Lectures

Expedition Medicine: The Expedition Doctor - Practical Considerations

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Expedition Medicine: Expedition Medicine an Intersection of Disciplines

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Q&A

How does pre-departure planning and preparedness impact your daily life?

This always takes time and you must set aside that time in order to be adequately ready to be an expedition provider. You must factor this in when attempting to balance this type of work and your daily life.

Are there sacrifices that are made in terms of having a normal job/career as a doctor in order to take part in expeditions?

The sacrifices are purely missing things at home when you go on expedition.

What is your favorite expedition you’ve been on and the favorite place you’ve been?

Peru is my favorite in the Cordillera and Blanca are incredible.

What are some things that you would recommend we do in order to make ourselves better candidates for emergency medicine residency programs that have a focus in wilderness medicine?

Try to pursue certifications that are at your level of training such as WFR, WEMT,AWLS and study hard.

Do you know of any summer opportunities/clubs/etc for medical students to get involved in the field of Mountain Medicine during their first summer? Or are there any opportunities (research, volunteer, etc) that medical students interested in this field should pursue at any point during their education to build interest and qualifications?

The biggest opportunities are the ones that take you into the back country and give you personal, expedition experience. You might also look at the University of Colorado section of wilderness medicine website for opportunities.

What sort of track do you take to become involved with expedition medicine, and are there any residencies or fellowships that focus specifically on training in this area?

There are fellowships after residency in expedition/Wilderness Medicine . If you look at the Wilderness Medical Society's website there are also other programs where you can pursue the study of these topics.

What residency attributes (community hospital, more rural, high volume, etc) best prepares you for expedition medicine?

A quick guide would be to think about all of the things that could happen when you are in a remote, wilderness type environment and seek to gain expertise in these areas.

What resources do you use to in your pre-expedition routine to assess specific environmental and infectious risks of a given area?

I use the World Health Organization, CDC, proMed mail sites, along with multiple weather and climate data-bases to prepare for infectious disease, climate and weather related concerns.

Do you consider purchasing medications in country where they are less regulated and can be bought OTC?

Absolutely, this is a good option, but make sure that you can access the amount, strength, supply that you need. Also make sure the quality is not of concern. Counterfeit medications are a problem worldwide.

How would medical coverage be for a PA-C or APRN?

This is tough because a lot of international organizations do not recognize these certifications. If you are part of the US-based team, typically you can acquire medical coverage/liability through that organization.

Is DIMM still the gold standard for expeditions in non-mountainous areas (desert, jungle, ocean, etc.)?

This would be a good starting point that would give you a very broad base. There are then modules that you can take to add to your diploma in Mountain medicine that would cover some of these other environmental locations.

Are there other certifications that are required/recommended like Wilderness Advanced Life Support?

See above.

How are language barriers handled (like w/ Nepal earthquake suturing example)? Have you found translators to have sufficient medical vocabularies?

We work with interpreters, and country that have sufficient medical vocabulary's. From my experience, it seems that such interpreters are always available. If they were not available, I think it is actually very easy to describe what you were talking about in lay-terms. This is a skill that is a necessity when working in different cultures, different countries and even in your own country. Patient often respond better to a provider who can explain things without using medical wording.

How do you balance learning/keeping up with technical skills (climbing, skiing, etc.) during your education and training?

The balance comes by studying hard and then pursuing my passions which are climbing, skiing and being outdoors.

What recommendations do you have for balancing work as an expedition physician with a regular practice domestically? or how do you do it?

It is a challenge, but it starts by finding work as an expedition provider and then finding a practice/partner/department that is willing to support your passions and work.

If you are the only provider on an risky expedition and need to evacuate a patient, do you go with them and let the rest of the team continue or does the expedition halt right there?

The expedition typically would not stop, but they may be without a provider while you help to evacuate a patient.

How far in depth would you take an MSK prescreen? To avoid those not disclosing "minor" training injuries that would incapacitate them during the expedition. Or, you let them take that risk of using that evac. insurance.?

This is a case by case decision and is difficult. You must work to align yourself with the goals of the expedition participants so they learn to trust you and report every "minor" thing to you. This is a challenge because often expedition participants do not disclose because they are afraid you may end their expedition. Once the participants learn to trust you they will report everything and it helps you risk manage the safety of the expedition. Creating this relationship must be done quickly and fully prior to departing on the expedition.

Are there other schools that teach Tropical Medicine similar to the London School of Hygiene & Tropical Medicine?

Johns Hopkins, the Gorgas school from the University of Alabama at Birmingham in Peru are two others that are fantastic.

How often do you travel and how does it affect your family life? Do they ever get to travel with you?

Make everything about balance. I travel alone typically once per month or for longer trips every other month. Occasionally my family will travel with me, but more often they meet me following the expedition for some quality time.

Are you able to treat possible Rabies in remote places or do you have to evacuate?

This is depending on the country, size/duration, and goals of the expedition. Typically I have participants pre-vaccinated for rabies prior to most expeditions. This makes treatment easier.