly adventurous Dr Andrew Peacock

 

Expedition & Wilderness Medicine

Have you booked your place for Dartmoor ’15? We’ll host our next Expedition & Wilderness Medicine course, 16 – 19 November and have new additional content on offer. Places are filling up fast, so if you’re keen to kick-start your Expedition Medicine career join us North Devon.

What’s a ‘traditional’ medicine career?

Dr Andrew Peacock works with us as a faculty member and also as Medical Director for Expedition & Wilderness Medicine Australia. Andrew recently spoke with RedBull.com about his adventurous career, giving an insight into how he balances a passion for outdoor pursuits and medicine. Click HERE to learn what makes the most adventurous of medics tick.

Poster competition

We’re super pleased with our new look Extreme Medicine Conference website. We’ve just added a page for our poster competition.
We’ve made it nice and easy for you to register and submit your abstract. Click HERE to be taken straight to the poster page.

Blogging for all the right reasons.

According to Uncharted Expeditions, “PTSD is a growing epidemic and the dialogue needs to continue for others to step out of the silence and get help”. In this blog one paramedic is finding peace in the mountains and she’s sharing her experiences.
This is a frank and brave blog, but one that is of great value to the writer and will hopefully help many others along the way. THIS LINK will take you straight there.

Antarctic job opportunity

The University of Texas Medical Branch is looking for an Emergency or Family Medicine physician with acute care experience to join them at the Amundsen-Scott South Pole Station.
You must have US citizenship, a US medical license and a love for dark snowy places.
The clinical load will is light, but the opportunity to work in this remote location should appeal to physicians interested in extreme and altitude medicine. This role provides a number of rare experiences like a view of the Aurora Australis and Milky Way from a perspective few others are fortunate experience.
Visit our jobs page HERE for more information and the relevant application contact details.

Kili’ opportunity

Action Challenge are looking for a medic to join their Kilimanjaro expedition, August 20 – 30. This expedition will follow the Lemosho route. The medic must be a fully qualified doctor – altitude experience and expedition medicine course attendance is preferred, but not essential and expenses for the trip will be covered.
If you’re looking for an adventure taking you up the world’s highest free standing mountain and are keen to tick off one of the Seven Summits, this could be right up your street.
For more information, take a look at the job advert HERE or to contact Action Challenge direct, call James Holland on +44 (0)20 7609 6695.

It’s your time to shine

If you have a story to share or know we want to hear from you. Blogs, vlogs interviews etc. are all welcomed, click HERE to share your experiences.

Expedition & Wilderness Medicine Courses

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Expedition & Wilderness Medicine and Extreme Medicine Conference & Expo.

Have you used ‘WEMEEXPO15SPECIAL30′ ? There’s only 8 days left to take advantage of this massive 30% off the Extreme Medicine Conference & Expo tickets. Full Ts&CsHERE

Dive Medicine – Raja Ampat

Only 1 space remaining!
From September 21, we’ll be spending 11 days exploring the under water paradise of Raja Ampat. Home to over 1,050 divers fish species, 537 coral species and 6999 mollusc species, this stunning location is considered by many divers to have the richest composition of sea life anywhere in the world.
During this exciting expedition you’ll be staying on the liveaboard Shakti, taking part in up to three dives per day, with up to two hours of CME per day – leaving you plenty of time to enjoy your surroundings and share experiences with your fellow delegates and faculty.
If you’d like to snap up the last space email us HERE and we’ll hold the space for the first person to get in touch.
For more information on this trip clickHERE.

Polar Medicine – New Zealand

In a little over two weeks we’ll be enjoying the snowy wonders of the Southern Alps, and we now have capacity for a couple more delegates to join us.
Our highly experienced team will develop your specialist skills with practical sessions giving you hands on experience of rescuing and treating cold water immersion, frostbite, altitude related illnesses and hypothermia. Essential cold weather skills such as building shelters, snowshoeing and dog sledding will all be included.
If you’re thinking of applying your medical skills in a cold environment, you can’t go wring by starting here.
For more information on Polar Medicine click HERE.
If you’d like further information on our Polar and Mountain courses the check out THIS LINK.

