You’re in an Argentinean hospital, toes turning blacker by the day. Local surgeons want to operate. You need a second opinion, and fast. That was the dilemma faced by a BMC member just weeks ago. Not knowing where to turn, his father back in England contacted the BMC, and a specialised network of climbing doctors was activated.
With the help of digital photographs of the patient’s feet a second diagnosis was swiftly made, and his repatriation to the UK overseen by BMC Insurance. But how was this all possible? Luckily for this mountaineer, his predicament coincided with some new developments in mountain medicine in the UK, designed to help in such situations.
For many years the BMC has been able to call on the services of a number of climbing doctors to act as advisors on medical issues. Doctors such as Jim Milledge and David Hillebrandt sit on the UIAA Mountain Medicine Committee, and Charles Clarke has written many of the definitive medical information sheets available on the BMC website. Their advice has also been available to the British Competition Climbing Team, and they have ensured that all correct safety and medical procedures are in place at competitions and other BMC events. But until recently there was no real infrastructure or means of attracting new doctors to this specialised area.
Several years ago the UIAA Medical Commission established a Diploma of Mountain Medicine in a number European countries. Aimed at qualified doctors, this was intended to enable doctors to utilise their skills for the benefit of mountaineering, with particular regard to practice in mountain environments. And at the 2001 UIAA Medical conference in Kathmandu the two BMC representatives, Jim Milledge and David Hillebrandt, were asked to look at the need for a UK version of this Diploma. They admitted to being “very sceptical about another mountaineering qualification”, but were won over by the practical nature of the syllabus and the obvious enthusiasm of their European colleagues.
The next step was to find a means of delivering the course. Medical Expeditions is a UK based charity that has a remit for mountaineering medical education and research supported by its sister club Medex. Medical Expeditions already ran the respected three-day annual Play y Brenin Mountain Medicine Symposium and they agreed to administer the Diploma. A group of twenty mountaineering doctors spent over a year discussing the content and acting as guinea pigs for an initial pilot session before running an extremely successful course last November. 25 climbing doctors were accepted onto this course and a further seven are on the waiting list for 2004.
The aim of the course is to give registered medical practitioners the theoretical and practical knowledge to manage the specific illnesses and diseases that may occur in the mountain environment. This includes an understanding of the physiological changes associated with exercise and with living at altitude; an appreciation of the mountain environment and the environmental factors that may lead to illness or injury; aspects of travel medicine that are important to mountain travel; proficiency in the practical skills of survival and mountain rescue; training in the management of altitude related disease and in the specific problems of managing illnesses and injuries that occur during a journey to the mountain environment.
The UK Diploma is being run on a modular basis with a course logbook similar to the tried and tested system currently used by the Mountain Leader Training Boards. The personal logbook will contain sections on pre-course experience (both medical and mountaineering), each course module and, most importantly, continuing post course experience. The four course modules are: Altitude and environmental medicine and physiology, travel and expedition medicine, mountain rescue and traumatology, and personal mountaineering skills.
UIAGM guides assess candidates on their ability to look after themselves in the mountains during the UK summer, Scottish winter and Alpine modules. While the international syllabus has an emphasis on the needs of Alpine rescue doctors this has been adapted to our home conditions to cover more travel and expedition medicine for doctors working for commercial expedition companies. It also covers the unique conditions of Scottish winter.
The thinking behind establishing this Diploma goes deeper than simply giving a number of doctors increased skills in Mountain Medicine. One of the other main items on the agenda is to get a nationwide list of qualified Mountain Medicine Doctors with practical hill experience that the BMC could use to refer climbers with medical problems.
The fine details of how this could be funded have yet to be arranged but within three years there should be a network of doctors all over the country with the Diploma. All will have their own personal and professional interests such as cardiology, trauma care, A&E work, expedition work, travel medicine, sports climbing, ski touring, mountain rescue and so on. In such a network if the initial contact doesn’t know the answer they will quickly be able to locate a colleague who does.
So it was this fledgling network that helped save one of our member’s toes. Adam had recently made a successful ascent of Aconcagua, but suffered frostbitten toes during the descent. He’d managed to walk out on the frozen feet and reached Mendoza hospital where they dressed his toes. Once back in Buenos Aires a local surgeon suggested surgery to remove the dead flesh followed by a skin graft from the groin. It was at this point that Adam started to query the decision.
The BMC contacted one of the medical advisors involved in the Diploma, and within hours a number of UK frostbite experts had been consulted. His return to the UK was swiftly arranged, and within a few hours of touching down, a UK vascular surgeon, also a Faculty member of the Diploma, was seeing him. As we go to press it looks like he will keep his toes, and soon return to active mountaineering, perhaps with some warmer boots though! And following on from this incident, the UK team have already set links to obtain further advice from the international frostbite experts in Chamonix if needed in the future.
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