Preparing medical personnel for expeditions

1. Preparing medical personnel for expeditions Dr Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FACRRM Anton Breinl Centre for Public Health and Tropical Medicine James Cook University Townsville Australia

2. About the author • Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 1993. He has also been on the faculty of the South African travel medicine course, conducted since 2000, and the Worldwise New Zealand Travel Health update programs since 1998. Dr Leggat has assisted in the development of travel medicine programs in several countries and also the Certificate of Knowledge examination for the International Society of Travel Medicine.

3. Objectives In this session we will look at: • What are the types of expeditions? • Why be part of an expedition? • Need for expedition medical personnel • What will you do? • What training is needed? • Are there any issues to consider? • How do I find an expedition? • Further resources

4. What are the types of expeditions? • Professional expeditions: • conservation, educational, scientific or adventure • Commercial travel and premium expeditions • Sporting/recreational/charity expeditions • School/university/cadet/defence expeditions

5. Why be part of an expedition? • Inexpensive or free travel • Ability to visit remote or unusual areas • Life experience/discovery/be famous! • Development of medical skills and experience

6. Expeditions force your own life into sharper focus by presenting a contrast with the rest of the world. Expedition medicine offers the rewards of overcoming unexpected challenges in the face of bizarre adversities….. Source: Student BMJ 2000;8: 279

7. Need for expedition medical personnel? • Remote from medical care • Legislative/legal/safety requirement • Nature of participants/selling feature • Risk of injury/illness

8. What will you do? • Training and development of skills • Risk assessment • Travel health plan for participants • Medical planning/stores/equipment • Assessment and management of medical problems on expedition • Medical debriefing/post-travel health plan

9. What training is needed? • Usually doctor, nurse or paramedic • Broad general training: • General/rural practice, accident and emergency, infectious diseases • Travel and tropical medicine: • General risks of travel, destination related issues, tropical diseases • Activity dependent: • Altitude, diving, aviation, boating, camping, aid to the population • Remoteness may demand surgical, anaesthetic & dental experience • eg Australian Antarctic Division, Some cruise expeditions • Participant dependent: • Children, older persons, disabled persons

10. Are there any issues to consider? • Length of trip • Lost holidays, salary and goodwill • Risk of a serious incident in remote area • Risk of litigation

11. Are there any issues to consider? • Need to be able to deal with worst case scenario • Need to be familiar with common problems associated with expeditions • Needs to be able to undertake multiple tasks

12. What is my liability? • Employer may have some responsibility? • Depends on contract and whether indemnified • Discuss with medical defence or insurance organisation

13. How do I find an expedition? • Register with major expeditionary organisations, eg: • Royal Geographical Society, Australian Antarctic Division, Raleigh International (British based charity) • Commercial/travel/cruise expeditions • Volunteer/school/university/cadet/adventure training groups, military

14. Resources • Expedition Medicine (2004). • Warrell & Anderson, Royal Geographical Society • Ch. 15. Altitude and Expedition Medicine (2001) • Murdoch, Pollard & Gibbs. In Zuckerman J (Ed) Principles and Practice of Travel Medicine. Wiley. • The Medical preparation of expeditions: the role of the medical officer (2005). • Shaw & Dallimore. Travel Med Inf Dis 2005;3:213-23 • Expedition, wilderness and travel medicine courses, eg • http://www.wildernessmedicaltraining.co.uk/about.htm (accessed 5 April 2006)