Kili’ medic opportunity

Action Challenge are looking for a medic to join their Kilimanjaro expedition June 30 – August 09 2015. The expedition will be following the Machame route. The medic must be a fully qualified doctor – altitudue experience and expedition medicine course attendance preferred but not essential. Expenses for the trip will be covered.
Contact James Holland +44 (0)20 7609 6695 for more info.

Conference news

Keep your eyes peeled for a special newsletter this weekend with conference announcements that you just wont want to miss!

Poster Competition Liaison

James Yates works for the Great Western Air Ambulance as a Critical Care Paramedic. James has worked nationally and internationally, as a clinician and educator, as well as spending time with HART and UK-Med.
After completing an Expedition & Wilderness Medicine course, James has worked on various events across the world and we’re please he can now use his skills to assist us.
To entre our poster competition for the Extreme Medicine Conference email usHERE

 

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The view from EWM towers is a very exciting one and here’s why.

Expedition & Wilderness Medicine

News and updates

The view from EWM towers is a very exciting one and here’s why.

Moving forward

We’re delighted to announce the development of a new postgraduate education programme in Expedition, Wilderness and Extreme Medicine where students will work towards a Certificate, Diploma and MSc.
Building on over a decade of successful evolving courses to highlight Expedition Medicine as a career option, we feel that now is the right time to take a step forward and offer a formal postgraduate programme that matches the increasing levels of clinical governance in this field. We think you’ll all agree that this is really exciting for us at EWM, but also for medics out there who wish to formalise the learning and skills they have picked up in this exciting field of medicine.
If you’re interested and would like to hear more news as we announce it, be sure to sign up to our postgraduate mailing list HERE.

Next stop…
..New Zealand.

To be a little more precise we’ll be off to the beautiful Southern Alps for our ever popular Polar Medicine course. There are only a few spaces left so click HEREif you’re thinking of joining us.

Course News

We listen to our delegates and as part of our improvement strategy extended our next UK based course, to four full days. The course, which will be held in Dartmoor, will allow time for additional learning, a little more free time and greater networking opportunities. For more information visit our Expedition & Wilderness Medicine Dartmoor page HERE.

Interns/Electives

Great news for our readership who approach us about intern posts or electives. We are re-establishing our EWMi programme to accept an intern on each of our UK based courses. For more information on the application process click HERE.
If you have any questions about electives we’d recommend you take a look at what our great friends at Adventure Medic are doing. It’s a fantastic resource which contains accounts from returning medics, but check out their resources section for elective opportunities!

We want to hear from you

Your experiences: We love a good blog (or vlog) that shares your experiences with the wider world. EWM was born out of adventure and although we’re passionate about delivering high quality training, adventure is still in our soul and we enjoy reading your tales and admiring your photos.

Your photos: Photography is another passion of ours, bridging languages, sharing culture and stirring the deepest emotions. If you have a great snap you’d like to see appear in our newsletter then get in touch HERE 
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Fanfare please! This week, we passed 75,000 “likes” on the Expedition Medicine Facebook page

Sir Ranulph FiennesLearning that we now reach so many medics across the globe has made us feel pretty good, so we’re offering a 7.5% discount on the cost of Expo tickets* until 12.30UTC on Sunday 3rd May.

Simply visit the Expo page:  www.extrememedicineexpo.com and enter the code: FB75KLIKES when registering to receive your discount.

Facebook enables us to extend the Extreme Medicine community far and wide with news, updates and camp fire tales from adventurous medics, so while you have your web-browser open, visit www.facebook.com/ExpeditionMedicine and “like” our page.

