Challenges Faced in Remote and Extreme Environments
Expedition medicine is the practice of medicine in remote, isolated, or extreme environments where there is little or no access to standard medical facilities or personnel. In such settings, clinicians may be faced with patients who are unable to be evacuated promptly or where factors like weather, logistics, and even geopolitics may impact access to care.
As such, managing patients and stabilizing life-threatening conditions in these settings can require thousands of dollars of equipment and years of experience in techniques like ultrasound-guided central venous placement, as well as bottom-up, open-access thinking regarding solving medical problems rather than resource-intensive solutions.
The other reasons that lay the foundation of the importance of expedition medicine are the knowledge and competency to be able to keep yourself as healthy as possible given the constraints within which you are operating, and knowing how different physiologic and environmentally induced conditions may limit your physical capability and thus the success of the mission. Remote and extreme environments are characterized by generally poor access to definitive medical care when required.
Simple medical problems or minor illnesses are relatively easily diagnosed and coped with on expeditions, and most expeditions carry considerable medical kits to deal with such problems. But emergency medicine is about the unexpected, the catastrophic. It is important to recognize where these catastrophes are most likely to occur and to increase our skills, knowledge, and supplies to deal with them. Where definitive medical care is far away, where the climate or terrain makes evacuation very difficult, and where it is almost certain that someone injured will have other expedition members looking after them, is where expedition medicine becomes most important to prepare for.
Limited Access to Medical Facilities
In remote areas and while at sea, medical help or access is not always a phone call away. Limited access to medical facilities in remote environments is one of the most striking differences between expedition medicine and more traditional medical delivery. This inherent lack of support demands that you have a great deal of self-sufficiency and a higher skill set than your primary care counterparts at home. The healthcare giver, often hundreds of kilometres from the nearest hospital with minimal laboratory facilities, must be able to recognize the seriousness of a condition rapidly, institute correct initial treatment and guide and accompany the patient to inpatient care.
In addition, expeditors often travel with minimal communication with the outside world. This could be out of personal choice - eschewing check-ins for some genuine solitude - although medical help in remote places is generally out there for a reason. In terms of medical support, nowadays, the further away from civilization you are, the more insistent the contracted doctors and the expedition planners become that you carry a satellite phone, to call a global assistance number in the event of an extreme emergency.
Furthermore, a patient's evacuation to definitive care even after diagnosis and treatment can take time to arrange and effect. Not only do you have to get the right people and equipment to the patient, bearing in mind that crew are relatively expensive and can't drop everything to head out; they are there to earn money and carry out the objectives of the trip first and foremost, but the weather and the environment could further hamper the evacuation.
Harsh Environmental Conditions
Expedition medicine is dependent upon various environmental circumstances in which a traveller is expected to function. A lack of social comforts such as regular food, shelter, and access to healthcare can all take their toll on physical health and thus on medical practice. Furthermore, drastic changes in general living conditions can expose travellers to medical emergencies. Harsh environmental conditions that can cause emergencies include extreme altitude, temperature extremes, diverse meteorological conditions, and limited possibilities for early retrievals or conventional medical assistance.
Some illnesses due to these conditions are very common and unusual in everyday medicine and under other conditions might not be dangerous at all. Environmental factors also heavily influence the concept of medical practice when a medic is working in the field. Expedition medics are accustomed to both a lack of contact as well as the importance of being explicit and to the point when doing so. However, working with less experienced medics can cause significant problems if the client, medic, and controlling physician are all unaware of the impact a lack of experience could have. Mentally, motivation should be geared towards coping with vague and uncertain information, unpredictable scheduling, filters, and personal knowledge of the medic or local physician, and changes in health risks due to possible changes in the weather. Guidance for travellers should be developed in close relation to the feeling of relevant risks.
