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Course accreditation update

Given our new academic focus, we have chosen not to renew our accreditation with the Wilderness Medical Society (WMS), therefore we  are no longer able to offer CME through the WMS for our courses.

CME is generally considered to be educational content that is appropriate for the speciality that a doctor works in. Expedition and wilderness medicine is not part of any core medical specialty programme and as such does not fit any conventional CME programmes except the WMS. Historically, we chose the WMS to accredit our courses to provide clients with an opportunity to claim CME/ CPD credits. Very recently we learned that the WMS had changed their internal processes which meant that in addition to us re-applying for course accreditation, our faculty would also need to have their FAWM in order to teach on our courses. We recruit our staff based on their academic qualifications along with their skills, experience and research that has contributed to the world’s understanding of expedition medicine. As such, we do not consider it necessary for them to also have their FAWM.

This coincides with the considerable amount of effort we’re applying to develop our Extreme Medicine post-graduate and Masters programme. This is work undertaken in collaboration with the University of Exeter, one of the top 100 universities in the world, and will result in a universally recognised academically consistent qualification, which holds more weight. This introduces a competency based programme across our entire course portfolio. Whether you’ll be part of the post-graduate programme or you’re choosing to take part on one of our stand alone courses, all content will be subject to the same review and approvals process by the University.

Right now, you’re a client who is at a bridging point before the post-graduate programme is fully established. At the end of the course you’re scheduled to attend, we will give you a certificate of attendance and a list of competences / learning outcome which you can self-assess against your portfolios or CPD learning logs

We continue to strive for best practice within the expedition medicine world and think that courses based on competences offer a better outcome for our clients continued professional development and for the people ultimately under your care.

If you have any questions please do get in touch with us and we’ll be happy to discuss these with you.


The latest news, views and opportunities from EWM Towers

Expedition & Wilderness Medicine

To take advantage of the World Extreme Medicine Expo early bird offer use discount code WEMEEARLYBIRD30 at the checkout.

Response to the Paris attacks

The medical response to multisite terrorist attacks in Paris reviews the coordinated effort from the emergency services and Assistance
Publique-Hôpitaux de Paris (APHP) .
The article offers the perspective of an Emergency Physician, Anaesthesiologist and a Trauma Surgeon, before offering a conclusion.

It’s clear no matter what the plan, it’s the people; doctors, nurses, emergency services, administrators, volunteers and many others, that enable a successful response.
View the FULL ARTICLE on the Lancet’s website.

Jobs and opportunities

The European Space Agency is once again looking for a doctor to join them for a year of research and experiments at the Concordia research station in Antarctica.
Click HERE to see the post on the ESA website.

Luangwa Safari Association Medical Fund need a doctor for 3-6 months to provide care for staff and guest in addition to providing care at Kakumbi Rural Health Centre.
Check out the full details HERE and to read a previous doctor’s blog written during her time in the role click HERE

Course pick

Mountain Medicine 2016 following another extremely successful course in Nepal trekking to Kala Patthar and Everest Base Camp.
The first piece of feedback we received told us “this was the most amazing trip I have been on” and it is comments like these we aim for and pride ourselves on.
Pre-hospital Trauma Workshops will continue throughout 2016. We focus on initial care around head injuries, chest injuries, traumatic cardiac arrest, blast and ballistic injuries. We’ll also touch on crew resource management and effective leadership on scene in the single and multi casualty scenarios.

“We treat athletes like NASA treats astronauts”.

Last month saw the launch of Vollebak, a new brand that aims to tackle the fundamental issues faced by extreme sports people.

Having lived through the highs and lows that come with racing and training in the world’s toughest environments, founders and adventure athletes Steve and Nick Tidball, started working on products and experiments to help athletes relax and survive.
Click HERE to find out more.

Expedition & Wilderness Medicine Courses

World Extreme Medicine Conference & Expo


EWM’s Wild Medicine Course Changed our Lives

We know that education opens doors and as the EWM crew are both interested and a bit nosey, we love to hear what our alumni get up to after attending our courses.  Naturally then, we were delighted to hear from Ian P, who told us he and his wife loved the  2013 Wild Medicine course so much, they’re busy packing up in the UK and moving to Namibia…

Not many things you can say that change your life!  Attending the Wild Medicine course was one of those events.  Amazing set of people and a fantastic opportunity to learn about conservation and desert medicine.  

The kind of odd things we learnt…
– Take blood from a cheetah,
– Learn about (and touch – optional) many poisonous snakes,
– Sleep in a desert,  walk 14km through a dry river canyon,
– What are the problem animals with Rabies? (A: Kudu),
– How can carnivores live outside conservation areas & not get killed by farmers &

– How to build a vineyard in a desert … what?!.. 

