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Taking medicine to extremes

There are not many conferences where you can learn jaw wiring, ultrasound training, and interosseous access in one day and spend the next listening to astronauts, ultra athletes, and marine biologists speak about medicine that the average hospital doctor will never encounter.

The International World Extreme Medicine Conference 2016 took place recently in Edinburgh, Scotland. This annual event is a diverse gathering of adventurers, career break enthusiasts, and remote medicine specialists. It is an international mix of attendees with army doctors and flight surgeons chatting to GPs and paramedics who regularly deploy to some of the most remote and unstable parts of the world with Médecins Sans Frontières (MSF), Raleigh International or the Red Cross.

Medics under fire

Mr David Nott, recently honoured by the British Queen with an OBE for his career working in the world’s most extreme warzones, opened the conference discussing his recent work as a general and trauma surgeon in Aleppo, Syria. An inspirational man who has been working in conflict zones for two decades brought a room full of medics on a vivid tour describing the realities of Syrian hospitals today.

For most it was an assault on the senses, even for experienced trauma and emergency medicine doctors, which stimulated concerned debates about the escalating targeting of medical professionals and hospitals in modern warfare. Out of such conversations has come a new lobby group of doctors working under these extreme circumstances called Doctors Under Fire, which was officially launched at the conference. It is aiming to bring political pressure on all governments currently involved in Syria to stop the targeting of medical facilities and medical personnel.

The conference is four days in duration with a specific focus for each day. Day-one is disaster and humanitarian medicine; day-two examines extreme expedition and wilderness medicine; day-three focuses on human endurance and sports medicine; and day-four centres on pre-hospital medicine.

Heading up discussions on the NASA Extreme Environment Mission Operations (NEEMO) project, the world’s largest underwater laboratory, was Irishman Dr Marc Ó Gríofa, a medic and aquanaut. On the sea floor off the Florida Keys, this underwater laboratory houses scientists and doctors who conduct experiments and examine the psychological effects of a restricted environment on the participants. There is no fast evacuation available in an emergency as the decompression cycle to reach the surface takes 15 hours. Therefore, the medics must manage medical emergencies in a way which can be implemented at depth with restricted equipment.


Have you ever imagined living in Antarctica? Dr Beth Healey spent a year as the European Space Agency (ESA) doctor living at Concordia station, Antarctica, where ESA and the British Antarctic Survey are conducting experiments in the most inhospitable environment on earth.

She talked about the challenges of spending nine months in complete isolation, four of them in total darkness and the psychological pressure of being the only doctor for the crew stationed at Concordia over the Antarctic winter with no possibility of evacuation in emergencies.

Dr Mike Barratt, an astronaut, flight surgeon and former head of NASA’s human research programme, gave a stirring introduction to space medicine. He taught a room full of novices about the effects of cosmic radiation on the human body, how to do CPR without the aid of gravity, and NASA’s imminent plans for a mission to Mars.

The recruiters at the extreme medicine conference are not trying to sell traditional hospital packages. Varied opportunities for GPs, consultants, and registrars in emergency medicine, anaesthesia, and surgery were available with flying doctors services in Australia, as well as with Raleigh International, MSF, Rubicon, and the British Army.


On the final day of the conference, attendees heard the story of a young woman with undiagnosed long QT syndrome who suffered a cardiac arrest and died while at the gym. A defibrillator was left next to her at the scene but never used as none of the staff had been trained in its usage.

Her paramedic brother-in-law, Mr Eoin Walker, has been galvanised by her death into starting a campaign in the UK for the public to be trained in effective CPR and defibrillator use.

He invited another young woman to the stage to talk about her cardiac arrest while shopping on Oxford Street in London. Her story differed in that she was immediately attended by passers-by who initiated CPR and defibrillation.

Two similar situations with such vastly different outcomes show what a public health campaign demonstrating good quality CPR and defibrillator use could potentially do.

The collaboration of medics and allied health professionals working at the extreme edges of medicine gave rise to ambitious ideas and new ventures over the four-day period. It left attendees overwhelmed with the possibilities available to those with a medical degree and a sense of adventure. Plenty of food for thought before next year’s conference.

If anyone is looking for me I’ll probably be in Costa Rica.


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