Telehealth used in wilderness medicine.

Wilderness medicine and telemedicine have made significant progress with the advancement of communication technology and the rapid development of the application of drones, and examples of application are being established in different research and rescue missions. The literature is replete with examples of successful telemedicine deployments in resource-limited settings. The recent widespread adoption of telemedicine has had an important impact on wilderness medicine providers. Telemedicine essentially relies on a lot of technology and systems. The system relies on hardware, software and network systems to transmit information (images, vital signs, local environment) from one place to another. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi or communications satellites. However, communication bandwidth is still a limiting factor for many tightly set constraints. According to the literature, telemedicine services are usually divided into four categories: 1. Instant/interactive; 2. Store and forward; 3. Remote patient monitoring; 4. Mobile medicine. In Taiwan's mountainous environment, the current 4G/5G communication coverage situation will be different due to policy promotion, and the deployment speed in remote mountainous areas will be different. Combined with low-orbit satellite communication and drone communication applications, it can enhance communications to improve telemedicine. Now search and rescue personnel can dispatch high-tech communication equipment such as medium and large drones and SNG vehicles to take charge of emergency communication tasks. They can urgently deploy mobile aerial base station systems, which are powered by ground SNG vehicle generators. Through high-tech and lightweight The cable connection is provided to allow the helicopter to stay at an altitude of 100 meters for a long time. The SNG vehicle is then connected to satellite communications to perform the task of a wireless communication relay station. The communication reception range can cover 36 square kilometers or more. Each category has an applicable instance of wilderness medicine, but telemedicine has great potential to enhance the practice of wilderness medicine. Drones may transform wilderness medicine supply chains by facilitating the delivery of food, medicine and enhancing search and rescue efforts. Remote consultation can be combined with remote patient monitoring technology to provide highly specialized care in austere environments. However, each country will have different remote medical rescue methods based on the local environmental conditions of wilderness medicine. Further and more practical application cases and data are needed to determine a successful rescue model that combines wilderness medicine and telemedicine.

Telehealth used in wilderness medicine.

Wilderness medicine and telemedicine have made significant progress with the advancement of communication technology and the rapid development of the application of drones, and examples of application are being established in different research and rescue missions. The literature is replete with examples of successful telemedicine deployments in resource-limited settings. The recent widespread adoption of telemedicine has had an important impact on wilderness medicine providers. Telemedicine essentially relies on a lot of technology and systems. The system relies on hardware, software and network systems to transmit information (images, vital signs, local environment) from one place to another. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi or communications satellites. However, communication bandwidth is still a limiting factor for many tightly set constraints. According to the literature, telemedicine services are usually divided into four categories: 1. Instant/interactive; 2. Store and forward; 3. Remote patient monitoring; 4. Mobile medicine. In Taiwan's mountainous environment, the current 4G/5G communication coverage situation will be different due to policy promotion, and the deployment speed in remote mountainous areas will be different. Combined with low-orbit satellite communication and drone communication applications, it can enhance communications to improve telemedicine. Now search and rescue personnel can dispatch high-tech communication equipment such as medium and large drones and SNG vehicles to take charge of emergency communication tasks. They can urgently deploy mobile aerial base station systems, which are powered by ground SNG vehicle generators. Through high-tech and lightweight The cable connection is provided to allow the helicopter to stay at an altitude of 100 meters for a long time. The SNG vehicle is then connected to satellite communications to perform the task of a wireless communication relay station. The communication reception range can cover 36 square kilometers or more. Each category has an applicable instance of wilderness medicine, but telemedicine has great potential to enhance the practice of wilderness medicine. Drones may transform wilderness medicine supply chains by facilitating the delivery of food, medicine and enhancing search and rescue efforts. Remote consultation can be combined with remote patient monitoring technology to provide highly specialized care in austere environments. However, each country will have different remote medical rescue methods based on the local environmental conditions of wilderness medicine. Further and more practical application cases and data are needed to determine a successful rescue model that combines wilderness medicine and telemedicine.

