Expedition Medicine Blog
By Nathaniel Zona
Get ready to explore an alternative career as a physician in the field of expedition medicine. Sorry, pun intended. Today’s post discusses the practice of remote medicine and expedition medicine. Remote medicine is usually practiced in a stand-alone clinic at a remote outpost while expedition medicine is where the clinician may travel with a group of individuals to remote areas for the purposes of research, exploration, or volunteerism/charitable contributions. Remote medicine may also be practiced by telemedicine but this will be discussed in future episodes.
Wilderness medicine is basically taking the role of a regular physician and applying it in remote locations with limited resources, little to no available transportation, little if any diagnostic imaging/lab testing, and a lack of definitive care . In a lot of ways, it is like practicing medicine the way it was practiced a few hundred years ago BUT with the added knowledge from modern medicine. Just for clarification, this post may refer to a physician regularly but there are many other healthcare practitioners like physician assistants and nurses who practice wilderness medicine as well.
A lot of charitable and commercial organizations, scientific research groups, and even independent interest groups seek exploration and adventure travel for various reasons. All of these groups need somebody to prepare, prevent, and treat health-related matters. This is where the healthcare provider comes in. Because treatment typically occurs in remote areas, the physician must be comfortable with the concepts of urgent intervention, stabilization, and a general understanding of the spectrum of possible medical problems. Perhaps most important, they must have a strong reliance on clinical judgment . These qualities coincide with generalist specialties like emergency medicine, internal medicine, and family medicine. General or trauma surgeons can also be highly valuable for expeditions where heavy trauma might be expected, like military expeditions. General surgeons are also great for medical relief for charitable organizations that provide free surgeries in the developing world. Many of these surgeries are completed in situations with limited resources, solar-powered equipment, or dangerous surroundings. It is incredible what these practitioners are able to accomplish.
As mentioned, the physician certainly needs to be confident in their clinical judgment. When they are out on an expedition, there is no immediate access to advanced medical care or supplies, and, depending on the size of the expedition, there may not be another physician to consult. In hospital-based emergency medicine, physicians rely heavily on consultants, so this is already a big change. On top of that, in the case of an emergency medical evacuation, the patients are often a long way from the nearest hospitals, meaning stabilization of any medical condition is paramount for the prolonged evacuation time.
On an expedition, every adventurer's worst nightmare is to contract a serious disease, become critically injured, or get attacked by a dangerous animal. And although physicians will be prepared for these things, it is definitely the last thing they want to see as well. In reality, the most common cases dealt with on trail are rather mundane. Seventy percent of cases are GI, orthopedic, or other medical problems like respiratory infections and headaches. . Depending on the location of the expedition, environmental extremes can cause some medical issues for those that are unprepared . For example, altitude sickness is common on mountaineering trips. Heat exhaustion can be an issue in places with high temperatures, or on the other end of the spectrum, frostbite or cold injury can be a problem in frigid climates.
Preparation is extremely important for a successful trip. On mountaineering trips, the entire expedition can be jeopardized by one unprepared individual. As a physician on these trips, it is very important to recognize signs of illness, whether that be altitude sickness or other illness. Mountain climbers, in particular, are pretty tough, and pretty unwilling to give up a climb for any type of sickness, given the amount of preparation and money that is often involved in prepping for these expeditions. Sometimes, individuals on climbing expeditions are completely unaware, or unwilling to admit, how sick they are. They keep trying to climb, despite how they feel, which can put everyone on the expedition at risk. It is really important for a physician to step in at this juncture and help them understand their symptoms, why the symptoms are dangerous, and why they shouldn’t climb.
That was a bit of information about the kind of cases an expedition medical officer might deal with, but where do they practice? The short answer is, that depends. From the name, it is clear that a wilderness physician practices medicine in the wild, but where is “the wilderness?” That can be variable. The location of expeditions are really dependent on the goal of the group that is in need of the wilderness trained physician. There are locations that are much more common than others; in fact, over two thirds of expeditions take place in mountain ranges and tropical jungles. Other destinations include polar regions, like Antarctica, desert regions, and marine expeditions [2, 3].
