Medicine at minus 25

Course outline

The first mission of the week was to familiarize ourselves with the different modes of arctic transport, essential knowledge if faced with a casualty in the wilderness. We learnt to drive snowmobiles and their basic mechanics. Once orientated, we ventured to an exposed mountain top, where the wind was a brutal reminder of the importance of protective clothing, and how wind chill in this region can drop an already chilly temperature down as far as −50°C.

Back at base, with fingers tingling, faculty members who had spent many months in Antarctica lectured us on hypothermia and frostbite. The importance of rewarming hypothermic patients during cardiopulmonary resuscitation (CPR) was illustrated using the example of a Swedish radiologist who became trapped under a layer of ice for over an hour following a skiing accident. Her body temperature was 13.7°C when she was rescued. CPR, alongside extensive rewarming, continued for more than 3 hours before she showed signs of life and she went on to spend a further 2 months in intensive care—becoming the person with the lowest recorded body temperature ever to survive. In previous years, course delegates have experienced cold water immersion first hand by plunging into an ice hole—but due to an intense snow fall, the river was too fast flowing safely to undertake the challenge this year (phew!).

We received lectures on a variety of medical topics alongside more practical sessions on fire lighting, emergency shelters, navigation and methods of communication in the wilderness. We also learnt how to cross-country ski. The highlight for me was the dog sledding experience. We were each assigned a team of excitable dogs to harness up to the sledges and, after a brief driving lesson, we were off. It was quite a challenge attempting to exert some control over our direction as the dogs sprinted away. After a few initial pileups, we learnt to let the dogs take charge and just enjoy the scenery.

In preparation for the role of expedition doctor, we discussed the essential items in an expedition medical kit. We were then provided with a casualty to rescue in the snow, giving us a chance to carry out a primary survey in the wilderness. We worked together to keep our patient warm while improvising a stretcher—transporting ourselves on snowshoes.

The course concluded with a mini expedition and a chance to put our new skills to good use. Using satellite navigation, we skied by dark to our camp. Two giant teepees were waiting for us in the snow, where we spent a challenging night at −25°C. The following morning was spent trekking uphill to our next camp for the evening, which we built ourselves. In teams of four, we spent several hours digging our own snow holes before nightfall and, although the temperature was the same as it had been the night before, we all slept snugly in our homemade shelter.

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Winter in Norway

Practicalities

The course fee included food and accommodation—picturesque wooden cabins which, when accompanied with homemade cake and coffee, proved a very welcoming sight at the end of each day spent in the cold. Meals were based around local ingredients, such as elk and reindeer (vegans were also catered for). Following the evening lectures, there was time to relax in the hot tub with a beer while gazing up at the northern lights.

This was a fantastic week learning practical skills and networking with others. Previous course delegates have used the experience to seek employment as an expedition doctor. As generalists, GPs are ideally placed to take on this role. Several companies offer similar courses to build on these skills with options to pursue postgraduate qualifications in the specialty (see Box 1). I feel quite lucky to be in a profession that allows these sorts of adventures and encourage anyone interested in expedition work to get involved with the opportunities out there.