Wilderness Medicine: taking my career off the beaten track
I write this from the shores of Loch Tay in Scotland, where I am working as an expedition medic for the British Exploring Society, a youth development charity which enables young people between the ages of 16 and 25 to join life-changing expeditions to places like Nepal, the Canadian Yukon or the Amazonian jungle. While Scotland may not sound that exotic in comparison, it is great to be able to do this sort of work again - albeit with the necessary COVID safety precautions in place.
Canoes ready to depart from the shores of Loch Tay
I first became interested in expedition and event medicine at the end of my GP registrar year, when I began investigating what I should do next.
Rather than spending my study budget on a CSA revision course, I instead chose to attend an expedition medicine course run by World Extreme Medicine at Plas Y Brenin in Snowdonia. I found this great fun and set about working out how to develop this as part of a portfolio career.
Fast forward to 2021, and I am lucky to be out in the field supporting groups of young people as they trek and paddle around Loch Tay and the surrounding mountains. I have also provided medical cover to ultramarathons in UK and Kenya, worked on expeditions in the Canadian Yukon and supported long-distance cycling events from Land’s End to John O’ Groats. These have all been thoroughly enjoyable yet have presented a series of challenges and learning experiences. Alongside this, I have been able to continue working as a sessional GP and I also volunteer as the medical director for the Virtual Doctors charity. I think these complementary roles can be really refreshing and a perfect antidote to potential burnout.
Working as the Medical Lead for Race to the Stones 2021
I am often asked what experience is required to work on events and expeditions and how best to get involved. You usually need to be at least an FY2 to help on UK-based events, so that you have your full registration. You also should really have worked in A&E and be confident at managing a wide range of patient presentations. Most doctors working in expedition and event medicine tend to be GPs, A&E doctors or anaesthetists - however, this list is by no means exhaustive.
Having prehospital trauma life support (PHTLS) or advanced trauma life support (ATLS) training and attending a wilderness medicine course will stand you in good stead for working in this environment.
It is also important to be comfortable with managing uncertainty and trusting your own clinical acumen. Having a keen interest in the outdoors is obviously important, as you will likely be cold and wet at least some of the time without the creature comforts of home. Being physically fit, so that you are not an additional burden, and possessing relevant technical qualifications and skills may be desirable depending on the type of trip you are going on.
A lot of preparatory work needs to occur prior to an expedition - to screen and risk-assess potential participants and try to mitigate the risk of possible issues occurring in the field. While on an expedition or when working on an event, there will usually be a lot of feet to look after! It is important to remain up to date with the management of acute medical issues and have a robust evacuation plan in place should these occur – particularly management of major trauma, as road traffic collisions are a major risk when travelling. Accepting that definitive care may be hours or days away is important to consider. Mental health and musculoskeletal complaints are also very common. You will also be the go-to-person when it comes to water sanitation and hygiene measures within camp. As with all things - prevention is better than cure!
Often you are much more than just the medic. You may be the navigator, communications expert, pastoral support, cook… the list goes on.
After an expedition or event, you will be responsible for informing a participant’s GP if there have been any medical incidents or if any follow-up is required. Keeping good, contemporaneous records is essential and, as with all clinical work, having appropriate indemnity is important.
COVID-19 has significantly impacted the travel industry and the inevitable knock-on effect is fewer expeditions and mass participation events. As we enter the final months of 2021 and restrictions ease, expedition and travel medicine will become ever more relevant as we navigate an increasingly complex set of international travel regulations. I optimistically hope that individuals will be more aware of the importance of seeking appropriate pre-departure travel advice and have a greater appreciation of the pressures that travel can place on developing healthcare systems.
You only have to read about the recent COVID outbreaks at Everest basecamp earlier this year to witness how adventure travel can impact upon local communities. The potential knock-on effects of expeditions on local healthcare facilities can be vast, and, as with all areas of medicine, we must always consider the ethics behind what we are doing - even if it means turning down an exciting job opportunity.
Time for a brew!
My work in expedition medicine has allowed me to combine my love of the outdoors with working as a doctor. Furthermore, it has given me the chance to meet a wide range of inspiring and fascinating people, and to be able to help empower them to fulfil their individual goals is hugely rewarding.
This article was originally published on doctors.net.uk on 13/09/21