Operation Everest III COMEX.  A  simulated ascent to Mount Everest

Objectives. Operation Everest III (COMEX '97) was performed to evaluate the physiological, psychological and pathological mechanisms induced by a prolonged exposure to extreme altitude, up to 8,848m (altitude of Mount Everest).

Methods. Eight male subjects (23 to 37 years old) have been studied in normoxia, then, after 6 days of acclimatization at 4350m, in a hypobaric chamber (COMEX S.A., Marseille) where they stayed 31 days, from 5000m to 8848m of simulated altitude. Eighteen protocols, from 14 scientific teams, have explored various aspects of acclimatization to extreme altitude.

Results. The decrease in plasma volume is one of the factors involved in the reduction of physical performance, as witnessed by the 9% increase in VO2max at 6000m under infusion of 300 ml hydroxyethylamidon. Ventilatory and cardiac responses to hypoxia at exercise have an opposite trend, with an increase in ventilatory and a decrease in cardiac response. Autoregulation of cerebral circulation is altered above 7000m. Left ventricular function is maintained up to 8000m, in spite of an important increase in pulmonary artery pressure. Ventricular relaxation is altered, probably because of altered ventricular filling. The decrease in food intake contributes to the loss of body weight (mean of 5.4 kg). Nutritional habits are modified, with shorter and more frequent meals and a decreased interest for food. Lipolysis in fat tissue is blunted, suggesting, like for cardiac adrenergic receptors, a desensitization linked to a change in G proteins. Few psychological alterations were observed below 6500m. However, changes in mood state and a high level of anxiety have been noticed and correlated to other physiological or psychometric parameters.

Conclusion. Human body is able to develop adequate responsive mechanisms to oppose the severe hypoxia (mean arterial PO2 of 30.6 mmHg at 8,848m). Mental capacities are also slightly diminished, but only above 6500m.

Altitude sickness, update on prevention and treatment

An increasing number of persons perform physical activities for sports, leisure or work at high altitude. In that context, the question arises of risk factors for developing high altitude-related diseases: acute mountain sickness, high altitude pulmonary and cerebral edema. Recent epidemiological studies have identified these risk factors: history of severe high altitude-related diseases during previous exposures to high altitude, rapid ascent, history of migraine, regular endurance training, as well as physiological variables obtained during a hypoxic exercise test: ventilatory and cardiac responses to hypoxia at exercise, desaturation at exercise in hypoxia. These physiological data evaluate the sensitivity of peripheral chemoreceptors to hypoxia and allow a good detection of high-risk subjects. During a specialized high-altitude medical consultation, the first step will be to discard any medical contra-indication to altitude exposure. Then, using the clinico-physiological score elaborated by means of the hypoxic exercise test, personalized and adapted recommendations will be given to the candidate for a high-altitude sojourn. Preventive measures in the mountains rely mainly on progressive ascent (400m rule), limitation of exercise workload and in high-risk circumstances, the use of acetazolamide. Curative treatment depends on the severity of the manifestations. For acute mountain sickness, current analgesics (paracetamol, aspirin), acetazolamide and rest are sufficient in most cases. For High Altitude Pulmonary Edema, corticosteroids and pulmonary vasodilators (calcium blockers or PDE5 inhibitors) are recommended but the most efficient treatment is reoxygenation though inhaled oxygen, hyperbaric bag or descent to lower altitudes. For High Altitude Cerebral Edema, corticosteroids and rapid descent are highly recommended.

General Interests and Activities

I have been an expedition medic for World Expeditions since 2003 when I undertook a diploma in high altitude and travel medicine with Dr Jim Duff in the Khumbu valley, Nepal. Since then I have been the expedition doctor on remote and high-altitude treks for small and large groups. These include:

Kilimanjaro Rongai and Machame 2005 and 2006

Kenya 2007 – community project and walking safari, the rift valley.

China 2008&2012 – trekking/camping the Great Wall, Hebei province. 

Nepal 2009 – Khumbu Everest Base Camp trek.