 

Links
Facebook
World Extreme Medicine Conference

 

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Remote Medicine Conferences with EWM and Lindblad Expeditions …

EWM and Lindblad Expeditions team up…. again

After three years of successful collaboration Expedition & Wilderness Medicine have teamed up with Lindblad Expeditions to offer up some amazing medical conferences in some of the world’s most difficult to access areas.
Very limited availability and space goes quicklyreserve your space now!
Antarctica | Kimberley & Spice Islands| Galapagos

Paul Auerbach Wilderness Medicine

Antarctica

Remote. Untrammeled. Spectacular. Antarctica is one of the most exhilarating adventures on Earth. There are many reasons to explore it. Wildlife: scores of penguins and whales. Ice: an entire museum of colossal and magical ice forms defying description. And the dashing history of the Heroic Age of Exploration.
Find out more….

How to book

Your booking is made through Lindblad Expeditions and their terms & conditions apply.
Please email Liz Estes a completed reservation form.
Should you require further information regarding the itinerary, flights and travel arrangements or specific requirements regarding your stay, your point of contact is Liz at 888-773-9007888-773-9007, if ringing from outside the US on 001-212-261-9000001-212-261-9000 or email groups@expeditions.com.  We recommend your make your flights arrangements through Lindblad especially if travel from the US to tie in with local ground arrangements.

Medical Conference in Galapagos

Galápagos Islands

25 September 2015 to 04 October 2015

Join us aboard the National Geographic Endeavour, our expedition ship for a CME accredited medical conference.

Explore this amazing UNESCO listed region in the company of some of the world’s most knowledgeable experts and follow in the footsteps of Darwin.
Find out more….

Kimberley Medical Conference

Kimberley with the Spice Islands

You will  travel with an Expedition Leader, a team of naturalists, an undersea specialist, divemasters, an Expedition Leader, a Lindblad-National Geographic certified photo instructor, who are amazing experts in their own right, and consequently offer a superb environment from which to explore this incredible region.

Explore the remote, spectacular Kimberley region of northwest Australia and the string of idyllic Spice Islands of Indonesia to be invited into remote villages where history comes alive in traditional ceremonies.
Find out more….

Remote Medical Conferences

Medical Conferences with EWM

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Join Paul Auerbach & EWM, National Geographic and Lindblad Expeditions in Antarctica

Join Paul Auerbach & EWM, National Geographic and Lindblad Expeditions in Antarctica

Antarctic Medical Conference 28 November-14 December 2014 with the world’s leading authority on Wilderness Medicine Dr Paul Auerbach of Stamford University.

Flight deal…

Book by December 31, 2013 to receive complimentary airfare on this departure. Airfare based on round-trip economy group flights Miami/Buenos Aires. Subject to availability. New bookings only. Not combinable with other offers.

Antarctica

Remote. Untrammeled. Spectacular. Antarctica is one of the most exhilarating adventures on Earth. There are many reasons to explore it. Wildlife: scores of penguins and whales. Ice: an entire museum of colossal and magical ice forms defying description. And the dashing history of the Heroic Age of Exploration.

Find out more here….

 

 

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Antarctica Wilderness Medicine Conference with Dr Paul Auerbach

 

 

Join Paul Auerbach & EWM, National Geographic and Lindblad Expeditions in Antarctica

Antarctic Medical Conference 28 November-14 December 2014 with the world’s leading authority on Wilderness Medicine Dr Paul Auerbach of Stamford University.

Antarctica

Remote. Untrammeled. Spectacular. Antarctica is one of the most exhilarating adventures on Earth. There are many reasons to explore it. Wildlife: scores of penguins and whales. Ice: an entire museum of colossal and magical ice forms defying description. And the dashing history of the Heroic Age of Exploration.