Due to the wide range of practice locations, pre-expedition planning is a vital part of the job. Becoming familiar with the environment and the common problems in each austere location is the first step. On some expeditions, there is a need for medical input during the selection of team members . Unfortunately, depending on the expedition and the individual’s unique medical profile, it may be best for the applicant’s health, as well as for the other members of the team, for an applicant to not to participate in certain expeditions. Any medical emergency puts an entire crew or expedition at risk because the entire team’s resources have to be redirected to address that medical emergency. In some cases, it is impossible to treat a person’s injuries and the team is then faced with the decision to leave the person’s body in place in the wilderness or find a way to get the person’s body back to civilization. It is a harsh reality that must be considered when evaluating medical fitness and suitability for an expedition.
It is also important to determine what sorts of vaccinations should be given to expedition members. Vaccination requirements are highly variable and depend on what sort of diseases are expected in different areas of the world. The physician can be highly valuable when communicating vaccination needs and assisting members with obtaining those vaccinations or prophylactic medications, such as antimalarials. Additionally, in part of the practitioner’s evaluation of medical hazards, he or she must prepare proper medical kits . On long expeditions, this can be really difficult. Having a fully stocked medical kit may create too much weight to carry. This is why it is critically important to have a clinician who can evaluate what sorts of hazards can be expected, what is absolutely required, and what can be left at base camp or an outpost location. It is obvious that not bringing enough, or not bringing the correct medical supplies can also be troublesome. If a physician only brought one dose of antibiotics for a 20 person expedition where there is an outbreak of traveler’s diarrhea...everyone is in deep...well, you get the idea. Planning the medical kit is a critically important function of a medical provider on any expedition.
The point is, there is much more to expedition medicine than just treating patients while on the trip. Ideally, the physician will actually be doing as little medical care ON the trip as possible...which means fewer accidents. Rightfully so, fewer accidents come with deliberate prevention of these accidents by proper planning and training. Base camp health and hygiene is a large part of what a clinician should assist with planning for a mountaineering expedition. . Places like mountaineering camps can become major public health hazards. Everest Base Camp is known for being a rampant source of gastrointestinal illness due to densely populated areas without the best hygiene practices. Making sure kitchen hygiene, food storage, trash disposal, and water treatment are up to par is vital...and the word “kitchen” is used lightly. Most expeditions do not exist within the confines of a traditional building. The kitchen may just be a patch of ground away from sleeping tents and bathroom facilities. With gastroenteritis being one of the most common expedition complaints, attention to detail and cleanliness in densely populated, remote areas can save the clinician a headache -- and quite literally, a stomach ache.
Another crucial component of prevention is risk assessment . Although many experienced expeditioners will be familiar and capable of assessing risk, the medical officer should be willing and able to assist with risk assessment. Risk prevention includes safe route planning, making adjustments when needed, continued assessment of plants, animals, and climate safety, as well as ensuring simple safety measures such as proper helmets when climbing.
Dr. Warren Bowman wrote a great summary of the role of expedition physicians. He stated that physicians have to fill three roles when working in wilderness medicine. One role is the physician as a caregiver, dealing with medical issues that arise on an expedition. Another role is the physician as an advisor; this applies to all the risk prevention and pre-expedition planning that was discussed, from vaccination requirements to encouraged conditioning. And the third is the physician as a participant . It may be easy to forget, but just because the doctor is the one preventing and addressing all of the medical concerns on an expedition does not mean that they themselves are exempt from the stressors of the environmental extremes. The doc is just as likely to fall ill or face issues with exposure to extreme temperatures as the next guy. It’s necessary to do the research and know the little things about the environment that will be explored such as understanding proper clothing fabric and layering techniques and familiarity with the type of terrain.
Ultimately, it is important to note that while safety is of the utmost importance, the medical officer should be enhancing the enjoyment and achievement of the participants. Taking all the appropriate measures without limiting the enthusiasm of the trip creates the best experience. There is nothing better than that sense of accomplishment when safely finishing a big summit, dive, or hike.
Backer H. What is wilderness medicine? 1995;6(1):3-10. doi:10.1016/s1080-6032(13)80003-8
Johnson C, Anderson R. S, Dallimore J, Wisner S, Warrell A. D. Oxford Handbook of Expedition and Wilderness Medicine. Oxford University Press; 2008.
