Editorial Advisory Board Member Christo Motz shares his personal impressions of a recent event he attended – the World Extreme Medicine Conference, 2012, London, UK.

Expedition and Wilderness Medicine

Sunday, April 15: This dealt with the topics of wilderness medicine and expedition medicine.

Wilderness medicine is a relatively new faculty in Western Europe, though very popular and well known in the US, Canada and Australia.

Faculties are part of Medical Universities and research is done by medical doctors and biologists. The Wilderness Medical Society (USA) is one of the leading organisations in this field.

Wilderness medicine is about emergency medical care (trauma, acute illnesses and environmentally) mainly in remote areas and covers topics as: risk awareness, delayed access to professional health/medical care, limited numbers of rescuers, equipment and hostile environments, amongst others, such as health, hypothermia, bites and stings, altitude, acute illnesses and toxins.

Hikers, rock climbers, and other outdoor enthusiasts, but also park rangers who work and act professionally in such environments, are taking certain risks, of which they are (hopefully) aware. Very often people travel through remote areas and suddenly discover that they are trapped in extreme weather, lost or confronted by acute illness, a trauma related injury or environmental problems, such as an encounter with wildlife.

In those cases wilderness first aid courses offers a range of insight knowledge, practical skills which are based on scientific research, hands-on skills training and improvisation.

Expedition medicine deals with remoteness and very specific problems and challenges for teams who travels through extreme environments, and who share a similar set of goals, like climbing a mountain peak, a group of scientific (climate, biologist) researchers. They operate in remote settings like the polar areas, high mountains, oceans, desert and jungle.

These people are highly prone to all kind of emergencies, and have to rely heavily on themselves, their equipment and their communication with the outside world.

The advantage is that they know what they are up to, so it’s all about a clear risk assessment and consequence management.

Pre-hospital Medicine

Monday, April 16: The presented topics showed a vast range of procedures and approaches in the pre-hospital setting: What is the scene, what happened and how can we deal with these challenges from an emergency medical point of view?

Some of the topics dealt with an operational approach, such as reading the scene, catastrophic haemorrhage, difficult airways in remote settings, thoracic trauma, pre-hospital vascular access, permissive hypotension and fluid resuscitation.

A broader perspective, and wilderness medicine related are topics such as dive medicine, jungle fever and marine envenomation.

Guest speaker Australian Dr Mark Read, biologist, presented an interesting and inspiring lecture, named: Living with crocodiles. His research into the habitat, living conditions and risks about the different species (crocodiles) in the northern part of Australia (fresh and salt water crocodiles).

Disaster and Relief Medicine

Tuesday, April 17: The strategic approach of extreme medicine, also covered mass casualty scenarios, mortality and morbidity in displaced populations, wars and population movement in affluent countries, reproductive health in refugees, preparedness & logistics in natural/manmade disasters, the problems with humanitarian aid, code of conduct in disaster relief and natural disasters. Presented by excellent and bright people like Alexander van Tulleken, Arjun Katoch and Piers Cartner.

War reporter Jon Snow told delegates about his personal, breath taking experiences, while working in extreme and hostile environments.

On the other hand this day also covered topics on an operational level, medical exams and medical treatments of patients, like traumatic cardiac arrest, pre-hospital paediatric trauma, infection control-pre hospital.

All very important, though the combination of these different levels didn’t match so well with the earlier lectures during the morning.

Besides, I think that the patient treatment lectures could be focused on hands-on workshops instead of an ongoing cerebral, intellectual stream of talks and slideshows.

Pre-Hospital and Disaster/Extreme medicine

Wednesday, April 18: This day continued with pre-hospital medical care to a certain extent.

Most of the lectures dealt with patient assessment from a standard medical approach.

Paul Hartely, former Special Forces medic from the UK, and now an instructor with G4S, told delegates about security and safety in hostile environments, he presented a clear set of tools and tricks to keep safe and healthy.

Of course wound management, managing traumatic amputations, and difficult airways in remote settings are part of the general approach.

But what if disaster struck our vulnerable society and shut down all electricity? What would a medical doctor, expedition medic or nurse do in case the hospital has to deal with a lack of hygiene, equipment and other resources. These questions seems very interesting to me.

The organisation has tried to cover the most common aspects of extreme medicine, interestingly from a one dimensional approach. In that sense I found it inspiring and interesting.

Hardly anyone spoke about the cross-overs between battle medicine, war medicine, survival medicine and complementary medicine (herbal medicine and edibles) when disaster strikes. Would that be something for future meeting?

Christo Motz