How to book

Your booking is made through Lindlblad Expeditions and their terms & conditions apply Please email Liz Estes for a reservation form.
Should you require further information regarding the itinerary, flights and travel arrangements or specific requirements regarding your stay on the NG Explorer you point of contact is Liz on 888-773-9007, if ringing from outside the US on 001-212-261-9000 or email groups@expeditions.com.   We recommend your make your flights arrangements through Linblad espiecally if travel from the US to tie in with local ground arrangements.
I hope you will join us on this amazing journey and we look forward to answering any queries you might have.

Flight deal…

Book by December 31, 2013 to receive complimentary airfare on this departure. Airfare based on round-trip economy group flights Miami/Buenos Aires.
Subject to availability. New bookings only. Not combinable with other offers.

National Geographic Explorer, a state of the art expedition ship

Inaugurated in 2008, National Geographic Explorer is the world’s ultimate expedition ship.  Originally built for service along Norway’s coast as part of the famed Hurtigruten, or Coastal Express, her excellent maneuverability and just-right size made her a natural choice for addition to our fleet. Drawing on our nearly 50 years of pioneering expedition history and expertise, we completely redesigned and rebuilt her.  Explorer is uniquely equipped with an ice-strengthened hull and advanced navigation equipment for polar expeditions; a roster of tools for exploration; and a well-appointed interior with vast expanses of glass for an unprecedented connection to the regions we explore.
She provides a peerless expedition experience.

Proposed schedule*

The conference content is CME accredited for 10 hours by the Wilderness Medical Society and will include the following topic headings:  Altitude Illness,  Cold Weather Injuries, Post-traumatic Stress Disorder in Wilderness Environments, Wilderness Medical Kits, Interpersonal Features of Group Travel, Psychological Issues in Expedition Travel

Schedule*

  • Day 1 U.S./Fly to Buenos Aires, Argentina
  • Day 2 Buenos Aires/Overnight Hotel
  • Day 3 Buenos Aires/Ushuaia, Argentina/Embark Ship
  • Day 4 At Sea Day 5-10 Antarctica
  • Day 11-12 At Sea
  • Day 13 Ushuaia/Disembark/Buenos Aires
  • Day 14 Arrive U.S./Home

*Subject to change

 

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

 

 

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Emergency Medicine Doctor, Locum, Papua New Guinea

Emergency Medicine Job - Papua New Guinea***POSITION NOW FILLED**** Head Medical have a 4-8 week locum post available in Papua New Guinea, located in the south-western Pacific Ocean, PNG is one of the most challenging, culturally diverse and exotic countries in the world.

You will be working with the world’s leading international healthcare and medical services company starting December 5th 2013
You must have 4 years + Emergency Medicine experience working as a Middle Grade, Snr Registrar or Consultant and have ATLS & ACLS as a minimum.
Paid flights and secure accommodation provided.

Essential
• Minimum of 4 years appropriate postgraduate Emergency Medicine experience • ATLS/ACLS • You must have obtained your primary medical degree in the UK, Europe, North America, South Africa or Australasia

Head Medical are espiecally interested to hear from ‘Expedition Medicine’ medics so please do mention us when making contact!

Desirable
• Overseas experience in a remote location
In return you will receive:
• An excellent rate of pay plus benefits, including accommodation and travel expenses • An opportunity to broaden your international experience

If you’d like to find out more about this job or have an informal chat, please get in touch with us:

Yan Scouller

Recruitment Consultant
Tel: +44 (0)131 240 5274
Email: yan@headmedical.com
 

Of interest

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Never Off Duty? the daily routine of an expedition doctor

Never Off Duty?adventure medics

Katie Hawkins / General Practitioner / Scotland

Another great article curtesy of Adventure Medics

So, you’re a doctor and you want to go on holiday somewhere exotic? Have you it through before you go? Dr Katie Hawkins, newly married and a recently qualified GP, tells us the tale of her honeymoon trek in remote Nepal. Her story beautifully illustrates some of the problems that can be encountered as an off-duty medic in a remote place. Katie also includes some excellent advice to help you deal with such problems yourself, while giving us the lowdown on the GMC and defence unions’ views on Good Samaritan Acts. Despite her honeymoon, Dr Hawkins remains happily married and is now working for the International Porter Protection Group in Nepal. (Photos: Sam Hawkins)

