A Dxpedition is comprised of many different kinds of people. You have the leader who has the vision for the Dxpedition and assembles a team that is most capable to carry out his vision.
The Dxpedition leader always looks for strong operators who have high levels of stamina and can maintain high rates for long periods of time.
All of the team members work hard, often behind the scenes to build out stations, erect antennas and service generators.
Perhaps the most unsung heroes of a Dxpedition are the Team Physicians. They operate, they help set up and tear down the Dxpedition, but most importantly they act as the Dxpedition medical officer and work hard to ensure the good health and effectiveness of the Dxpedition team members.
As Dxpedition teams become larger and seek out more distant locations, the team physician is becoming increasingly important component of the Dxpedition team.
Dr. Glenn Johnson’s-W0GJ surgical kit.
The team physicians prepare many months in advance of the Dxpedition. They gather and assemble medical supplies that enable the team physician to be able to anticipate and address almost any medical issue. An emergency electronic defibrillator or AED is now becoming a critical component of the physician’s medical kit.
The VP8STI/VP8SGI team will have a Phillips Heartstart AED.
In addition to gathering and packing supplies, the Physician gathers team medical histories to further enable his ability to anticipate any issues. It is important that the Dxpedition team members openly share their past medical history with their team physician. It is also important for each team member to have a checkup with their Primary Care Physician and their Dentist.
Inside Dr. Arnie Shatz-N6HC’s medical kit.
Quite often, team members are required to purchase Medical Evacuation Insurance. Team members are also advised to purchase appropriate clothing and footwear for their destination.
Just some of the supplies that N6HC brings on a Dxpedition.
In preparation for this Blog post, I have consulted with many of the Physicians that regularly provide their services as a member of various Dxpedition Teams.
The most common issues that they have had to deal with are:
Laceration requiring sutures
Adverse Drug reaction
Less common but more critical issues:
Angina and CHF symptoms including shortness of breath, leg and feet swelling.
Fainting episode with severe low blood pressure requiring IV fluids.
Acute Psychosis due to anticholinergic poisoning.
Animal bites, seals, snakes, ticks.
N6HC sutures a wound by flashlight.
According to Dr Gary Stouder-K9GS, a Team Physician on many Dxpeditions, including 3Y0X-Peter 1 and K5D Desecheo, The three most important things the medical officer can do is to eliminate operators that pose major health risks, eliminate anything that can lead to injury from start to finish and to reduce the physical stress on the operators particularly with unloading and station set up.
Just one of many wounds encountered by Arnie-N6HC.
Dr. Glenn Johnson-W0GJ adds “The most important thing to stress to team members is to be in as good as physical shape as possible…I mean REALLY in shape…..not just a fast walk, but aerobic-make-the-sweat-pour-off workouts.” Glenn adds that while on site, the most important things are hygiene: hand washing and not sharing headsets and other personal devices. Glenn summarizes his thoughts by the following: 1) Get healthy 2) Stay healthy. 3) Have fun.
There is some debate among the Dxpedition Physicians that I consulted about the suitability of potential team members on blood thinners such as Coumadin and whether they are suitable for a role on the team or should they be eliminated to reduce risk to the entire team if they are injured. Factors that must be considered include the remoteness of the destination and the time required to transport the team member to a hospital.
Dr. Gary Stouder-K9GS stresses the importance of maintaining pure water supply and uncontaminated food in any environment and good personal hygiene.
Dr. Alan Eshleman-K6SRZ writes “In my experience, the top two ailments are sunburn and sea sickness, but I’ve also sewed lacerations, injected frozen shoulders, buddy-taped broken toes, and treated flare-ups of gout” Alan-K6SRZ adds “I would advise any doctor accompanying a DXpedition to a remote area to take an advanced cardiac life support (ACLS) and an advanced trauma life support (ATLS) course, which will cost somewhere around $800. There are some good books, including "where there is no doctor" "wilderness medicine" and several publications from Doctors Without Borders, including "surgery in remote areas".
If you’re planning a DXpedition that takes you far from the resources of modern medicine you should be fit, aware of the risks you’re taking, and trust in your luck. Your radio may be the most important piece of medical equipment”
Dr. Mike McGirr-K9AJ, a member of many Dxpedition teams writes that:
”The most common medical issue is sea sickness: A lot of hams show up on the boat w/ a pill box & think that will take care of their problem. But once they start to vomit, the value of the remainder of their pills is nill. Best is to use the scopolamine patches: TransDerm Scop. It is a prescription item in the US & the ham has to bring enough to be able to change them every three days while at sea. These can cause dry mouth & (if you touch your eye w/ the fingers you used to apply the patch) a dilated pupil which could alter your vision.
