Participating in expeditions often means visiting parts of the world that are less developed than the UK. In turn the quality of healthcare facilities is often below which we are used to. If things go wrong when you’re on a trip you might find yourself taking an expedition member to a local hospital. Most countries have some sort of basic national health system which may be free or relatively cheap. There are often private facilities which are usually more expensive and occasionally charity funded facilities which may provide free or subsidised care. Unfortunately more expensive does not mean better care.
So what can you do to work out if a hospital is any good?
Ideally you will know the answer to all these questions before you have an emergency.
- Does the hospital have an emergency department?
Many hospitals are not set up to receive emergency cases and will refuse to see new patients. It may well be worth bypassing a local hospital without an emergency department to travel further to a hospital with one.
- Does the hospital have a X ray or a CT scanner? (and does it work?)
Many limb injuries will require an xray and more serious illnesses and injuries will often require a CT scan at some point to help confirm the diagnosis and decide how the patient is managed. Ideally there will also be a qualified radiologist (doctor trained to interpret scans).
- Does the hospital have intensive care facilities (ITU)?
Some serious injuries (such as severe head injuries) and illnesses may require the patient to be placed into an ‘induced coma’. Breathing is often taken over by a ventilator machine and drugs that can help the heart and blood pressure can be given under close supervision. Make sure the ITU has an anaesthetist or critical care doctor, ideally available 24 hours per day.
- What kind of surgical facilities are available?
Get your patient to a facility that has what they need. If you think your patient has appendicitis they might well need an operation. Appendicectomy is a straightforward procedure that is carried out all over the world. However if you have someone with a serious head injury they may need a neurosurgeon (and a CT scanner). This may mean that the local clinic might not be the best place to take them. Some types of fractures will need surgery to fix them
- Do you need any specific type of patient care?
This may be dependent on your expedition. Leading a jungle trek in Belize? You should know which medical facilities have appropriate antivenom in case of snakebite. If you’re on a dive trip it’s essential to check where the nearest chamber is and ensure there are staff qualified to operate it.
- How can you get your casualty to the hospital?
With good travel insurance the best way to get a casualty to a hospital is going to be by helicopter. With this in mind when you do your research find out if the hospital has somewhere where a helicopter can land. Find out if they have a prefered partner for evacuating casualties by air. Additionally, research the details of the air rescue services. Will they fly to altitude? Do they need to be contacted by your insurance company in order to lift off in the first place? All of this is vital information.
Time in reconnaissance is seldom wasted …
If you’re leading a trip to a wilderness or remote location you can not expect your insurance company to have all the answers to these questions. As a part of your risk assessment you need to anticipate what sort of situations you might face, how you will evacuate your expedition members, and finally where to. As ever time in recce is seldom wasted: it’s all about preparation.
Joe is an Emergency Medicine doctor and former Special Forces soldier with an interest in pre-hospital, remote and expedition medicine.
He holds a Master’s degree in Austere and Military Trauma Science, Diploma in Immediate Care, is a faculty member for the Diploma in Conflict and Catastrophe Medicine and an Honorary Clinical Research Fellow at the University of Exeter where he is a module lead for the MSc in Extreme Medicine. He co-authored the Royal College of Surgeons of Edinburgh guidelines for medical provision for wilderness medicine and is currently medical director for Survivor USA, the world’s largest reality television show.
From September 2018 Joe will be joining us working on our expedition first aid courses.
Further training for the outdoors
- Outdoor First Aid – Five items of essential first aid kit for the outdoors
- What to do in an Emergency Outdoors
- One Item Of First Aid Kit Always Needed: The Least Appreciated
- First Aid Kit for Overseas Treks
- Dealing With Mass Casualties – Triage First Aid
- Save a Life With a Slice of Flapjack – Diabetes
- Expedition First Aid – Diarrhoeal illness
- Expedition and outdoor first aid – heat exhaustion
- Expedition First Aid – Hyponatraemia
- Top Tips For Footcare