Big plans

Imagine this: it’s your honeymoon, and you’ve been dreaming of a big trip – to go away together, to be just the two of you. You love mountains, climbing, walking and adventures. Finally you manage to arrange time off work. You’ve not managed to get time like this since University days, trekking in Nepal. It’s a must, and you’ve earmarked a trek you’ve heard only a few people do. It will be bliss.

There are a few mutterings from friends:

Have you met the people you’re going with?

Don’t worry, we’ve been assured that they’re all super fit and anyway, if we get bored of each other at least we’ve got company.

The day before you leave a kind colleague thrusts some dexamethasone and nifedipine in to your hand and says ‘this might be useful’. Also by chance you ordered the book Pocket First Aid and Wilderness Medicine by Jim Duff and Peter Gormly. This arrives on the morning of your departure.

On arrival, there are the standard problems of missing luggage, retained passports and road blocks. However somehow, later that evening and despite the chaos, you find yourself eating veg thali and sipping on a cool beer. Well here we are.

However, it’s not just the two of you. You’re sitting at the table with your trekking group, all in their 60s. You think:

This can’t be right. Well if they’re not young then they must be fit

They are really lovely people and are filled with the same enthusiasm for the mountains that you have. For some of them though, it’s even more than this – this is their adventure of a lifetime! You decide not to be ageist. They seem lovely and you look on the bright side.

However, a few warning shots are fired. One man pipes up that this is his first trekking trip. It seems he hasn’t camped or trekked before. He is also recovering from a broken leg.

Then it emerges that your group also has a woman recently recovered from an episode of vestibular neuronitis, and a man who had a pneumothorax last year. The man with the broken leg is not able to take big steps does not trust it on uneven surfaces. Still you’re all a team now and you get along well. You’re still enthralled by the sights, sounds and smells around you, so you decide to appreciate being here and try not to let it all worry you.

Funnily enough it’s slowly dawning on you that although you’re on your romantic holiday, you’re still a doctor. Well are you? The inevitable conversation at the start of the trek begins, what do you do back home?’ Will you say it? What harm can it do? ‘Okay, I’m a doctor’. ‘Ah, she’s a doctor’, someone says to the trek leader… Help.

On the road

You come to the first village and due to their excessive loads, many of the porters have blisters. It seems that the trek leader’s kit has no tape in it, so you offer them some of your Compede. ‘She’s a doctor’ they all say and soon you have 5-10 people coming up to you for help. ‘You should get your local nurse to see to that’ you say to the man with a nasty sore. ‘There isn’t one for miles’. A quick check of the other people, and alarm bells are ringing. Only treat people in an emergency, you think to yourself. Is that right? What should I do? You soon escape the village, having handed over iodine solution and some plasters and realise you need a rethink. ‘I am a doctor, but I’m on holiday’, you tell the trek leader. Phew that should sort it.

Diarrhoea starts spreading around the porters, another comes to you with really painful athletes’ foot. Another porter bashes his head and is sent home (alone?) before you’ve even set eyes on him. Where does my responsibility lie?

Before you left you had a quick briefing. ‘If you get altitude sickness you must go down’. Back in your medical student days you’ve been to altitude with young, fit classmates. You vaguely remember one chap feeling a bit funny and heading down and not getting to the top, but otherwise everyone seemed okay. How would I recognise altitude illness? How fast should I really be ascending? You’ve always known it’s slow but not really thought about the specifics of how to avoid it and how to diagnose it?

You realise soon enough that the group are looking to you for advice:

Should we take Diamox?

How much water should I drink?

Should my hands be this puffy?

How should I manage my nasty cough at altitude?