Another reported side effect is urinary retention in older males (w/ enlarged prostates). I’ve not encountered this but I always bring urinary catheters w/ me just in case. I usually have a med administered by an IM "shot" for those w/ intractable vomiting. Anecdote: giving an IM shot for sea sickness to a BS7H team mate while, at the same time, I was using his "barf bucket"!
Next most common issue is skin problems: Sunburn: I’ve seen a second degree sunburn (blisters) on a ham installing an antenna on an island on the equator who was only exposed to the sun before 10am! Sun block & maximum clothing coverage is important in the tropics.
Insect bites, heat rashes, allergic reactions to unfamiliar plants are common. Abrasions, lacerations, cellulitis (bacterial skin infections) are equally common.
I always take several suture sets (for stitching wounds). In the tropics: heat & moisture can cause skin & nailbed infections. I’ve drained abscesses numerous times on DXpeditions. In cold places: feet kept in wet socks inside boots can cause "trench foot".
Orthopedics: Things I’ve seen on past trips: shoulder dislocation, wrist fracture. These can usually be dealt w/ on site.
Mundane but significant: Nonspecific viral infections/flu-like illnesses can take a lot of team members off-line & especially impact phone ops who are liable for laryngitis. Unfortunately, no magic bullet for these problems.
AEDs: I find these problematic. On the one hand, on DXpeditions, we usually have an older aged group of hams, some of whom may have already had stents placed. In the "real world" (ie: back home), once resuscitated from cardiac arrest, a victim is transferred first to the ER and next either to the cardiac lab or to the CCU/ICU. He might require a ventilator and/or other high tech support. On a DXpedition to a place a week’s sail from the closest airport, from which the victim would then be air lifted thousands of miles just to reach to the nearest similar facility, there is no immediate post-arrest care/support available.
A report from the Sudden Cardiac Arrest Foundation in 2014 showed that of adult cardiac arrest victims w/ a shockable rhythm, only 28% survived-even in the best of medical environments. Those without a shockable rhythm had an even worse outcome. Physicians on DXpeditions tend to take AEDs because previous high profile operations have taken them & these physicians don’t want to appear to be providing inferior care for their team. But I fear the instances where a team member might have ventricular fibrillation in front of someone who can retrieve the AED & be shocked into a normal rhythm quickly enough to just wake up & ask "what happened" are rare. And, after such a team member is so treated, where is the catheterization lab? How does he get the stent he likely needs? Most likely the only available treatment is a daily aspirin tablet until he gets to a cath lab in a week or more.
Dr. Alan-K6SRZ manipulates Miguel-PY3MM’s dislocated shoulder at Conway Reef.
The area visited by the Dxpedition team can possess inherent factors that must be carefully considered. Some destinations require precautions to minimize disease carrying bugs and animals such as mosquitoes, rats and ticks. Immunizations can help prevent hepatitis, typhoid, dengue fever, cholera and malaria. Near freezing climates carry different risks including wind chill, loss of body temperature and frost bite.
Preventable foot rot from excessive moisture.
Almost all of the Physicians I consulted felt that it was critical for any remote Dxpedition to include the skills of a Physician or a well trained and experienced Paramedic if no Physician team member is available.
Any Dxpedition Leader who gathers a team and takes them to a far off place without medical care is being careless and sacrificing his team’s health to make radio contacts. Radio contacts are certainly important but not at the risk of a team member not coming home. The Dxpedition Leader must make the health and wellbeing of his team members of paramount importance. If a team is healthy and happy, many contacts will be made.
Dr. Gary Stouder-K9GS writes that “many conditions that are easily treated in a hospital setting can spiral out of control and cause death or long term disability if it takes a week to get to a hospital. All team members must realize that ruptured aneurysms, bowel obstructions, crush injuries, severe infections and vascular accidents will probably result in death” (#)
What do you think?
Dr. Gary Stouder-K9GS
(#) CQ Magazine-November 2009. Medical Considerations for DXpeditions.
Dr. Glenn Johnson-W0GJ
Dr. Ralph Fedor-K0IR
Dr. Arnie Shatz-N6HC
Dr. Alan Eshleman-K6SRZ
Dr. Mike McGirr-K9AJ
Dr. Lew Sayre-W7EW