I was lucky enough to attend the inaugural World Extreme Medicine Conference and Expo, held at the Royal Society of Medicine in London from the 15th to the 18th April this year. The four day conference brought together experts from around the globe and interested parties from a range of backgrounds to talk about the diverse and eclectic fields that interact when medicine is practised in a remote or extreme setting.
The three main themes of cutting edge pre-hospital medicine, remote environment healthcare and disaster relief work were brought to life by the speakers, with many of the presenters having been involved in events and programmes that the rest of us may have seen on television.
Attending this conference as a paramedic was somewhat intimidating, especially as, despite having a keen interest in the subject, I have no remote medicine training or experience to speak of. However, I was very pleased to see a number of other paramedics from several countries across the world in the audience. The Royal Society of Medicine venue was a very pleasant place to spend the long days, especially considering that the packed programme meant that talks often started before nine in the morning and went on till eight in the evening.
The conference was hosted by Expedition and Wilderness Medicine and supported by a number of companies such as Raleigh International, Prometheus, Surfing Doctors and International SOS who had stalls around the venue and who were more than happy to converse with attendees interested in their specialist areas. There were a number of student posters covering various relevant topics available for viewing in the breaks, and a competition for the best poster was held, won by Magdalena Tarchala and Margaret Pietrowski's poster entry entitled Acute Appendicitis in Remote Antarctic Environment.
‘The talk, like many others, was illustrated with several, often gruesome pictures, many from the speaker's own personal experiences which really brought the subjects to life’
Day one
The first day covered expedition and wilderness medicine, touching on a wide range of topics in the field.
Dr Gordon Giesbrecht, AKA Professor Popsicle, a name he gained from his work on hypothermia and his repeated use of himself as a test subject, talked about his work on hypothermia and linking it to the experiences of the passengers who ended up in the North Atlantic Ocean nearly 100 years to the day when the Titanic sank. This talk immersed the audience into the experience, distinguishing the difference between death by drowning and death by hypothermia, and dispelling some of the myths held concerning both fatalities. Dr Giesbrecht showed some video footage of his experiments, many of which involved exposing students to freezing water as a warning for anyone that wants to study in this field!
One of the foremost points of the talk which I shall remember is to treat hypothermia victims gently and keep them flat, good simple advice which is applicable anywhere. (See www.coldwaterbootcamp.com/pages/home.html for more information).
One of the leading toxinologists in the world, Professor David Warrell, spoke about his experiences around the globe and the patients he has had to treat following encounters with a whole spectrum of poisonous terrestrial critters. The talk, like many others, was illustrated with several often gruesome, pictures, many from the speaker's own personal experiences which really brought the subjects to life. The subject of terrestrial envenomation was followed by marine envenomation, a talk delivered by Dr Mark Read, a respected marine biologist from Australia.
‘This talk made a poignant argument by raising the issue of analgesics in pre-hospital care, iterating the subsequent benefits that could arise from increasing flexibility of analgesic administration’
Day two
The second day was on pre-hospital medicine which I thought would have particular relevance for me as a paramedic. I actually found that all the days covered different aspects of working in pre-hospital care. Admittedly, many of the conditions described are unlikely to be encountered in normal UK ambulance work but the principles of treatment are very similar, regardless of whether the trauma was caused by a road traffic accident or falling off a mountain. The importance of having a high level of confidence in your basic skills was repeated throughout the event and is as applicable in urban pre-hospital practice as it is to anywhere.
Highlights of the second day included Dr Tim Lowes from James Cook University Hospital in Middlesbrough. This talk covered pre-hospital analgesia and anaesthetics, currently a topic of great interest in the British paramedic field considering the impending Joint Royal Colleges Service Liaison Committee (JRCALC) update, rumoured to include more options for paramedics in the UK to administer analgesics.
The talk made a poignant argument by raising the issue of analgesics in pre-hospital care, iterating the subsequent benefits that could arise from increasing flexibility of analgesic administration.
Doubtless, every paramedic can think of patients where our standard analgesics such as morphine have worked very well and other patients whom it doesn't seem to have any great effect on.
Dr Mark Byers described the current state of pre-hospital care for CBRN (chemical, biological and nuclear) emergencies and the ongoing threat that exists across the world, which, despite a cheery delivery did much to terrify as well as educate his audience.
Dr Malcolm Russell from Surrey and Sussex air ambulance discussed the treatment of catastrophic haemorrhage, with reference to his military background, as well as the continuing lessons being learnt in places such as Afghanistan, informing developments in pre-hospital care in the civilian world. The evidence for the use of tourniquets to control catastrophic haemorrhage seems overwhelming and the changing of central tenets of paramedic practice such as the move from ABC to (C)ABC have the potential to save lives in any trauma.
Day three
The third day covered disaster medicine. There were many interesting views on this topic from various speakers with experience in the subject, though often they held differing standpoints on treatment and response.
However, the varying opinions, from the surgeon on the ground to the coordinator of a multinational disaster relief effort in another country demonstrated beyond contention that the range of people involved needed to work together for any treatment or response to be fully effective.
Professor Anthony Redmond OBE talked through his long career providing emergency medical support in disaster areas, including heading the UK surgical team that travelled out to Haiti following the 2010 earthquake. Less obvious, though just as relevant, perspectives on the subject of disaster medicine were provided by Arjun Katoch, a disaster management advisor who manages the United Nations Disaster and Assessment Coordination (UNDAC) system, and journalist Jon Snow, who described a different side of working in a disaster area, mentioning how media and medics often find themselves in similar situations.
Day four
The fourth and final day of the conference covered the whole range of subjects that had already been covered and drew some common themes together. Wound management and its importance in extreme environments were described by Ben Cooper, a nurse from Sheffield A&E, who provided some truly innovative medical ways, learned from experience, on how to use duct tape in the arctic. Cooper himself showed the polarised duties performed by those working as medics across the globe, from the normative to the extreme.
Dr Anne Weaver who is the lead clinician for London Helicopter Emergency Medical Services (HEMS) talked about the way HEMS work and train, and discussed the changing thoughts on pre-hospital permissive hypotension and fluid resuscitation. The ‘pit crew’ method of working and training now seems to be appearing in a range of settings, and there could prove to be a lot of lessons to learn for paramedic practice which can sometimes prove to be slightly chaotic. Learning simple lessons such as packing all the bags the same way, laying out the equipment in a kit dump in a standard fashion and regular skills drills could benefit us all.
Dr Kevin Fong who appears regularly on television, blended the subjects of NASA, the rapid developments in medicine over the last 300 years and a few mentions of Top Gear into a fascinating lecture on pre-hospital care. The closing talk was given by Dr Kate Prior, who worked on the Medical Emergency Response Team (MERT), and Charlotte Madison, Britain's first female Apache pilot who described their conflicting experiences in Afghanistan.
The tales of the two women brought home the harrowing reality of modern conflict as seen from the cockpit of a veritable flying arsenal and balanced this with the incredible work being done by medics treating servicemen injured in the same arena. The close working relationships developed by the paramedics and doctors working on the MERT was described and how each played a vital role in the care of the wounded.
Conclusion
The speakers came from a range of backgrounds and countries, many with military experience and a large number of whom were involved in remote medicine in addition to holding down normal medical professions. Such conferences could be immensely valuable to anybody with an interest in remote or extreme medicine, though the focus on good clinical based diagnosis, the need to improvise and adapt and the wide range of situations people can get themselves into would resonate with any paramedic in any environment. Overall the event was thoroughly enjoyable and those who attended learnt a great deal on an array of subjects.
I left with very itchy feet and wondering how I can get to the conference in Boston next year.