One of these seems easier to answer than the rest, or does it? Where’s my stethoscope and sats probe? I didn’t think I’d need them on holiday.

Somehow you feel you’re in a role you were not prepared for. You tell the group that you’re interested in mountains but not the expedition doctor. They need to make their own decisions. You will try and help in an emergency but that’s it. However, you feel a sense of impending doom.

Altitude blues

You arrive at camp at 4800m. It’s been a fairly long day and you’ve now made it to well above the tree line. You can feel the altitude a bit here, but having trekked up and beyond the previous camps each night, you feel you’re acclimatising well. So you kick off a game of Frisbee with the porters. Beautiful light caressing the peaks, glowing with florescent colours. No wonder people used to think the mountains were Gods. You feel small and insignificant with these towering above you. And then the light is gone. A cold wind and chill sweeps through the valley. Although the mountains are tempting you up them, this is a stark reminder that ‘this is no place for men’.

Back at the tents you realise that one of the group has started to panic. This has been a recurring theme all the way up but you’ve got them to this stage so you feel you’ve done quite well. ‘He’s cold’ they say. Luckily you’ve been reminding yourself how to treat hypothermia by reading the pocket book. Hot drink, bottles in the sleeping bag and huddling in mess tent. He seems better pretty quickly. In the back of your mid you’re thinking is this AMS?

There’s the call of ‘Dinner is ready’. You see a woman emerge from their tent and stumble, trip, wobble. ‘This is how I always walk’, she says. This is true in part but how do you distinguish pre-existing vestibular neuronitis from cerebral oedema? You revert to your now trusty text. No advice there. You decide that it would be difficult. It’s dark and icy. You say:

It’s probably best that you go down

I’ll just have my dinner thanks and I’ll be fine

Can you argue with that? She’s certainly walking a bit better after dinner. You’re not sure what to advise, and should you be advising anyway? She refuses to descend so you make sure her tentmate will keep an eye on her.

In contrast, the man hardly eats anything at dinner. ‘I’ve had lots during the day.’ You advise him to go down as well but he refuses but agrees to share a tent with one of the other guys who will keep an eye on him. By now alarm bells are not just tinkling, they’re ringing loudly. You scribble down some notes before going to sleep; I probably ought to keep some sort of record. However, at the same time you plan a possible escape for the two of you.

At 0030, you have the dreaded feeling of needing a pee. This has been quite normal occurrence over the past few nights. You’re just having the same argument with yourself about leaving your warm sleeping bag, when you hear a kerfuffle outside.

Five porters are carrying the man in his sleeping bag to the shelter. Oh help. This is an emergency. I’ve no choice but to get involved now.

He looks a bit puffier, claims he can’t stand up, can’t see and his headache has returned. What headache? This time it’s 1am, you’re feeling the altitude yourself. Armed with your first aid kit and trusty book, you check his finger nose point test, he cannot walk and his respiratory rate is 40. This is an emergency. We’ve got to get him down. You give him a Diamox whilst the trek leader is ordering soup.

The rivers are bigger at this time of night due to the melt run-off in the day. It’s also icy (-20°) and the porters have flimsy plimsolls on their feet. The leader says they can’t take him down. You try to treat him. You look up the doses for nifedipine and dexamethasone. Soon after you’ve fumbled with boxes and books and plucked up the courage to give him the treatment, a decision is made to attempt descent.

You’re realising now that altitude sickness is unpredictable. Will descent make him better? You hope so, but now, being this involved you decide that you would not forgive yourself if anything was to happen. You’re going down too. The porters and leader prepare a basket with poles across the bottom and strap the man, in his sleeping back, into the basket with a belt. Three able porters then take it in turns to carry the basket, using straps across the fronts of their heads, and down you go.

The streams are bigger, throwing out the melting ice, rubble and dust from the mountains down to the camp below. The porters negotiate these, but also the landslides at top speed. By 5am, still dark, you can hear the familiar sound of the tinkling of Yak bells in the camp below. You’re all down safely. The man is feeling better and the porters are your new heroes.

