How to get mountain medicine advice

Posted by Dr David Hillebrandt on 19/10/2009
Where can you get mountain medicine advice you can trust? Photo: Alex Messenger.

Dr. David Hillebrandt, Medical Advisor to the BMC, gives a rundown of essential websites, courses and books for mountain medicine. Plus, how to get personal advice and access the Medex network of doctors.

Many people contact the BMC for general or personal medical advice. In a genuine emergency the BMC medical advisors will try to help, but many questions could be answered by consulting reputable texts and websites or by attending one of the many courses run on mountain medicine. This article attempts to steer those with problems, those requiring information or simply those who are happily neurotic to the best source of advice.

Websites

The web is a fantastic resource for information and discussion but equally is also a potential source of unreliable misinformed opinions with no peer review filter system. One only has to scan the postings on UKClimbing.com to appreciate the prevalence of ideas based on poorly understood medical concepts, or how many ideas still circulate based on outdated medical concepts. As a BMC advisor I keep well away from most of these postings, although I will comment if dangerous points are drawn to my attention and will try to steer the participants in the right direction for more up to date information. Personal medical advice has no place on an open forum. So what websites do I respect and recommend?

The BMC
Congratulations, you've found this one already! I would recommend it wouldn’t I? A team of British mountain medicine experts have committed themselves to keeping this site regularly updated with articles and updates on new research.

The UIAA - The International Mountaineering and Climbing Federation
News and preventative advice sheets on many subjects including:

  • Children at Altitude
  • Mountaineering with Pre-existing Medical Conditions
  • High Altitude Illness
  • Treatment of High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE)
  • Traveller's Diarrhoea
  • Water Purification
  • How to assess the quality of a Commercial Trek or Expedition
  • Diet for Mountaineering


IKAR - The Commission for Alpine Rescue
The rescue equivalent of the UIAA’s preventative advice so for practical treatment advice at an international level use this site. Click for an English translation and then on the section for Alpine Medicine. Under Recommendations there are good articles on hypothermia and frostbite. Also useful section on international rescue services. Under Publications one can find details of their excellent avalanche rescue DVD, Time is Life.

Fit for Travel
Travel advice on immunisations, malaria and foreign medical risks. A free government-sponsored site open to the layman but used by many doctors and travel clinic nurses. Based on good quality international data.

Ciwec Clinic, Kathmandu
Where in the world would you expect a clinic to have a massive database on Traveller's Diarrhoea and High Altitude Illness? Get your information direct from the international experts based in Nepal. Well worth a read to update yourself prior to any high altitude trek to a country where you are likely to spend several hours suspended above a remote latrine.

Centers for Disease Control and Protection
An American government site from Atlanta, Georgia for those who really want to enjoy ill health abroad.

National Travel Health Network and Centre (NaTHNaC)
The British government equivalent to the Centers for Disease Control. With a stiff upper lip you will not be as anxious as if you were to use the American equivalent.

Medex and Medical Expeditions
A British-based mountain medicine education charity that produces a free downloadable altitude travel booklet and runs a variety of course for doctors and the interested layman. This site also lists all the holders of the UK/UIAA/IKAR/ISMM Diploma of Mountain Medicine with details of their specific areas of expertise.

Courses

Most people do not consider undertaking a first aid course until standing next to an injured companion on a boulder mat at an indoor wall or in a remote Scottish corrie. For the former a basic Red Cross, St John or St Andrew first aid course will be ideal but for the latter a more specific outdoor course is much more relevant.

Whilst there are some excellent courses on remote area first aid available that are run by genuinely experienced expedition doctors and paramedics there are also some “Rambo” style courses which would have the lay mountaineer performing advanced surgery in a remote setting. Be careful. The courses that I am aware of and that have a good reputation are listed below but this list does not pretend to be comprehensive.

Rescue Emergency Care Courses
These modular courses vary from a two day basic course to a three day remote area module and a daylong high altitude module. All are run by approved trainers and the emphasis is on a very practical approach to problems with scenario based training normally held in the outdoor environment. Courses are run at Plas y Brenin or via other providers.

Wilderness Medical Training
These well established “Far from Care” courses are run by Dr Jon Dallimore and his team and vary in length from a two day basic to a week long intensive course. They cater for two groups of clients. The Explorer courses are for the layman and the Medic courses are designed for doctors and other healthcare professionals. Some of their courses are run in conjunction with the Royal Geographical Society.

Expedition Medicine Courses
Expedition Medicine is run by Dr Sean Hudson and his wife Dr Caroline Knox. It too runs respected courses for medical professionals and those with previous first aid skills. Courses are designed for specific challenging environments.

