64) a Seven-Year Experience in Expedition Medicine: the Juneau Icefield
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The Journal of Emergency Medicine, Vol. 25, No. 3, pp. 257–264, 2003 Copyright © 2003 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/03 $–see front matter doi:10.1016/S0736-4679(03)00199-9 Original Contributions A SEVEN-YEAR EXPERIENCE IN EXPEDITION MEDICINE: THE JUNEAU ICEFIELD RESEARCH PROGRAM Christopher Ho, MD,* Guy Adema, MS,† Daniel Davis, MD,* and Mark Stinson, MD‡ *Department of Emergency Medicine, University of California San Diego, San Diego, California, †Glaciological and Arctic Sciences Institute, University of Idaho, Moscow, Idaho, and ‡Department of Emergency Medicine, University of California Davis, Sacramento, California Reprint Address: Daniel Davis, MD, Department of Emergency Medicine, UCSD Medical Center 200 West Arbor Drive, #8676, San Diego, CA 92103-8676 e Abstract—There have been relatively few attempts to strategies regarding selection, transportation, and adminis- document the optimal medical support for wilderness ex- tration of medical equipment or the types of illnesses en- peditions, and none of these previous reports includes phy- countered, and wilderness medical directors generally have sician-level providers. Here we document our experience used cumulative experience, anecdote, and trial-and-error in with physician-level medical support to an annual wilder- designing the ideal approach to medical care for a given ness expedition in Alaska. This report utilizes data collected expedition. Although each location and activity requires from 1994 to 2000 as part of the medical response to the Juneau Icefield Research Project, an annual research expe- that specific medical needs be anticipated, it is clear that dition to the Alaskan wilderness involving up to 60 students individuals and programs with a history of successful ex- and professors. Medical supplies and equipment were cat- pedition medical care have much to offer with regard to alogued, and 7 years of medical logs were reviewed with their experiences. We describe our own approach to med- data presented in descriptive fashion. The majority of dis- ical direction that has been refined for over 50 years in an eases encountered included gastrointestinal illness, minor extreme wilderness setting. Specific equipment and strate- orthopedic injuries, urinary tract infections, illness related gies for its transportation and distribution are included. In to sun exposure, and kidney stones. Several patients re- addition, we document our experience in the management quired evacuation by helicopter to the nearest medical and treatment of medical problems encountered in this facility. The logistical challenges of medical treatment in wilderness setting by our medical staff for the past 7 years. this setting are discussed. © 2003 Elsevier Inc. This represents an extensive cumulative experience with e Keywords—expedition medicine; Juneau Icefield Re- wilderness medicine and is the first report of physician-level search Program; Alaska; wilderness medicine care in an expedition setting. METHODS INTRODUCTION Design Medical direction is a vital component to the success of any wilderness expedition. There have been relatively few at- This is a retrospective review of data collected from 1994 to tempts to systematically document the efficacy of various 2000. Institutional review board approval was obtained. RECEIVED: 7 June 2002; FINAL SUBMISSION RECEIVED: 5 February 2003; ACCEPTED: 5 March 2003 257 258 C. Ho et al. Setting Table 1. Contents of the Individual First Aid Kits Carried by Each JIRP Participant The Juneau Icefield Research Program (JIRP) is an ex- Card with identification, emergency information, and individual pedition-style research program in the fields of geology, medical history 10 large adhesive bandages glaciology, geophysics, geomorphology, ecology, mete- 1 large sheet of Moleskinா orology, hydrology, and surveying, held for 8 weeks 1 package of Spenco Second Skinா every summer in the Juneau, Alaska and Atlin, British 1 roll of 2Љ athletic tape 1 roll of 2Љ gauze Columbia regions of the Juneau Icefield. The program 6 gauze 4Љϫ4Љ dressings has been in existence since 1946, and is supported by the 6 gauze 2Љϫ2Љ dressings Glaciological and Arctic Sciences Institute at the Uni- 1 package of butterfly bandages or steri-strips 1 large triangular bandage versity of Idaho, the National Aeronautics and Space 3 large safety pins Administration (NASA), the U.S. Army Research Office, 1 razor blade and the Foundation for Glacier and Environmental Re- 12Љ compressive bandage 2 oz. betadine solution search. The program is carried out as a full-scale Arctic 1 tube antiseptic ointment scientific expedition, with up to 60 participants in the 1 tube aloe vera field each year, including undergraduate