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Expedition medicine: A southern African perspective

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SAMJ: South African Medical Journal

Health and Medical Publishing Group

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      Abstract

      A growing number of people are undertaking expeditions and adventure travel to previously inaccessible areas. The risks posed by increasing accessibility of remote regions and interest in extreme sports have not been fully obviated by modern equipment and communications. Therefore, there remains a requirement for medical care during wilderness expeditions, for which expectations and formal standards continue to increase. Expedition medicine should take cognisance of the predicted problems, plan for contingencies, and be practised pragmatically in austere settings. Southern African medics have a broad skill set, which makes them ideally suited to the field, but they should seek to understand the epidemiology of expeditions in different environments, undergo specialised training, and become involved in all phases of planning and execution of an expedition. Routine general practice complaints and accidental trauma are ubiquitous; travel medical issues such as blisters, diarrhoea, insomnia, sunburn and dehydration occur commonly; area/activity-specific issues such as infectious disease risks and altitude illnesses must be addressed; and women's health and dental problems are frequently overlooked. The expedition medic plays a wide range of roles, and should have knowledge and skills to match the requirements of the expedition. Fortunately, many resources exist to assist medics in becoming competent in the field.

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      Most cited references 11

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      Extreme, expedition, and wilderness medicine.

      Extreme, expedition, and wilderness medicine are modern and rapidly evolving specialties that address the spirit of adventure and exploration. The relevance of and interest in these specialties are changing rapidly to match the underlying activities, which include global exploration, adventure travel, and military deployments. Extreme, expedition, and wilderness medicine share themes of providing best available medical care in the outdoors, especially in austere or remote settings. Early clinical and logistics decision making can often have important effects on subsequent outcomes. There are lessons to be learned from out-of-hospital care, military medicine, humanitarian medicine, and disaster medicine that can inform in-hospital medicine, and vice-versa. The future of extreme, expedition, and wilderness medicine will be defined by both recipients and practitioners, and empirical observations will be transformed by evidence-based practice.
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        Expedition health and safety: a risk assessment.

        Little has been published on the risks of participating in an expedition. A questionnaire survey was conducted to quantify those risks and to determine how expedition organizers plan for medical mishaps. 246 expeditions, taking 2381 participants to more than one hundred countries, were studied retrospectively. 65 expeditions (26%) reported no medical incidents; the remaining 181 reported 835 in 130,000 man-days (6.4 per 1000 man-days). 59% of the medical incidents seen on expeditions were preventable, one-third of these being due to gastrointestinal upsets. 78% of medical incidents were classified as minor and only 5% (40) as serious. There was no excess of serious incidents in any particular organizational group or environment. The findings of this survey suggest that the health risks of participating in a well-planned expedition are similar to those encountered during normal active life.
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          Acute high-altitude illness

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            Author and article information

            Affiliations
            Cape Town orgnameWildMedix South Africa
            Cape Town orgnameMountain Club of South Africa South Africa
            orgnameUniversity of Cape Town orgdiv1Faculty of Health Sciences South Africa
            Cape Town orgnameWildMedix South Africa
            Cape Town orgnameRed Cross War Memorial Children's Hospital South Africa
            orgnameUniversity of Cape Town orgdiv1Faculty of Health Sciences orgdiv2Department of Paediatrics and Child Health
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Journal
            samj
            SAMJ: South African Medical Journal
            SAMJ, S. Afr. med. j.
            Health and Medical Publishing Group (Cape Town, Western Cape Province, South Africa )
            0256-9574
            2078-5135
            August 2017
            : 107
            : 8
            : 659-663
            S0256-95742017000800010
            10.7196/samj.2017.v107i8.12676

            This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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            Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 5
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            Product Information: SciELO South Africa

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