Expedition medicine is a relatively new branch of emergency care, but one which draws on many skills within the prehospital domain. Defining an expedition medic officer's (EMO) role is difficult as it can be a nebulous term that encompasses skills from doctors, paramedics, nurses and physiotherapists. Often the unique skill sets can be matched to the particularities of an expedition but dealing with medical emergencies can require clinical (and non-clinical knowledge) from more than one specialty.
Despite each expedition bringing varying challenges, the key components for the EMO remain constant as clinical, expeditional and personal. Clinical and expeditional skills will be largely dictated by the expedition details (location, environment, goals), and a rich variety of personal skills will be an asset in most situations. Expeditions are a lot of hard work, so during times the medic is not required, they are expected to contribute in other ways; we have operated sound booms for film crews, caught seals for researchers and been chase truck drivers to name a few. It is certainly an advantage if the EMO can bring expedition-appropriate skills in all areas (such as trauma management, bushcraft or climbing experience).
Working with a sports team at events brings the challenge of dealing with the mental health of competitors. An accident at a rally in Greece leading to an obvious closed fracture of the foot resulted in first successfully persuading the racer to attend hospital, and subsequently counselling him when he was medically unfit to continue the event. Ensuring the health and wellbeing of the team can sometimes result in being ‘the bad guy’ when medical advice goes against a racer's competitive nature.
Most lengthy expeditions include soft-tissue injury management in some form. Whether from athletes pushing their bodies to exhaustion or a slight injury at the start of a long trip, a small issue can turn into a major one without careful management. A sprained ankle in the remote Bárdenas Reales area of Spain resulted in the rider not being able to wear a motorcycle boot for a few days until the swelling had been controlled with kinesiology tape and medication. Management of the injury meant the rider was able to complete the rest of the trip after a few days of rest, rather than being sent home.
The ethical issue of using time and resources to treat those not associated with the expedition is one which does occur. At a rally event in Europe, I found that some teams were asking me to assess/treat their racers before going to official medical support. This raised the issue of using consumable medical kit with persons not related to my team, and a duty of care to injured/unwell people asking for help. It also meant possibly hindering the official race medics in their duties to the competitors. My solution was to assess them as I would my own team and refer anyone who needed further assessment or ongoing treatment to race medics. The conflict of help vs hindrance is one which can occur on any expedition, and EMOs need to be aware of the ethical issues that could arise in situations that create a healthcare imbalance in local regions or the consumption of equipment meant for the expedition members.
Risk management both before and during is an integral part of any expedition. Although dynamic risk assessing is part of any prehospital clinician's role, the specifics of expedition risk management can be very different. This has ranged from working with an expedition leader to ensure there is enough support truck cover to rescue all riders on Canada's ice roads, to giving vaccination advice for international travel. This ties in with knowledge of global health issues, which is an integral part of formal expedition training and exercised for every expedition. From knowing which pockets of antibiotic resistance will affect traveller's diarrhoea treatment to endemic outbreaks of viral haemorrhagic fevers, EMOs must be aware of any in-country risks.
While being a paramedic is certainly a good start to becoming a well-rounded EMO, it is such a unique area of operations that it requires a multidisciplinary approach. The non-clinical skills that paramedics practise daily translate very well for use on an expedition. However, this must be supplemented by an element of pharmacology, physiotherapy, psychology and common sense. The role of EMO brings many unique challenges that would not be encountered in a ‘traditional’ paramedicine role within the NHS.