Medicine poses plenty of challenges in traditional settings, but what about the extra trials of treating patients in extreme environments? MDU member Jeremy Windsor explains what it's like to be a mountain medic.
How did you get into mountain medicine?
For more than a decade I was able to divide my time between anaesthetics training and life in the mountains. Thanks to a series of very supportive training programme directors (TPDs) I was able to spend months away climbing and mountaineering and always had a job to come back to.
The time away varied. Some trips were just a couple of weeks away with friends, while other large scale expeditions often took several months. Over time I picked up the skills and experience that led to work not only as an expedition doctor, but also mountain guide, lecturer and researcher.
In 2012 I finally completed my CCT and decided to focus upon hospital medicine. The teaching continued but the expeditions stopped - at least until now! There's a plan to go to Mt Kenya and climb the south east face of Nelion in January 2019.
What extra qualifications are required?
The Diploma in Mountain Medicine (DiMM) is now seen as THE qualification for those wanting to practise medicine in the mountains. Like any qualification, DiMM holders need to keep up-to-date with their CPD. A range of different courses are now available too. We run a Mountain Medicine Update Course and the Hathersage Mountain Medicine Festival. These, together with our blog, provide lots of CPD for anyone interested in mountain medicine.
The British Mountain Medicine Society (BMMS) is a recently formed organisation that seeks to support healthcare professionals working in the mountains, with a range of different courses available.
Are there any specialities that lend themselves to mountain medicine?
Plenty of experience in acute medicine, general practice and emergency medicine is a great way to start. But that will only get you so far. The best practitioners are out there in the hills week in, week out, learning to deal with whatever's thrown at them. Time spent working in a mountain rescue team can provide that.
What sort of conditions are common?
Soft tissue injuries are common to all mountain activities. These can range from cuts and sprains to multiple fractures and organ damage. Heat illnesses are seen at low altitude, together with a range of stings and bites.
On higher mountains, cold injuries are commoner. The risk of high altitude illnesses such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) increases with height. HAPE and HACE are rare but fatal if left untreated.
Are there any medico-legal aspects particular to practising medicine in the mountains?
As medical professionals we are often the first to offer help when someone becomes ill or injured in the mountains. Despite going largely unreported, these 'good Samaritan acts' have been responsible for saving countless lives. What we are able to offer depends upon our skills and experience. A psychotherapist is not expected to intubate and ventilate a critically ill climber. However we should all be able to identify a sick casualty, ensure that they're safe and take the first steps in arranging their evacuation.
However if you're receiving payment or recognition for your medical role in the mountains, expectations will change. Let's use a charity trek to Kilimanjaro as an example. As the expedition doctor you'll need to have completed a medical assessment on each participant, optimised any medical condition before departure and importantly, agreed a 'rescue' strategy if they should deteriorate.
You will also need to liaise closely with the guiding team and contribute to the trek's risk assessment. On Kilimanjaro this would focus on three key areas of altitude (it is possible to ascend very quickly, so it is crucial to minimise the risk of developing acute mountain sickness (AMS) and other high altitude illnesses), temperature (extremes are common in Africa, and heat stroke and frostbite have been known to occur in the same group) and hygiene (the combination of large numbers of visitors and a limited supply of clean water means that there is a significant risk of infection). It would be your responsibility to focus on each of these areas and prevent problems from occurring.
In addition, you will be expected to have assembled a medical kit and be able to treat the problems that might occur. For serious life threatening conditions you'd need the skills to resuscitate and stabilise the trekker before organising a safe and effective evacuation. All medical problems would need to be carefully documented and shared with the trekker, their doctors and insurers after your return.
Clearly, the responsibility of practising mountain medicine is great. Before setting out ensure that you've received the right training - and importantly, you have the appropriate indemnity.
Indemnity arrangements for mountain medicine and other activities will depend on your individual circumstances. Please contact our membership department for advice if you'd like to find out more.
Jeremy Windsor is a consultant in anaesthetics and critical care at Chesterfield Royal Hospital. He has been climbing and mountaineering for more than twenty years. In 2007 he climbed Mt Everest as part of the Caudwell Xtreme Medical Research Expedition. He has completed an MD in high altitude medicine and written more than a hundred abstracts, book chapters and research papers on the subject.
He is a co-founder of the Hathersage Mountain Medicine Festival and in 2018 launched the Anaesthetics, Critical Care and Mountain Medicine Fellowship at Chesterfield Royal Hospital. His blog can be found at deathzone.io The views expressed here are his own.
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