Preface

Wilderness: ‘a tract of solitude and savageness’

(A Dictionary of the English Language, Samuel Johnson, 1755)

Should the urge to explore, enjoy, and carry out research in wilderness environments be constrained in any way by issues of health, safety, the environment, and the well-being of the local inhabitants? We think it should, but please read on.

Expedition medicine (known in North America as ‘wilderness medicine’) is concerned with maintaining physical and psychological health under the stresses and challenges of expeditions to remote and challenging places. Its aim is to encourage adventure but, at the same time, to attempt to minimize the risk of trauma and disease by proper planning, preventive measures such as vaccinations, the acquisition of relevant medical skills and sensible behaviour. Responsible attitudes towards the environment and the welfare of indigenous peoples and other local helpers in the area of travel are also of great importance.

This book is a product of the Royal Geographical Society (with IBG) Expedition Medicine Cell, which was formed to provide medical advice to RGS-IBG expeditions and those seeking advice from the Society. In it, we have collected and summarized the experience and skills accumulated by explorers, expeditioners, researchers, and remote area travellers from all around the world.

The first edition, published in 2008, was designed to be a practical and portable guide to the prevention and treatment of those medical problems most likely to be encountered in extreme and remote environments. We are delighted that it proved so popular and has been used during the course of expeditions by doctors, nurses, paramedics, and first-aiders, as well as by non-medical expedition members.

The second edition builds upon this foundation, but includes additional topics. Since prevention of disease and accident is fundamental to working in remote and potentially hazardous areas, the sections on risk management have been expanded. To help decision-making, we include more treatment algorithms. We recognize that travel in remote areas is no longer limited to the young, fit, and experienced traveller.

Historically, exploration and wilderness travel have proved distinctly dangerous. Admiral Anson circumnavigated the globe in 1741–1742, losing five of his six ships and 626 of his 961 crew, a disaster eventually mitigated by the capture of a Spanish treasure ship which left him and his surviving sailors wealthy men. All 124 members of Sir John Franklin’s ill-fated voyage to the North-West passage died. During Stanley’s great trans-Africa expedition from Zanzibar to the Congo (1874–1847), 114 of his original 228 expedition members died from battle, murder, smallpox, dysentery, drowning, crocodile attack, fever, execution, insanity, getting lost, or falling victim to cannibalism, opium, or starvation. This level of expedition mortality was unacceptable even in those days, and led to Stanley being branded a ruthless and irresponsible leader. The twentieth century saw safety improve and mortality fall, but until the 1980s 1% of Antarctic base members died of accident or disease, while for every ten climbers who summited Everest, one person died on the mountain.

The twenty-first century has seen a vast increase in numbers of people visiting remote areas for research, education, and recreation. In 2010, over 400,000¹ UK nationals booked an ‘adventure’ holiday; during the 2012–2013 season, more than 25,000 tourists landed on Antarctica,² while on one day, 19 May 2012, 234 climbers summited Everest. With few un-trodden places remaining, the predominant aim of expeditions has shifted from discovery and sovereign possession in the nineteenth century to geographical and scientific investigation in the twentieth century, and has now added pleasure, personal development, and cultural exchange in the twenty-first. Travellers still find novel ways to fuel their desire for adventure; participation in extreme sporting and endurance challenges is increasing rapidly. Gap-year adventure is acquainting school leavers and their anxious parents with some of the realities of wilderness travel. The commercial opportunities have resulted in the marketing of adventurous journeys by numerous companies, blurring the distinction between an expedition and a leisure activity, and exposing people to physical and psychological hazards for which they may be unprepared. Explicit standards such as British Standard 8848: a specification for the provision of visits, fieldwork, expeditions, and adventurous activities, outside the United Kingdom set out good practice for organizing ventures and seek to optimize planning and risk management.

Many of the hazards encountered by previous generations of explorers still challenge expeditions in the twenty-first century, but we are now in a radically stronger position to minimize risk through careful planning based on a vast fund of physiological research, medical knowledge, and the development of drugs, vaccines, technology, and skills. Since our last edition was written, the advent of the smart phone, tablet, and e-reader have altered the way we access knowledge, while cellular and satellite networks link us to the Internet from previously isolated locations. Video communication with remote research stations in space or the heart of Antarctica may be only two mouse clicks away from a computer anywhere in the world. We expect a significant proportion of our future sales to be in electronic format.

Increasingly, doctors and other clinicians expect to receive appropriate training to equip themselves for new challenges. A number of organizations have produced competency-based syllabuses for expedition or wilderness medicine. We have tried to structure the book so that it covers most of the topics included in these courses.

We hope that this handbook will encourage many people to experience and enjoy expeditions and wilderness travel in a responsible way, and to identify and minimize avoidable risks without allowing these concerns to detract from the essential excitement and sense of achievement.

Chris Johnson

Sarah R. Anderson

Jon Dallimore

Chris Imray

Shane Winser

James Moore

David A. Warrell

April 2015