What now?

Your only way out now is over a 4900m pass or 7 days of undulating trekking to back your starting point. The man assures you that now he’s fine and can continue the trek. You are at least certain of one thing: no chance. Fed up with the commotion and feeling sick with the lack of sleep you start strolling back to the previous day’s camp. On your way up you meet the chesty woman, still stumbling, coughing and looks as though she’s aged 20 years. Again??

So now, two casualties, both insisting they can carry on trekking, and you’re pretty sure that they can’t. Luckily the trek leader steps in and is very willing to organise a helicopter. Within two hours it arrives and they are both whisked away. Gone. All that’s left is the fluttering in the breeze of the makeshift ‘H’ made out of loo-roll. A small child is dancing delightedly holding a piece aloft.

Onwards

From here your trek goes up over a pass and into a still colder and higher valley. From this point, although missing the banter from the others, the pace picks up and there’s more time to spend together and stand in awe amongst the towers, pillars and giants above you.

Twenty-eight days finishes with smiles; a wonderful, memorable holiday to a magical place, the mountains of the gods. Yet there are still questions playing on your mind, most notably: did I do the right thing?

My honeymoon, as well as plenty of others’ tales, raises some of the issues to consider when going on holiday as a doctor. Although advice and guidance may differ depending on which country you travel to, I have attempted to offer some tips below.

It’s you!

Know when you might/need to help in an emergency

The GMC Good medical Practice Guide states that ‘In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care.’ Good Medical Practice applies to all doctors, whether they have a licence to practice or registration only.

In other words, you are in it, whether you like it or not.

Indemnity

Make sure you are aware of what your indemnity covers you for prior to departure.

The latest responses from the three leading UK defence unions from email and telephone advice (Feb 2013) are as follows:

MDU / The MDU is primarily a UK indemnifier. We are not set up to handle claims arising from overseas. For this reason we advise our members to seek indemnity in their destination country for work abroad. There are some circumstances where indemnity might be granted for overseas work but this is on a discretionary basis, We are unable to offer this for the USA, Canada, Australia, Zimbabwe, Hong Kong, Bermuda, Israel, Nigeria.

MPS / As a truly Global organisation, MPS provides indemnity and support to healthcare professionals in over 40 countries, We can offer access to indemnity for our UK-based members who undertake medical work abroad, including those who work as an expedition medic. The rate charged for this will vary largely on the location, nature of work to be undertaken, earnings of the doctor and the time period over which the indemnity is to be provided. Existing members will benefit from reduced subscription costs. MPS is unable to indemnify health professionals working in some countries, including the USA or Canada. If the act is a ‘good Samaritan act’, the MPS will aim to assist no matter where in the world the care is being provided or action is brought.

MDDUS / Doctors are only covered to go on expeditions provided that they are going on a voluntary basis with a UK registered charity. We require written notification from the charity confirming details of the expedition, and we only cover claims raised within the UK jurisdiction. If the doctor is being paid as the expedition medic and /or the doctor is not going with a UK registered charity, the doctor will not be covered. All members do have worldwide cover through MDDUS membership for Good Samaritan acts in emergency situations.

Kit

Think carefully about what you take in your first aid kit.

When you make up a first aid kit to go abroad, you must make decisions based on whether you are providing for yourself, for you and the group, or for everyone including porters and locals. If you are also providing for your group and locals, your treatment is no longer a ‘Good Samaritan act’. You would need to contact your defence union to make sure that you have the correct indemnity for this.

Jim Duff and Peter Gormly’s book provides a handy resource to help in emergencies. Ultimately, what you decide to take is your own personal decision but there are plenty of resources out there. For example, Adventure Medic’s own Resources Section.