Indonesia 2013 - Mt Rinjani, Lombok. 

Morocco 2017 - Mt Toubkal.

Ethiopia 2018 - Ras Dashen

I have worked as the location medic for media productions, including in the Ruwenzori mountains with Ben Fogle’s ‘Extreme Dreams’. In March 2010 and 2011 I was employed by Remote Trauma as the location medic for ITV’s ‘71 Degrees North’. Ccelebrities were pitched against the arctic environment and each other, challenges included ice climbing, under-ice swimming and ski-doo racing.  There were significant medical risks, events occurred in extreme conditions and I was self-sufficient in the field.  

I was the location medic for the BBC’s Children in Need Rickshaw Challenge in November 2015, 2016 & 2022, working with the whole filming crew and participants, some of whom had very significant physical disabilities. I provided medical backup for all the team’s requirements, alongside a sports physio and paramedic team.  

I have worked for World Expeditions in an advisory capacity since 2012. I have designed and run first aid training for World Expedition’s Himalayan mountain guides in Nepal from 2014 to 2019.  I similarly advised Bull Precision Expeditions and Terra Nova Expedition Services where I was on-call for medical issues during their expeditions. I have provided top-level cover for expeditions including Jason Fox and Aldo Kane’s record-breaking transatlantic row in 2016.

I co-author the Cicerone’s Pocket First Aid and Wilderness Medicine since the 12th Edition of and continue to work with my co-author on this book.

I gave a remote lecture to the Taiwan National Mountain Medicine education conference in October 2023 on general considerations in Wilderness medicine

Wilderness or expedition medicine is a young specialty that has been growing in scope and profile in recent years. As more people have the means and interest to travel to remote locations, where resources may be limited and environments more extreme, we as a profession must become more aware of the issues our patients can face when outside our clinics and hospitals.

In his lecture, Dr. Anderson will share his experiences as the expedition doctor on remote and high-altitude treks and as the location medic for media productions. He is going to cover some examples of how to prepare and treat our patients for the challenges faced when venturing into the outdoors. This will be followed by a thought-provoking reflection on the medical challenges faced by increasing numbers of older people with chronic conditions going to remote locations and attempting to take part in adventurous activities.

Professor Lim Swee Han MBBS, FRCS Edin (A&E), FRCP Edin, FAMS is the Senior Consultant and former Head of Department (2003-2009) at the Department of Emergency Medicine at Singapore General Hospital (SGH). He is also the Associate Designated Institutional Official SingHealth Residency. He is Clinical Professor Duke-NUS Medical School and Adj Professor Yong Loo Lin School of Medicine, National University of Singapore; and Adj Professor Lee Kong Chian School of Medicine, Nanyang Technological University.

He is currently the Chairman of the Singapore Resuscitation and First Aid Council, Assistant Secretary and former Secretary (2009-2017) and Treasurer (2017-2021) for the Asian Society for Emergency Medicine; Treasurer and Past Chairman of Resuscitation Council of Asia. He is also the immediate past President of the Society for Emergency Medicine in Singapore and former Treasurer / BLS taskforce and current First Aid taskforce member with the International Liaison Committee on Resuscitation. He has more than 100 publications in peer-reviewed journals related to management of acute cardiac diseases, resuscitation and cardiac biomarkers.

Drowning is the process of experiencing respiratory impairment due to submersion/immersion in liquid. In 2019 alone, there were 236,000 deaths due to drowning, averaging about 650 deaths per day; and listed as one of the top 10 leading causes of death in people under 24 years of age. South-East Asian region alone reported the second-highest number of deaths after the Western Pacific Region.

Most of the drowning cases involved water recreation amongst others; it is preventable with the creation of safe places and installation of barriers to control access; teaching swimming, water safety and safe rescue skills to the young; and teaching bystanders in safe rescue and resuscitation.

CPR with ventilations is preferred, followed by high-concentration oxygen where available. Compressions-only CPR is not ideal in the resuscitation of drowning cases as the primary cause of death from drowning is due to lack of oxygenation.