Warrell D, Anderson S. Expedition Medicine. Revised Edition. Routledge; 2013.(Video) The story of how Expedition Medicine became World Extreme Medicine
Bowman D. W. Perspectives on being a wilderness physician: is wilderness medicine more than a special body of knowledge? WEM. 2001;12(3):165-167. doi:https://doi.org/10.1580/1080-6032(2001)012[0165:POBAWP]2.0.CO;2
Expedition Medics are responsible for the physical and psychological wellbeing of people during expeditions, often in austere environments where access to medical services is limited, or in some cases, non-existent.What does a expedition surgeon do? ›
An Expedition Doctor is responsible for the physical and mental wellbeing of people before, during, and after an expedition. Excellent planning and evaluation of risks before an expedition is integral to its success.How much do expedition medics get paid? ›
A generous salary, starting at £39,000 to £42,000 per year dependent on experience.What is the purpose of a medic? ›
Respond to 911 calls for emergency medical assistance, such as cardiopulmonary resuscitation (CPR) or bandaging a wound. Assess a patient's condition and determine a course of treatment. Provide first-aid treatment or life support care to sick or injured patients. Transport patients safely in an ambulance.Why would you go on an expedition? ›
Expeditions are probably the best learning environment for young people. Travelling to an entirely new part of the world pushes us outside our comfort zones, both mentally and physically. This is where the magic happens.What is the highest paid surgeon specialty? ›
A 2022 Medscape survey of over 13,000 doctors named plastic surgery as the top-earning medical specialty in the US.
Primary duties: A medical director is the highest level of a doctor, and they hold the most power and responsibility in a hospital or clinic.Where do flight medics make the most money? ›
The typical NHS General Practitioner salary is £89,689 per year. General Practitioner salaries at NHS can range from £42,876 - £175,962 per year.Do Army doctors get paid more? ›
Most military physicians know they are getting paid less than their civilian counterparts. Exactly how much less varies by specialty with some primary care physicians having the ability to make more than the median pay for their specialty at higher ranks.
Motivation to study medicine and genuine interest in the medical profession • Insight into your own strengths and weaknesses • The ability to reflect on your own work • Personal organisation • Academic ability • Problem solving • Ability to deal with uncertainty • Risk management and an ability to deal effectively with ...What skills do medics have? ›
Medical knowledge is one of the most common examples, though other skills like communication, empathy and decision-making are also important. Paramedics use these skills to earn their certifications, respond to calls and provide high-quality patient care.What makes a good medic? ›
“Physicians should be personable, great listeners, and empathetic to the concerns of their patients,” he elaborates. “They should not be condescending or arrogant. They should treat others as they want to be treated.” “Physicians should be personable, great listeners, and empathetic to the concerns of their patients.”What can you learn on Expedition? ›
Discover the wider world, as well as the community and culture of different places. Learn how to become a team member and work at building relationships with other team members. Depending on the expedition you go on, they will learn new skills such as trekking, diving, or white water rafting.
Exploration gives us the sense that anything is possible. Exploration leads to knowledge and understanding, and means that you make the world a better place as you explore. People have always tried to leave the world a better place for future generations. Exploration is one way we can do that.How fast can an Expedition go? ›
The 2022 Ford Expedition has a top speed of 120 mph. This number has slightly increased since the full-size SUV was introduced back in 1997 when its top speed was 106 mph. Starting at $54,315, the latest Expedition comes in six trim levels: XL.Who is lowest paid doctor? ›
Pediatricians earn on average $221,000 and work an average of 47 hours per week, yielding an average hourly wage of $94. It should be noted that pediatricians have the lowest annual salary out of any specialty on our list; however, they also work fewer hours than most specialties.What is the easiest doctor to become with high salary? ›
- Emergency Medicine.
- Physical Medicine & Rehabilitation.
- Child Neurology.
- Internal Medicine.
A Doctor of Medicine (MD) is the highest degree for physicians and surgeons.Why are surgeons MR and not DR? ›
Afterwards they took an examination. In London, after 1745, this was conducted by the Surgeons' Company and after 1800 by The Royal College of Surgeons. If successful they were awarded a diploma, not a degree, therefore they were unable to call themselves 'Doctor', and stayed instead with the title 'Mr'.
