Article from October, 2012

trip_prep

The objective of an expedition is to achieve the goal while maintaining the health and safety of the expedition members.  We try to do that while leaving a minimal footprint on the environment and being mindful of its flora and fauna.  Even more basic to that premise is the concept of personal mindfulness when it comes to health care in the field.  While that responsibility extends beyond personal needs for the medical officer of an expedition, limited resources will constrain the care that can be administered.  Therefore, each individual has an obligation to prepare properly for personal needs and to disclose any condition that would jeopardize personal or overall expedition safety.  I have seen expedition members deny potentially life-threatening medical conditions like diabetes or hide recent major surgery until it was uncovered in a remote area, behavior driven by a fear of missing the event.  Unfortunately, the medical officer and the expedition leader are left to deal with these issues which impact everyone.

Much has been written about the design of personal and group medical kits and good information can be found through organizations such as the National Outdoor Leadership School (NOLS), Outward Bound, and the Wilderness Medical Society.  No single medical kit fits all circumstances so one must customize personal and group supplies accordingly.  Factors that must be considered by all members include the expedition purpose and destination, the length of time gone, the degree of risk, constraints on bulk and weight (and cost), possibility of replenishment for supplies and medications, and the likely medical problems you will face.  Some of these factors have implications for pre-trip preparation for vaccinations and specific disease prevention such as malaria.  Problems such as blisters or diarrhea readily dealt with at home can be most vexing in the field and should be considered.  I cannot emphasize enough that all members going to a remote area should have appropriate medical evacuation coverage which costs about $200 but, without coverage, evacuation will be delayed and can cost into six figures.

The individual should be self-sufficient for basic medical needs (see table), have their kit readily available, and hand carry important medications.  Do not count on group supplies as the medical officer is not a pharmacy and the supply will be limited if it is even available.  Plan to take extra meds in case your expedition is extended inadvertently.  It is also prudent to bring some extra meds for common problems because I guarantee that if you are the only one with antidiarrheal pills or ibuprofen, your suffering colleagues will want your personal supply.  You would be surprised at how often things that seem obvious can be forgotten or not considered in the excitement of departure.

Questions often come up about supplies.  One must consider the level of medical training on the trip.  For non-medical expedition members, only bring personal medical supplies unless requested by the medical officer or expedition leader.  Levels of training and experience can vary widely among doctors, nurses, and emergency personnel and it is incumbent upon expedition medical personnel to determine inclusion of practical specialized medical equipment correlated to their experience.  For example, it makes no sense to bring a defibrillator on a remote trip where sophisticated local resources do not exist and evacuation will not be timely.  Someone who needs defibrillation will not likely survive.  Furthermore, weight and bulk are critical and you are better off stocking more useful items.

One key to efficiency for meds is to consider what can be used for more than one function.  Specific medications are not listed here but one such medication is Benadryl which can treat allergies, cough, nausea, motion sickness, muscle cramps and sleep problems.  For antibiotics, a broad spectrum agent like Levaquin or Zithromax that can treat diarrhea, skin infections, bronchitis, and urinary tract infections should be selected.  Ibuprofen is used for pain, cramps, fever, and inflammation.  Be sure to check that your meds are stable in heat or cold if you are going to austere climates.  Sunscreen, insect repellant, and lip balm are essentials.

Supplies should also be selected with similar crossfunctional use in mind and improvisation is a fundamental skill in expedition medicine.  Splints can be made from tent pegs, ski poles, and basically anything that can be stabilized.  A catheter used to relieve urinary obstruction is small and also great for intranasal pressure for a bad nose bleed. One of the most valuable items to carry is duct tape.  Not only will it patch a hole in your duffel bag or tent, it is very good for lacerations, blisters, splinting, eye patches, and creating a sling.  Be creative!

Lastly, it is important to manage expectations of medical care when afield, both your own and your fellow expedition members.  Understand from the leader or medical officer what actions to take if an accident occurs, follow the chain of command.  Bring your personal medical history on a flash drive.  If you are personally mindful and prepared, you will have peace of mind and contribute to the success of the mission.

TABLE.  Suggested basic personal medical kit.

  • Personal prescription medications (include generic names for meds and dose, note from physician for controlled substances)
  • Antidiarrheal medication
  • Antibiotic for self-treatment of moderate to severe infections
  • Antihistamine and decongestant
  • Antimotion sickness medication if susceptible
  • Ibuprofen, Tylenol with codeine for strong pain
  • Cough suppressant/expectorant
  • Antacid
  • 1% hydrocortisone cream
  • Bacitracin or similar antibacterial ointment
  • Antifungal cream

 

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This article was published in The Explorers Journal

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