T-Shirt in the Snow
It’s snowing today in Seattle, but I’m wearing a t-shirt. That’s for two reasons- one is that the coffee shop I’m writing from has the heat on high. That and the fact that I’ve just returned from Antarctica, guiding a mountaineering trip to the top of the Continent’s highest mountain. With temperatures lower than -40 f, and windchill values lower than -60 f, today’s weather feels pretty balmy.
Mountain guiding was my full-time profession until a few years ago. Life changes (read: two kids) precipitated professional changes that had been in the works for a while. Now I get to use my experience to support the guiding and adventure travel industries via my work at Remote Medical International. But I still keep active guiding, on a limited basis.
Unique Opportunity
Guiding in Antarctica gave me the unique opportunity to combine my professional “lives”. As a guide, a significant part of my responsibility is managing the safety and well-being of my team. I have to be able to manage common issues, and also have contingency plans in place should I have to manage a serious medical or logistical issue. This can be a real challenge- I’m one person, and have to rely on my own medical training and the medical kit that I can carry with me.
As an account manager at Remote Medical who provides risk management and medical support for expeditions, it’s my job to know all of the assets currently available to teams undertaking such adventures. I have used my guiding experience to inform the solutions I put together for my clients, and I’m always on the lookout for products or services that will represent upgrades for the industry. For this trip, my second to Antarctica, I got to employ state-of-the-art services for my own team. I also got to test some new gear, carry a prototype expedition medical kit that we will be offering beginning this spring, enjoy telemedicine backup, and test a communications system designed specifically for the world’s most remote and challenging locations. For me, as a real user of these types of services, I need to know what works and how it works, not only for myself but for my RMI clients who rely on me and my advice.
Objective
Our climbing objective was the summit of Vinson Massif, at over 16,000′ the high point of the Antarctic continent. It’s located in the Sentinel Range of the Ellsworth Mountains, a long, long way from definitive medical care. It’s a long way from anywhere! In a worst-case scenario it could be 2-3 weeks from the time of an incident to delivery of the patient to a US-level hospital. The common occurrence of no-fly weather in our basecamp and in the base where we access the continent via a Russian Ilyushin cargo plane coupled with extreme conditions on the mountain make managing medical care a real challenge.
Concerns: 2003
The last time I guided this trip, in 2003, I felt less than 100% prepared to manage my team’s safety. I had a WFR certification, the guiding industry’s standard minimum training. Great skill set, but for an expedition this remote it felt lacking. We carried a medical kit that included wound management materials and some Rx elements, mainly for treating altitude-related illness. But I felt pretty exposed. What was I going to do if our team’s resources were overwhelmed by a medical emergency?
Specifically, my concerns were:
- Level of Medical Training I was concerned that for a remote, extended expedition such as this one I needed more training
- Medical Kit Contents Did I have an adequate kit? What would a remote site medic recommend, for example?
- Emergency Response Plan Or lack of one. My understanding of basic risk management systems was lacking.
- Liability As a guide, my understanding of legal matters that directly affected me was limited. The job carries huge responsibilities- was my employer going to be on my side if things went sideways?
- Managing and Dispensing Prescription Medications For international trips, carrying specific medications is important- epinepherine, antibiotics, and medications for managing altitude illness for example. But I’m not a pharmacist, an MD, or a lawyer- what were my responsibilities, and how could I know whether dispensing a medication was the best course of action?
- Backup For medical issues, having a second opinion with a higher level of training is invaluable. And during any incident with medical or logistical challenges, I was likely to have my hands full. What if I couldn’t reach the team at the office when they were awake or available?
Serious concerns. I would have my hands full with preparing for and leading the trip, and didn’t know of any resource to answer my questions. Moreover, I was guiding a trip at high altitude in Antarctica. Little issues could easily become big issues. Despite the best guiding practices, and best equipment, things do happen. The conditions in Antarctica leave very little room for error. Challenges include:
- Remoteness Climbing takes place two plane flights and thousands of miles from the closest medical facility
- Weather and Environmental Issues Extreme cold, wind, and altitude are a given and factor into everything you do
- Limited Resources Gear is limited to what you can carry. With up to 120 pounds per person that includes food, shelter, and extreme cold weather gear you have to make hard choices with regards to what you bring.