And the thing that changed our lives? Meet the Bushmen and see their need for healthcare!  My wife and I are volunteering at Naankuse to run the Bushmen medical services. The real thing we learned? There are many people out there that can benefit from our skills … 

Oh and by the way Namibia is amazing you get to see loads … but you can also get a 4×4 and do a week or so trip before the course.


Other courses of interest:
Remote Medicine
Extreme Medicine Conference

This years Wild Medicine Course



FAWM point approval for Extreme Medicine Conference

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

wilderness medical societyThe 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.

The Academy of Wilderness Medicine

Extreme Medicine Conference




Conservation Course in Namibia accredited for CME

Expedition & Wilderness Medicine’s new Conservation Medicine course in Namibia has been accredited for 16.5 CME

Located at the stunning N/a’ankuse Lodge and Wildlife Sanctuary only 42kms east of Windhoek is Expedition & Wilderness Medicine’s new Conservation Medicine Course. This truly unique lodge is set amidst a natural savannah, with riverine vegetation, lush grass plains and magnificent mountain views, and offers a malaria free Wild Medicine course.

The main objective of the course is to educate attendees as to how we can integrate the diagnostic and problem solving skills of both human and animal health professionals with the knowledge of conservation professionals. Ultimately this should help all concerned to better manage the environment and biodiversity to the benefit of all the inhabitants of our beautiful planet.

The emerging interdisciplinary field of conservation medicine, which integrates human and veterinary medicine and environmental sciences, is largely concerned with  zoonose. At the present time there is very little sharing knowledge in both an academic and practical session and this course serves to address this significant gap.

To book your place


Of interest – Desert & Wilderness Medicinal Training Course


Expedition Medicine – April News





Welcome to the latest edition of Expedition & Wilderness Medicine eNews

We’ve just completed a fantastic week in Keswick enjoying the splendour of the English Lake District in amazing spring sunshine, details of the Extreme Medicine Expo in London are getting firmed up & we’ve news of our Desert Medicine course in Namibia, Diving in the Maldives & our exciting new Antarctic Medical Conference in association with Lindblad Expeditions & National Geographic plus some pretty interesting & eclectic job opportunities.

  • Mountain Medicine Course Leader Dr Luanne Freer reports from Everest
  • Desert Medicine Course prepares to gather in Namibia
  • Dr Nick Knight reflects on the recent Keswick course
  • Development of the International ‘World Extreme Medicine’ Conference & EXPO – ‘Taking Medicine to the Extremes’
  • Dr Amy Hughes talks to the camera about Expedition Medicine
  • Jobs

We hope you enjoy this edition of EWM eNews.

If you haven’t already why not join us on Facebook? We update daily, the latest jobs and course news go up here first and its a great place to meet both like-minded medics and hear about expedition opportunities. So come on and join us.


 Find Expedition Medicine on Facebook


Mountain Medicine Course Leader Dr Luanne Freer reports from Everest

Leader of this years Mountain Medicine Course in Nepal Dr Luanne Freer head of the EverestER clinic providing medical cover for Everest climbers & Sherpas alike makes her initial report from Base Camp.Luanne reports; ‘Each year we are amongst the first to arrive at Everest Base Camp for the spring season and we are amongst the last to leave. As we work to set up the EverestER clinic, workers from climbing teams level ground and set up tents in anticipation of the later arrival of the climbers and guides. One of the most important tasks taking place during this time is the planning and setting of the route up the treacherous Khumbu Ice Fall.An elite group of Sherpa climbers, known as the Icefall Doctors, bear the difficult and dangerous task of setting ropes and ladders across the numerous crevasses that make up the ice fall.

Ang Gyeltzen Sherpa is a member of the Icefall Doctors and an electronics wizard. Each year he provides assistance to the clinic. This year, bored because snowfall has delayed work on the icefall route, Ang Gyeltzen helps us set up our new solar charging system.

Spaces on the Mountain Medicine course are extremely limited secure your place now

24 October 2011 to 08 November 2011




Desert Medicine Course prepares to gather in Namibia



Our Desert Medicine course departs for Namibia at the end of this month led by Dr Amy Hughes and Dr Christoffer van Tulleken of Channel 4’s ‘Medicine Men Go Wild’ fame.Chris is currently an academic registrar at University College London Hospital in Infectious Disease & Tropical Medicine & has extensive experience of remote medicine. Chris has been the medical consultant and location medic for more than 12 documentary series including BBC’s Tribe, Amazon & Human Planet. He has also presented several documentaries about humanitarianism, science & remote indigenous societies.

