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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 This paper is a synopsis of a presentation during an invited symposium on Expedition Medicine held during the 5th European Conference on Travel Medicine, Venice, Italy, March 2006.
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About the author Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 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 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. Dr Peter Leggat is Associate Professor and Deputy Director, Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, Australia, and Visiting Professor in the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. His qualifications include: MD (higher doctorate in medicine), University of Queensland, Australia PhD (in occupational health), University of South Australia DrPH (in travel medicine), James Cook University, Australia Dr Leggat is a specialist in public health medicine and holds Fellowship of several professional organisations. He is a former Fulbright Scholar and also the recipient of the Surgeon General’s Medal (Australia) in 2002. He has been a Board Member for the International Society of Travel Medicine ( ), the World Safety Organization ( , ; incl. Director-General ), and the Australasian College of Tropical Medicine (1991-Present; incl. President , ; President-Elect, 2005-Present).
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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 This lecture will endeavour to address these objectives. The lecture will endeavour to address these objectives.
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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 There are many different types of expeditions. Medical personnel can become involved in all of these.
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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 There are many reasons why medical personnel should consider supporting expeditions. The rewards of achievement can be met at all levels of expeditions. Some expeditions can be a claim to fame as well!
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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….. Some comments have been extracted here from reflections of one expedition doctor. Source: Student BMJ 2000;8: 279
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Need for expedition medical personnel?
Remote from medical care Legislative/legal/safety requirement Nature of participants/selling feature Risk of injury/illness Expeditions need medical personnel; sometimes for different reasons. Some of the main reasons are listed here.
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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 These are some of the activities, which expedition medical personnel may be involved with.
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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 Supporting expeditions requires training, both in terms of expedition training and specific medical training. The training depends on the type of expedition and who is travelling on the expedition.
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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 Supporting an expedition is not without risks. It is important to consider all the possible consequences and manage these risks accordingly.
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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 These are just some of the issues to consider before accepting a medical support placement with an expedition.
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What is my liability? Employer may have some responsibility?
Depends on contract and whether indemnified Discuss with medical defence or insurance organisation Liability is an interesting area. For most medical personnel, they will not be registered outside of their country of practice and registration. It is important to consider legal implications and seek advice early on these matters.
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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 Expeditions are occurring all the time. There are a range of established expeditionary organisations, travel companies and volunteer groups to approach.
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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 (accessed 5 April 2006) There are a number of further resources available on expedition medicine. A few have been listed here.
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