ExpeditionMedicine

To describe the incidence and type of injury and illness occurring during an expedition-length adventure race and identify those resulting in withdrawal from the event, a prospective cohort study was conducted of the injuries and illness treated during the Subaru Primal Quest Expedition Adventure Race™ held in Colorado July 7–16, 2002. All racers, support crewmembers, and race staff were eligible to participate in the study. When a member of the study group received medical care due to an injury or illness, the encounter was recorded on a Medical Encounter Form. If an injury or illness resulted in withdrawal from the race, this was also recorded. Information from the Medical Encounter Forms was used to generate the Medical Log. There were 671 individuals eligible to participate in the study. A total of 243 medical encounters and 302 distinct injuries and illnesses were recorded. There were 179 (59%) injuries and 123 (41%) illnesses. Skin and soft tissue injuries and illness were the most frequent (48%), with blisters on the feet representing the single most common (32.8%). Second was respiratory illness (18.2%), including upper respiratory infection, bronchitis and reactive airway disease-asthma. Respiratory illness was the most common medical reason for withdrawal from the event. Injuries accounted for almost 60% of all injury and illness yet they contributed to less than 15% of the medical withdrawals from the race. Blisters accounted for almost one-third of all conditions treated. Providers of medical support for expedition-length adventure races should be prepared to treat a wide variety of injury and illness.  

An overview of the top five most common polar expedition injuries and illnesses.  

To describe injuries and illnesses treated during an expedition-length adventure race and combine the results with those from previous studies to identify common patterns of injury and illness during these events.  

To study the effectiveness of ibuprofen versus placebo in preventing acute mountain sickness (AMS) and high altitude headache (HAH).  

High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. Toward this end, we initiated a prospective, double-blind, randomized, placebo-controlled trial in the Nepal Himalaya designed to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.  

Exercise-associated hyponatremia (EAH) typically occurs during or up to 24 hours after prolonged physical activity, and is defined by a serum or plasma sodium concentration below the normal reference range of 135 mEq/L. It is also reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited or often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.  

This study was conducted to better define the pathophysiology, risk factors, and therapeutic approach to exercise-associated hyponatremia. Medical records from all participants in the 1998 Suzuki Rock ‘N’ Roll Marathon® who presented to 14 Emergency Departments (EDs) were retrospectively reviewed to identify risk factors for the development of hyponatremia. Hyponatremic patients were compared to other runners with regard to race time and to other marathon participants seen in the ED with regard to gender, clinical signs of dehydration, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An original treatment algorithm incorporating the early use of hypertonic saline (HTS) was evaluated prospectively in our own ED for participants in the 1999 marathon to evaluate improvements in sodium correction rate and incidence of complications. A total of 26 patients from the 1998 and 1999 marathons were hyponatremic [serum sodium (SNa) ≤135 mEq/L] including 15 with severe hyponatremia (SNa ≤ 125 mEq/L). Three developed seizures and required intubation and admission to an intensive care unit. Hyponatremic patients were more likely to be female, use NSAIDS, and have slower finishing times. Hyponatremic runners reported drinking “as much as possible” during and after the race and were less likely to have clinical signs of dehydration. An inverse relationship between initial SNa and time of presentation was observed, with late presentation predicting lower SNa values. The use of HTS in selected 1999 patients resulted in faster SNa correction times and fewer complications than observed for 1998 patients. It is concluded that the development of exercise-associated hyponatremia is associated with excessive fluid consumption during and after extreme athletic events. Additional risk factors include female gender, slower race times, and NSAID use. The use of HTS in selected patients seems to be safe and efficacious.  

 

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I'm an SHO, but I don't have your typical ward based job. In the last four years I have treated in jungles, underwater (in scuba gear), 5m from a gorilla, up a volcano, on a beach, at altitude, on safari, in a bog and on a boat. Expedition medicine is a great way to travel the world, take time out whist expanding your CV, and be physically and mentally challenged and develop your skill and knowledge base. As a doctor, you can undertake expeditions during your 'spare time' but it is more common for doctors to go on expeditions between F2 and specialty training. This is the ideal time either because you have been working for the last 7 years and either you need a break, the NHS has broken you, or you don't know what you want to do with your career and need time to think. At this point I would recommend using your F2 course/study budget on an Expedition Medicine course. They are expensive, but the knowledge and skill base you gain makes you more prepared and competitive for expedition jobs. There are many types of Expedition Medicine jobs ranging from endurance sports races to scientific expeditions. Although the jobs differ, there are many ailments common to all. You should expect to treat diarrhoea and vomiting, insect bites, blisters, cuts, injuries, and GP complaints such headaches and exacerbations of chronic illnesses. More serious injuries and illnesses can occur so it is good to be prepared as possible. To help, ensure your medical kit is labelled and organised e.g. labelled cannulation kit, emergency kit is always accessible and you are familiar with the casevac plan. Your role as an Expedition Medic involves more that the treatment of clients. A typical job also includes client selection and education, risk assessment, updating casevac plans, stock-checking kit, health promotion, project management and writing debriefs. What's Right For You? If you're keen to do Expedition Medicine, first think about where you want to go and then for how long. Think hard about these choices. A 6 month expedition through the jungle sounds exciting, but if you don't like spiders, creepy-crawlies and leaches, and the furthest you have travelled is an all-inclusive to Mallorca, then it might be best to start with a 4 week expedition in France. When you have an idea of what you want to do there are many organisations that you can apply to, including: Operation Wallacea Raleigh Across the Divide World Challenge Floating Doctors Doctors Without Borders Royal Geographical Society Action Challenge GapForce Each organisation will have different aims, clients, resources and responsibilities so pick one that suits you. Have fun and feel free to post any question below.  

We have some extremely exciting content and globally renowned speakers lined up for November's World Extreme Medicine Expo, under the key areas of Disaster  

Extreme Medicine Conference 2015 Date: Saturday 7th and Sunday 8th March Venue: King’s College London, Guy’s Campus, SE1 9RT Timings: 09:00 – 18:00 Audience: Any student with an interest in Pre-hospital or Wilderness Medicine Cost: £40 including all refreshments, certificates and entry to the conference social Ticket Sales: http://www.kclsu.org/ents/event/2127/  

Tom Yeoman / Breaking into expedition medicine: finding a job, courses, kit and taking the first steps up Mount Kilimanjaro with Action Challenge