The course, set in the shadow of Namibia’s highest peak in a stunningly remote area of Damaraland, covers a whole gamut of desert related subjects including envenomation, desert navigation, tropical medicine & looking for water.

The meeting place is in Windhoek on the morning of the 1st May & to secure your place email us now

01 May 2011 to 07 May 2011




Dr Nick Knight reflects on the recent Keswick course




With the sunshine out and the rasping sounds of the Search and Rescue Teams over the two-way radios out on the Cumbria hills, you would have been easily mistaken in thinking you were in the middle of a real emergency. In fact, it was the final Search and Rescue exercise (with CASEVAC) of a fantastic 4 day Expedition Medicine Course in Keswick in Cumbria.As the University Liaison for Expedition Medicine, it was the first course that I attended as a new member of the ‘EM faculty’ – and what a fantastic experience it was. Not only did I get to absorb the electric atmosphere of the 60+ delegates there alongside the seasoned expedition medics leading the course but it gave me ample opportunity to see how such courses can align themselves with my role as University Liaison and to stimulate a few more ideas.

Read more of Nick’s article

Spaces on this course are limited secure your place now

16 May 2011 to 19 May 2011 – Plas Y Brenin, Wales
12 September 2011 to 14 September 2011 – Keswick, Cumbria




International ‘World Extreme Medicine’ Conference & EXPO – ‘Taking Medicine to the Extremes’.

We are very close now to confirming the content, which will be modular in nature & CME certified, the location & the dates. We are able to offer a great discount rate for nurses, paramedics & students & we are hoping to get all this information out to you over the next couple of weeks.Pre register your interest by emailing here

London late April 2012
Salt Lake City September 2012





Dr Amy Hughes talks to the camera about Expedition Medicine.As Expedition Medicine’s new medical director Dr Amy Hughes, Pre-hospital Care Registrar with the Kent HEMS Team, speaks about the growing opportunities for medics as Expedition Medicine, a medical sub speciality, continues to grow & develop.This article is in video format & can be watched by following this link  





If you want to ensure that you hear about the job opportunities as soon as we receive them then we recommend that you ’like’ our Facebook group. *URGENT: Doctor required for charity expedition with the Ultimate Travel Company.

  • Dates: 9-18 June 2011
  • Location: Kilimanjaro Rongai route
  • Group size: 35 people from a national charity
  • Details: You will be in a team with 2 UK Expedition Leaders along with an expert team of local guides. Medical kit, oxygen and hyperbaric chamber provided
  • Fees: All flights, trek expenses, food included + fee of £400

Outline duties/responsibilities: You will be trekking with the group and will have your own porter to carry the medical kit. You will be expected to provide medical advice, dispense medication and services as appropriate and within your capability to the trek participants and other expedition staff. This may involve triage, stabilization, initial treatment and transfer of anyone suffering a serious illness or injury. You would be expected to have very good communication skills, be an excellent team player and work at all times with the GMC guidelines of Good Medical Practice and the Duties of a Doctor.If you are interested in this post please contact Jennie or Stef at the Ultimate Travel Company with a short resume of your relevant experience email Jennie or Stephanie here or telephone 020 7386 4673.

The Khomas Medical Centre in Windhoek, Namibia, a private multidisciplinary group practice, is looking for qualified doctors to work in their busy practice.

Successful applicants will get a lot of hands on experience & encounter a wide variety of infectious diseases such as HIV & TB as well as ample chance to explore this amazing country Interested doctors should contact Karen Trümper.




We hope you enjoyed this edition of Expedition & Wilderness Medicine news, we’ll be back next month with more news and offers.

Bye for now

Mark Hannaford

Expedition & Wilderness Medicine


International ‘World Extreme Medicine Conference & Expo’ – London 2012

International Extreme Medicine EXPO-  Expedition & Wilderness | Tactical | Disaster Medicine

‘Taking Medicine To The Extremes’

A major new International ‘World Extreme Medicine conference and EXPO’ series with the first inaugural event in London  April 2012 followed by Salt Lake City in September 2012 with the very best speakers from around the world, leading figures from the world of expedition and wilderness travel, displays from focused industry leaders and also awards. All CME accredited on a modular basis to allow you select just a day or to attend the entire medical expo. 

Over the last ten years the care of casualties in a remote environment has come a long way. This has been driven by conflict, the apparent exponential rise in natural disasters and our capacity to respond on an international scale and not least by the evolving interest in the field of expedition and wilderness medicine. The conference concept was generated out of a desire to amalgamate the associated specialties in this field and to share the skills and knowledge we have acquired. It will run over 4 days and involve some of the major specialists in their field of remote and austure medicine.  