and graduate acetominophen caps ibuprofen caps students, university professors, research scientists, and antacids expedition support staff, resulting in two to three thou- 1 pair small scissors sand participant-days of exposure each season. ϭ Thirteen main stations and 17 lesser camp and re- JIRP Juneau Icefield Research Project search facilities are located in the field, with permanent metal-sheathed buildings containing cooking, sleeping, and communications facilities at the main field sites. The medical supplies and physician and individual first Communication between camps is handled by radio, and aid kits have evolved over the history of the program in the expedition is supported by periodic helicopter air- response to specific needs that arose in previous years; in drops. Ground transportation consists of foot travel, skis, addition, supplies reflecting the anticipated response to and over-snow vehicles. more significant illness are maintained. Supplies have Participants are required to undergo a preparticipation been updated over the years, including newer blister and physical examination by their personal physician, with foot care, modern sunscreens, and currently used antibi- medications, allergies, and past medical history recorded otics and other medications. Physicians who accompany on a card that is kept with each participant at all times trail parties to remote locations carry additional medical during the expedition. Although there are no absolute supplies in their packs. All participants undergo a rigor- medical criteria for exclusion from the program, partic- ous 4-day Wilderness Field Medicine Course during the ipants are required to overland ski, climb rock and ice, early part of the program, instructed by expedition phy- travel over glacial and crevassed areas, camp in remote sician staff. areas without support, and survive the Arctic environ- The program supports one or two physicians in the ment, often with limited communication, in areas inac- field for the majority of the expedition; most participat- cessible by helicopter or snowmobile. Evacuation from ing physicians are trained in Emergency Medicine or the icefield generally requires helicopter extraction to Family Medicine with specific interest in wilderness and Juneau, Alaska, or Atlin, British Columbia, and is de- environmental medicine. Physicians undergo specific pendent on weather, location, radio communication, and orientation and instruction in medical issues specificto estimated risk to the rescuing party. Participant ages the program. Physicians are available for any significant range from 18 to 80 years, and all participants are given medical issues that arise and are responsible for main- extensive safety, communications, and first aid instruc- taining the camp medical supplies and their own first aid tion. kits; in addition, expedition physicians inspect and mod- ify recommendations for the individual first aid kits each year. Participants can approach physicians with any med- Medical Response ical questions or issues at any time. Table 1 lists the contents of the modular personal first Expedition physicians function as visiting professors for aid kit carried by each participant. It is designed so that the program, and are supported by several field staff multiple kits can be combined to provide sufficient sup- members with Emergency Medical Technician (EMT) plies for many emergency situations, and so that each training. Medical supplies are maintained at each main individual kit is small and lightweight. Table 2 lists camp, and each participant carries a personal first aid kit. supplies and equipment that are available at each base A 7-Year Experience in Expedition Medicine 259 camp. These supplies are packed and stored in such a Table 2. Medical Supplies Maintained at JIRP Base Camps way that they can be easily loaded onto a helicopter or a Supplies Quantity snowmobile, but they are generally not taken to field stations or out with trail parties. Table 3 lists the contents Module 1 Eye supplies of the medical kit carried by the expedition physician. Cyclopentolate 1%, cc 2 With any significant injury or illness, an expedition Sulfacetamide ophth 10%, cc 15 physician is contacted immediately via radio. When pos- Gentamicin ophth gtt, cc 5 Tetracaine ophth dropperette 1 sible, the patient is transported to the base camp for Dacrose ophth solution, cc 15 evaluation; otherwise, the physician goes to the patient or Fluoroscein strips 2 scene of the accident by ski or snowmobile. Participants Eye patches 2 Dental are generally within2hofaphysician at all times during Cavitா pkg 1 the expedition. Evacuation by Coast Guard helicopter Parenteral medication requires at least8htoreach definitive care, weather Ceftriaxone 1 g vial 2 Metoclopramide 10 mg vial 1 permitting. Ketorolac 60 mg vial 2 Epinephrine