Royal Geographical Society
Has an active medical cell with some courses, conferences and other information.

High Altitude Medicine and Physiology Course
This three day course is run on alternate years in November or early December by Medical Expedition at Plas y Brenin. It is primarily geared for doctors but others with an interest in the subject and basic understanding of human physiology seem to also enjoy this event. There is an international panel of high altitude medical experts in attendance to give formal lectures and run workshops.

UK Diploma of Mountain Medicine
This is the UK version of the internationally recognised UIAA/IKAR/ISMM Diploma of Mountain Medicine. In the UK it is administered by Medical Expeditions and the University of Leicester. It is made up of four one week residential modules with additional course work and is open to doctors, final year medical students and those with paramedic registration or equivalent. It normally takes two year to complete the course but the modules can be spread over four years. All candidates start with the theory module at Plas y Brenin in the Autumn and finish with an Alpine module. Fifty percent of the syllabus involves practical mountain skills and this is overseen by UIAGM guides.

Books

Travel at High Altitude
A free internet download compiled by a Medex team (yes, them again!). Well if it’s free you cannot go wrong but in fact if you do read this you will not go far wrong. Available in English, Greek, Serbian, German and Nepalese and more editions in preparation. Designed for the layman with simple pre-trip advice. Now in its second 2008 edition.

Pocket First Aid and Wilderness Medicine
A simple layman’s guide to remote area first aid including altitude problems. Guidebook size.
By Dr Jim Duff, 10th edition 2007.
Published by Cicerone Press.
ISBN 13: 978-1-85284-500-1

Bugs, Bites & Bowels
Very readable travel medicine book for the layman or GP.
By Jane Wilson-Howarth, 2006
Published by Cadogan Guides.
ISBN 13: 978-1-86011-332-1

The High Altitude Medicine Handbook
Written for the layman but used by many travel medicine doctors and nurses as a simple reference.
By Pollard & Murdoch, 3rd Edition 2007.
Published by Radcliffe Medical Press.
ISBN: 1-85775-849-8

Oxford Handbook of Expedition and Wilderness Medicine
A new book, written with RGS involvement, that is rapidly becoming the standard UK expedition planning text for all doctors and medics.
By Johnson, Anderson, Dallimore, Winser and Warrell, 2008
Published by Oxford University Press.
ISBN 13: 978-0-19929-661-3

Casualty Care in Mountain Rescue
The best mountain rescue medical book to date.
Edited by John Ellerton, 2nd Edition.
ISBN 13: 9-780-95017-657-4.

High Altitude Medicine & Physiology.
The bible for high altitude physicians; not really suitable or practical for the layperson.
By West, Schoene & Milledge, 4th Revised Edition 2007.
Published by Hodder Arnold.
ISBN: 0-34091-344-4

Personal advice

For personal medical advice the first point of call should be your General Practitioner. There is no substitute for a face to face consultation with a doctor who knows your medical background but do not expect all GPs to be experts in all fields of medicine. With warning many will be happy to do background research and if necessary contact a colleague for advice, possibly using the Medex list of holders of the UK Diploma of Mountain Medicine for a second opinion.

Diploma of Mountain Medicine
There are seventy holders of this diploma which guarantees that they will not dismiss climbing patients as suicidal idiots. There is now likely to be a holder in most areas of the UK and covering most specialities. Some holders of the UK Diploma of Mountain Medicine are available for personal advice but do note that this would not fall within the remit of the NHS. Other members will advise expeditions on preparation prior to departure or run lectures or training sessions on general mountain medicine and first aid topics.

Physiotherapy
Many climber’s personal medical problems are best dealt with by sports physiotherapists. Possibly one day the BMC will have a list of those with an interest in climbing medicine. If you live in an area with a lot of climbing you will almost certainly find a local qualified physiotherapist who is a climber. Ask at your local climbing wall or outdoor shop.

Emergency
In a genuine remote area emergency the BMC medical advisors may be available to give advice by phone, satellite phone, or email. Contact the BMC office.

Frostbite
The UK has had a frostbite advice service for about four years and it has helped in excess of thirty climbers, often with remote area advice followed up with a rapid consultation on return to the UK. It is run by three holders of the UK Diploma of Mountain Medicine, all with practical expedition experience. One should be available at most times. Digital images may help advice. On return to the UK we have access to the services of an experienced vascular surgeon and scanning if needed. For details see this website, preferably prior to departure:

Want a doctor for your trip?
The Royal Geographical Society keeps a list of experienced and interested doctors for expedition work  and some holders of the diploma indicate availability.
 



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