Practising medicine on expedition medicine trips and in remote locations requires a particular, distinct set of skills. A firm foundation in clinical medicine and emergency medicine is an essential first step. The ability to assess and manage acute disease is often fundamental to a role in expedition medicine. Initial training in trauma is also a common requirement, as trauma is one of the primary reasons that people will need urgent medical care in a remote setting.

Expedition medics also need a good knowledge of wilderness survival skills and remote area living. Trainees should have the ability to engage with people from all walks of life and be able to closely coordinate care with other members of the expedition team. Being culturally aware is also important, as it expedites team coordination and prevents upset to any hosts in the countries where you are working. You should be comfortable working with translators and be aware of the issues around translation in simple medical guidelines such as those for hygiene practices or basic medical therapy.

Problem-solving is a fundamental aspect of modern clinical medicine. It is important to remember that as an expedition doctor, you are rarely an island, and it’s always a good idea to ask for advice. Alongside these skills, a good expedition doctor needs a solid knowledge of environmental hazards and their human health implications; this is the subject of this curriculum. Expedition medicine is the subspecialty and the true clinical area of practice dedicated to the health of those who travel to remote or unusual parts of the world. Requirement number four of the speciality training describes the skills and knowledge required of an expedition medic.

These are extensive but can be broadly summarized as the clinical skills required when providing specialist care in an expedition environment; the knowledge required to advise individuals and teams regarding preparation for the environmental, psychological, and physiological stresses of such an environment; the knowledge and skills required to deliver safe and efficient general health delivery in these conditions; a public health understanding of the health impact and care delivery to local populations; the ability to deliver information and learning opportunities regarding these areas to others.

Prerequisite to all these subtopics, and running through all of them, is the fundamental base of good knowledge and the clinical skills to competently and appropriately deliver expedition first aid in the field. While this sounds simple, in reality, the information and the way we need to apply it are very different from those within mainstream first-aid teaching and practice. We actively include the skills of leadership, team management, and education in the curriculum, but while these are generic, their focus is always specifically on expedition clinical care.

First Aid and Trauma Management

Although there are rare situations in which an expedition medical professional must perform long-term treatment of a single patient, there is a consistently high likelihood of such personnel having to provide first-line, first-aid-type treatment for injuries, illnesses, and trauma, making it relevant to many scenarios such as hill walking, cave exploration, skiing, and disaster relief, to name a few.

In particular, an obvious but important skill set is required for managing trauma since, even if the illness is the most common underlying condition in travellers, trauma forms a frequent subgroup of such casualties requiring essential and often lifesaving intervention. As such, the expedition medical professional must be educated as to the most appropriate and up-to-date trauma care guidelines before they undertake any major risk-related activity, which is about the local environment and resource accessibility. This may range from demonstrating basic life support to advanced trauma training for clinicians and prehospital personnel.

Certain injuries will cause significant mortality within a few minutes or hours of the precipitating event happening not, perhaps, because of airway compromise or tension pneumothorax. An expedition with better-trained medical professionals will, potentially, be safer than one with inadequately trained ones, particularly in locations with limited immediate evacuation capabilities, thus favouring the training of all expedition medical personnel to an appropriately high level.

There is an element of fieldcraft in response to injury which, like any fieldcraft, can be practised, risk-assessed, and drilled to enhance skill retention and immediate intuitive responses to such trauma emergencies. In short, mental improvisation, possibly the pinnacle of training, is imperative, as well as the practical skills one would expect from an acute care clinician in this core phase of the illness-treatment spectrum.

Wilderness Survival Skills

While wilderness survival training relates to the provision of casualty care in remote areas, it is important to remember that survival skills that go beyond basic first aid are also necessary for practical expedition medicine. It is the responsibility of the expedition medical officer not just to provide care and to arrange evacuation if necessary, but also to prevent any preventable illness or injury among the expedition team members.

This involves several non-medical skills that go alongside navigation, shelter building, source of water identification and procurement, edible and poisonous plant identification, emergency food procurement, and a method to deal with hypothermia victims and other casualties where evacuation is impossible. Practitioners need to be able to build an emergency shelter, find safe water, and identify a few incidental plants and animals to provide the daily zero-casualty event environment necessary for a successful expedition. The ability to navigate successfully, without dependence on electronic devices, is also crucial.

Other relevant skills that may or may not be required by a member of an expedition team's expertise may include self-defence, short conflict resolution, awareness of local political and cultural restrictions, towing a sledge or other transport, strong and light backpacking, and canoeing skills. There is, of course, no substitute for an appropriate prior training program and the wealth of practical experience it brings in a range of environments.

Participation in training anywhere, perhaps particularly in a variety of countries and wilderness areas, is recommended. Such a program broadens experience and keeps these skills fresh for when, unexpectedly, they are needed in earnest.