Health care is described as different levels of care: primary, secondary, tertiary, and quaternary. Primary care is the main doctor that treats your health, usually a general practitioner or internist.Are surgeons higher than doctors? ›
Surgeons are among the highest paid doctors, with a median salary of $409,665. In comparison, family practice physicians earned $230,456; psychiatrists earned $255,543; and anesthesiologists earned $453,687.Is medic really a doctor? ›
A paramedic is a medical professional who specializes in emergency treatment. They are not doctors, nurses, or physician's assistants. The word paramedic is a combination of two terms. "Para" means next to, and "medic" means doctor.What is a medic on a ship called? ›
A naval surgeon, or less commonly ship's doctor, is the person responsible for the health of the ship's company aboard a warship. The term appears often in reference to Royal Navy's medical personnel during the Age of Sail.What are medics in the Air Force called? ›
but the generic medic in the Air Force, equivalent to a Combat Medic Specialist in the Army or a Hospital Corpsman in the Navy, is known as an Aerospace Medical Service Technician or med tech for short.Is there a difference between a medic and a combat medic? ›
Though there are similarities, the two are not interchangeable. Aside from the civilian-military differences, a paramedic holds an EMT-Paramedic license while the Army combat medic holds an EMT-Basic license.Why medics are called doctors? ›
Doctor comes from the Latin word for "teacher" and originally referred to a small group of theologians who had approval from the Church to speak on religious matters. Eventually the term saw greater use referring to qualified academic and medical professionals.What rank is a medic? ›
1 – these are medics at the entry level and may be of ranks Private through Corporal (E-1 to E-4). 2 – this is a medic who has the rank of a Sergeant (E-5). 3 – this is a medic who has a rank of Staff Sergeant (E-6). 4 – this is a medic who has a rank of Sergeant First Class (E-7).How do you become a ship doctor? ›
- Must hold a diploma from an accredited school of medicine.
- Minimum two-three years of formal post-graduate/ post-registration clinical training.
- Board certification or equivalent in Emergency Medicine, Family Practice or Internal Medicine.
Mild indisposition was not enough to excuse a sailor from duty, but severe sickness, disease, and injuries often earned him a stay in the ship's infirmary. Called the “sick bay,” or “sick berth,” the ship's hospital was a place where the sick could be nursed back to health, isolated from the rest of the crew.
All oceangoing cruise vessels have at least one doctor and two nurses who live onboard and are on call 24/7. Larger ships might have a second doctor and additional nursing staff.Why are combat medics called 68 whiskey? ›
Why "whiskey," you ask? Although the position is typically listed as "68W," the Army will say "68 Whiskey" because it follows the NATO phonetic alphabet. The alphabet also includes "Alfa, Bravo, Charlie, Delta," which simply means "A,B,C,D." Just a little helpful context as you tune in!Which military branch has the best medics? ›
Army Special Forces Medic
Medics in the Special Forces Operational Detachment are first and foremost, special forces qualified. The 18D (18 Delta) medics in the Army special forces are highly trained Special Operations Combat Medics who attend training for more than a year, learning a variety of skills.
Special Forces Medical Sergeants (18 Delta) in the U.S. Army play a key role in delivering medical care in both combat and civil affairs arenas. Given the breadth of skills required and potential decrement of skills with time, recertification is desirable and mandated.Are medics off limits in war? ›
Medical neutrality refers to a principle of noninterference with medical services in times of armed conflict and civil unrest: physicians must be allowed to care for the sick and wounded, and soldiers must receive care regardless of their political affiliations; all parties must refrain from attacking and misusing ...Do combat medics carry a rifle? ›
Thus, in most modern forces, medics are armed and do not wear large identifying red cross insignia. A rifle or carbine is standard, often augmented with a sidearm because the medic may have to pass his rifle off to his patient or fellow war fighter in order to treat the wounded.Can a medic carry a gun? ›
In modern times, most combat medics carry a personal weapon, to be used to protect themselves and the wounded or sick in their care. By convention this is limited to small arms (including rifles).