Developed specifically with medical professionals in mind the International ‘World Extreme Medicine EXPO’ will also be of interest to other medical specialists and students for which there will be a discounted rate.

To pre-register your interest for ‘Extreme Medicine’ email us here.

Extreme Medicine Conference and Expo


Pre-hospital Expedition Medicine Series – Pelvic Injury

Pre-hospital Expedition Medicine Series

Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar and HEMS paramedic Dave Marshall, both part of the Kent Helicopter Emergency Medical Team, continue their series examining pre-hospital expedition trauma care and associated kit.

In the second article in the series, Dave Marshall gives an overview of managing pelvic fractures pre-hospitally and in an expedition environment, and introduces the use of the pelvic splint.

Edited by Dr Amy Hughes.

Pre hospital and Expedition management of pelvic trauma and use of the pelvic splint

Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential. Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Pelvic Sam Splint is essential.

Mechanism of Injury

Pelvic fractures often result in extensive disruption of the bony structures and associated ligaments of the pelvis and are potentially life-threatening injuries. The fractures associated with the greatest morbidity and mortality involve significant forces such as motor vehicle crashes, motorcyclist crash, pedestrian versus car, falls from height and crush injuries. Early suspicion, identification and management of a pelvic fracture at the prehospital stage is essential to reduce the risk of death as a result of hypovolaemia, (1). It is especially important to be able to identify, treat and minimize risk of further damage when in a remote area miles from the nearest medical facility.

Understanding the mechanism of injury is vital in being able to predict the potential for significant injury to the pelvis and its underlying structures, even in the absence of clinical signs. It is, therefore, essential that time is taken to evaluate the mechanisms involved in any accident resulting from significant force or where there is pain or injury to the spine, abdomen, pelvis or femurs.

In motor vehicle accidents – a not uncommon event on expeditions – learning how to ‘read’ the wreckage to help identify possible pelvic injury, in conjunction with clinical suspicion, can significantly aid diagnoses.

The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis

The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis


The intrusion into fuel tank shows the imprint of the riders pelvis. This would often result in significant fracture to the pelvis – often multiple, often ‘’open book’’ pelvis

Anatomy of the pelvis

Anatomical structure of the pelvis (2)

The pelvic ring is often likened to a polo mint in that it is almost impossible to have a significant break in one place and not another. The most common area to be damaged in trauma is the pubic rami, acetabulum and the sacroiliac joint. There is extensive vasculature through and around the pelvic ring, most notably the iliac vessels. For imagery see

The greatest risk of a pelvic fracture is catastrophic haemorrhage and gentle handling of the patient in the initial and subsequent stages could literally be the difference between life and death. Whole blood clotting time is approximately 10 minutes, (depending on the environment). Expedition medics should be familiar with the ‘first clot best clot’ theory. In other words, a patient sustaining a traumatic injury resulting in haemorrhage will begin to form a clot using their own clotting factors. If this clot is disrupted they could easily bleed to death. A full fluid resuscitation will not be practical in the field as most expeditions carry a maximum of 2 litres of crystaloid. However it should be noted that overloading the patient with fluid can be equally harmful, and small boluses should be given to maintain a central pulse and cerebral perfusion. This is known as permissive hypotension and will be discussed in more detail in a future article. Disruption of this first clot in the prehospital setting could be fatal, and without access to blood and clotting agents the patient may die. Trauma will result in the patient becoming acidotic, hypothermic, and coagulopathic. (3)

This coagulopathy cannot be easily reversed pre-hospitally, each factor contributes to the decline in the others. (see above diagram). Any disruption to the first clot will have devastating consequences. Ultimately, the patient requires definitive haemorrhage control, (surgery, angiography and embolisation), and replacement of blood and clotting agents.

The glass pelvisThink of the pelvis as being made of very fragile glass, and you can see the clot in the form of a cartoon jelly inside. The jelly is very delicate and unless movement is gentle and kept to a minimum, it will ‘wobble’ to the point of destruction very easily. The same applies to the blood clot! Early recognition of the potential for a pelvic injury, gentle handling and prompt stabilisation is vital to improve the outcome of a patient injured on an expedition.

Clinical Features of a pelvic injury: (4)

  • Asymmetry of the pelvis – do not spring the pelvis. Visual alignment and gentle palpation of the Anterior Superior Iliac Spine may help demonstrate pelvic injury, but often the pelvis visually appears normal, thus mechanism of injury is vital in determining injury
  • Shortening/rotation of the leg/s
  • Inguinal pain
  • Localised swelling/contusion
  • Hematuria/urinary incontinence
  • Bleeding PR/PV – PR examination not recommended to determine pelvic injury.
  • MECHANISM, MECHANISM, MECHANISM! (albeit not a clinical feature!) – there may be no obvious clinical abnormality despite significant injury. Thus clinical suspicion is essential.