If you prescribe for others on the trip think carefully about why you are doing this, especially at altitude. The GMC states:

Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship’. If you prescribe for yourself or someone close to you, you must make a clear record at the same time or as soon as possible afterwards. The record should include your relationship to the patient (where relevant) and the reason it was necessary for you to prescribe.

Tell your own or the patient’s general practitioner (and others treating you or the patient, where relevant) what medicines you have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody close to you) they object.

You must not prescribe or collude in the provision of medicines or treatment with the intention of improperly enhancing an individual’s performance in sport. This does not preclude the provision of any care or treatment where your intention is to protect or improve the patient’s health.

If you are prescribing a medicine for somebody overseas which is being dispensed overseas, you should check whether you need to be registered with the country in which you are prescribing.

Specialist?

If you do have mountain medicine experience, be wary of stating you are a ‘specialist’ as you will be judged against your peers.

Vetting

When going in a group, make sure you do your best to vet your companions carefully. You may be able to meet before-hand, speak over the phone or email. This will at least give you some idea of what you are letting yourself in for. I found this out the hard way, as problems within the group had been denied by the agency but only revealed themselves on our arrival. Some companies have medical vetting procedures and some don’t. It would be worth asking your company about this, even if you are only going on holiday somewhere remote.

10% off…

Be wary of companies that offer that you can act as Expedition Doctor and get a 10% reduction. This may be tempting but make the decision carefully. Check whether they would provide first aid kits/medications and what they would include. Check your indemnity. The extra cost may actually be considerably more than the 10% reduction.

Treating the locals?

Even if you are not medically qualified, if you employ local porters or guides, you are responsible for their health. They should be treated in the same way as any other member of the group. See the IPPG ‘Guidelines on Ethical Trekking’ for more on this subject.

The decision as to whether or not to treat local people en route is difficult. Unless the problem is an emergency it is usually best to refer the problem to local health care workers. Treatment may be appropriate if i) the problem is an emergency, ii) you can provide a full course of treatment, iii) you will be around in the area to give the patient adequate follow up.

In the case of chronic illness it may be appropriate to provide a letter for the patient to take to their nearest health care facility.

If a medical problem arises, keep detailed notes of what happened. This is important medico-legally, even if acting as a Good Samaritan. The GMC states ‘you must keep clear accurate and legible records, reporting relevant clinical findings, the decisions made, and any other drugs prescribed or other investigations or treatment’ and ‘make the records at the same time as the event you are recording or as soon as possible afterwards’.

Beware of buying medications abroad. It is common that medication ‘is not what it says on the tin’. Also be aware of internet sales as in >59% cases medicines from illegal sites have been found to be counterfeit.

Opiates

The home office website has some useful advice on where you can take opiates. Make sure you speak to them and also the country of origin prior to travelling, as well as taking all prescriptions with you. It is not advisable to take any opiate through United Arab Emirates countries or Saudi Arabia (5, 6).

Putting the ‘surgeon’ in Tree Surgeon

Consider the option of not telling anyone you’re a doctor. If you really are going on holiday, and fancy a break, there is always the option of not telling anyone you’re a doctor, but remember in the event of an emergency, GMC guidance says that you must step in. In such an event, it may then be hard to explain to your companions why a part-time musician/novelist/barmaid has suddenly morphed into a full-time, business-like clinician.

References

Duff, Jim; Gormly P. First Aid and Wilderness Medicine. Tenth ed. Cicerone Press; 2007. GMC. Good Medical Practice. Point number 11. P. 11. 13th Nov 2006. GMC. Good practice in prescribing and managing medicines and devices. GMC. 31 Jan 2013. World Health Organisation. Medicines: spurious/falsely-labelled/falsified/counterfeit (SFFC) medicines. WHO May 2012. Home Office: licensing for drugs.  Accessed 31/1/2013. Home Office: list of UK based Embassies. Accessed 31/1/13.

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Extreme Medicine Conference opens in five days!

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