- Communications A serious challenge in Antarctica. Yet crucial to access support when needed
Better Prepared: 2008
When I departed for Chile to stage for this year’s trip, I was in a much different place than I had been in 2003. In effect, I had become one of my own Remote Medical clients! I had put extensive work into preparing effective and functional risk management and emergency response systems into place. I was prepared for a variety of contingencies, had redundant systems in place, and had lightweight yet very solid tools to manage the medical care of my team. I also carried gear that represented potential upgrades that I could pass on to my RMI clients going forward. The end results included readiness, great service for my climbing clients, reduced exposure to legal liability, and peace of mind. Here are some of the specific upgrades I employed for this expedition:
- Risk Management Planning My preparations began with building a solid Emergency Response Plan, a Risk Management Plan, and revising my waiver and medical information forms. Having these materials in place gave me and my team solid protocols to direct risk mitigation and emergency response, and ensured that my legal documents were up to par. They helped to demonstrate a commitment to safety, which helps to limit liability. Lastly, having these forms organized and in place was instrumental in my securing the comprehensive insurance necessary for guiding this trip.
- Communications Director I secured a dedicated communications expert to hold all critical forms and manage communications and emergency response while I was on the Ice
- Personal Medical Training Upgrade In 2007, I completed the Wilderness EMT training and certification, a personal goal that gave me a serious upgrade with regards to my medical skill set. Also viewed as a risk management upgrade, attractive to insurers, clients, and my lawyer!
- Expedition Medical Kit I regularly outfit teams with custom medical kits in my work at Remote Medical. The kit I brought along for this trip was the prototype of an Expedition Medical Kit that our team has designed, and will be rolling out to the public this spring. I wanted to personally check its utility, weight, durability and design. The kit was organized into separate modules: emergency interventions, wound management, diagnostics, prescription medications, etc. Each module was vacuum-sealed, clearly labeled, and the selection of contents came from years’ worth of real field experience.
- Telemedicine Backup Our team was backed up by a telemedicine subscription good for the duration of our trip. This element was extremely valuable for such an expedition. It gave me 24/7 access to MDs and specialists in the case of any medical emergency. It also gave my clients that same access- now, if I (the WEMT) was the one who had a medical issue, they had direct access to medical support. Lastly, the medical direction offered by the telemedicine team allowed me the ability to better qualify the use of any prescription medications, giving me the ability to carry a very powerful medical kit while building in real control over the use of any Rx medications. The way the service works requires the caller to contact medical direction first before dispensing any medications.
- Communications System I field-tested a unique communications kit from Human Edge Tech. The system came with an Iridium satellite phone (the only system that works in Antarctica), batteries, a solar panel charger, a PDA, cables and software that allowed me to upload photos, audio, text and video from my position in Antarctica directly to a hosted website for webcast or other utility. This system was challenged by the limitations of the Iridium network and keeping batteries charged in extreme cold. But the system worked and allowed me a clear line of communication with the telemedicine support, my Communications Specialist, and family and friends. My understanding of the utility of this system helps me expand the reach of Remote Medical ACCESS telemedicine service to virtually any corner of the globe.
Back Home
This year’s trip was tough, but a success. We had much colder temperatures than my trip in 2003. Lows dipped below -40 f, and we had winds to 60 mph. Illness, extreme weather and the need to constantly adapt to changes while carrying major loads and dealing with frostbite weather added a lot of stress. In spite of these challenges we had a safe trip, a good time and summitted on December 1. Once we got back to Patriot Hills to wait for the Ilyushin flight out, I could finally relax after 11 days of straight climbing with loads and over 24,000′ of elevation gain accrued. And relax I did. Regular naps and massive caloric intake was the program for the next few days as the body recovered.
We flew back to Chile on the 5th of December, and were back in the States the next day. Now I’m back in Seattle, and far from -60 f windchill. I love it in Antarctica, but I’m also happy to be home. I also came back with some valuable info that will help other teams and operators with similar challenges. Climbing, guiding and exploring the far corners of the planet are activities I love, and believe in so it’s great to be able to support teams via my work. And there’s enough shivering to go around for everyone!
Contact me if you have any concerns or needs regarding your next trip or expedition, I’m happy to share my expertise and put together a support package for your team.
Tom Milne
Account Manager
tmilne@remotemedical.com
1 (206) 734-3427