Management of pelvic fractures and clot preservation:

As we have already discussed, a patient with a suspected pelvic fracture must be handled very carefully. Whether in a medical facility or the most extreme expedition environment, the same principles apply to prevent worsening the injury and preserving the clot.

Log rolling the patient should be avoided at all costs!

The medical kit available on expeditions will be minimal. Stretchers may have to be improvised and transportation limited. However, all medical kits should have some sort of pelvic binder which should be applied carefully and correctly at the earliest opportunity, (see images below).




Application of the pelvic SAM splint.

The casualty will inevitably have to be placed in the supine position, to evacuate them on whichever device is available. This can be achieved by a coordinated team approach utilising other members of the expedition.

One person should be at the head end of the patient maintaining in manual inline immobilisation, (MILS), and they will give clear commands to the team when moving the casualty, (“ready, brace, roll”). A pelvic binder such as the one shown can be applied using a minimal 10-15% roll, (enough to get a bum cheek off the ground!)














The most common problem associated with pelvic binders are incorrect positioning. Identify the greater trochanters and line up the binder. Ideally it should be applied over bare skin, though clearly this will depend on environmental factors.


Once in position the device can be tightened just enough to maintain anatomical alignment. Do not over tighten as this could cause significant further damage!














Log rolling patients, whilst sometimes useful in a controlled hospital environment following appropriate imaging, should be avoided in the pre hospital field. In simple risk versus benefit terms it could have catastrophic consequences. By using the hands available and correctly briefing the team about the amount of movement required (one cheek off!), it should be possible to optimise the care of the casualty prior to evacuating them to definitive care.

Improvised methods of pelvic splinting on expeditions

Much of the challenge of expedition medicine is improvisation. The medical kit you take out with you may not have SAM splints in them. Providing a support can be placed across the greater trochanter, then any sort of material could be used – for example clothing, a sheet, or a canvass of some kind.


The approach to fluid management in trauma has changed. Two litres of fluid is not necessarily required for management of pelvic injury. Titrate fluid according to the presence of pulses or cerebration (alertness). The presence of a radial pulse, and even in certain circumstances (without associated head injury) presence of a femoral pulse signifies the blood pressure is sufficient to perfuse the necessary organs and promote clot preservation. Further details of permissive hypotension will follow in another article.


Essential – this depends on what is available. Intravenous opiates or a fentanyl lolly is ideal for analgesia, after the use of paracetamol or a NSAID.

Other injuries

Pelvic injuries are often present in conjunction with other significant injuries – spinal, femur, urological or abdominal as examples. Whether or not other injuries have been excluded, spinal precautions are essential in conjunction with good management of the pelvis.


  1. Lee C, Porter K. The prehospital management of pelvic fractures, Emergency Medical Journal 2007;24:130-133
  2. Image 1: Available at:
  3. Maya A, Matinowitz U, Kluger Y. Coagulopathy in the critically injured patient, Yearbook of Intensive Care and Emergency Medicine 2006, Part 5,232-243
  4. Crawford C, Pelvic Fracture in Emergency Medicine, available at:

MDDUS interviews EWM Medical Director Dr Amy Hughes

MDDUS (Medical and Dental Defence Union of Scotland)  took the oppurtunity in one of the quiter periods in Expedition and Wilderness Medicines Medical Director Amy Hughes hectic schedule to interview her about her career in expedition medicine.

Dr Hughes co-leads the Mountain Medicine course in Nepal with Everest ER founder Dr Luanne Freer in October

View and download PDF

Extreme doctoring, expedition medic Dr Amy Hughes career


MDDUS (Medical and Dental Defence Union of Scotland) is an independent mutual organisation offering expert medico-legal advice, dento-legal advice and professional indemnity for doctors, dentists and other healthcare professionals throughout the UK.


Some feedback just makes us smile!

Feedback on our recent Polar Medicine training course in Norway has clearly affected some of the course delegates by creating a need for ‘biggles-speak’…

PapaFoxtrot calling Red Leaders AlphaHotel, AlphaCharlie, DeltaBravo, Bravo and Delta

Congrats on recent Operation Polar Bear

Wizard week

No prangs

Best ever

Location stunning

Bunks and chow excellent 

Red Leaders all SPLENDID

Hope all returned to base safely

Please pass on to all members of Polar Bear as don’t have call signs

Do you read me ?