Expedition medicine

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Expedition medicine
Medicine chest for Antarctic Expedition 1910 Wellcome L0074486.jpg
Medical equipment used by Robert Falcon Scott on his 1910 Antarctic expedition
SynonymExpeditionary medicine
FocusMedical care, planning, and prevention in remote and resource-limited settings
Subdivisions
Significant diseases
Glossary Glossary of medicine

Expedition Medicine (sometimes known as expeditionary medicine) is the field of medicine focusing on providing embedded medical support to an expedition, usually in medically austere or isolated areas. Expedition medicine provides the physical and psychological wellbeing of expedition members before, during, and after an expedition. [1] Expedition medicine may be practiced in support of commercial, non-governmental organizations, and government expeditions. [2] Some medical governing bodies consider expedition medicine as a field within wilderness medicine, whilst others considered it be a separate discipline. [3] [4]

Contents

History

Ancient Era

This field of expedition medicine has ancient origins and has been practised almost since the advent of medicine and expeditions. Many ancient civilizations embedded medical staff with military units. [5]

Medieval Era

As expedition and merchant crews grew during the later medieval era, barber surgeons and other medical staff were added to the crew complement. [6]

Age of Discovery

During the Age of Discovery, expedition medicine planning became more integral to explorers on land and sea, especially in the prevention of scurvy. [7] Many explorers traveled with surgeons as part of their crew. Cristopher Columbus's crew included barber surgeons to include Diego Álvarez Chanca. [8] [9] A Genoese barber-surgeon traveled with John Cabot on his 1497 voyage to the coast of North America. [10] [11] Three barber surgeons traveled with the Magellan expedition and one, Hernando de Bustamante, was part of the crew of 18 Castilians who returned on the Victoria, the first ship to successfully circumnavigate the world. [12] David Samwell, a Welsh surgeon, traveled with James Cook on his third and final voyage aboard the HMS Resolution. [13]

Modern Era

Expedition medicine became more formalized during the modern era, leveraging advancements in medicine, survival skills, and trauma care. As expeditions pushed into more hostile environments—including higher altitudes and the planet's freezing cold poles—the medical challenges became more specialized, focusing on prevention and treatment in more extreme conditions.

Early Modern Era

Benjamin Rush provided medical training and equipment to the Lewis and Clark Expedition Benjamin Rush Painting by Peale.jpg
Benjamin Rush provided medical training and equipment to the Lewis and Clark Expedition

Lewis and Clark Expedition (1804-1806): Benjamin Rush furnished the Lewis and Clark Expedition with essential medical preparation by providing Meriwether Lewis rudimentary training in practices like bleeding and purging. [14] He also supplied a portable medical chest containing necessary instruments and medicines, ensuring the expedition was medically prepared. [15] [16]

American Settlement (Early 19th Century): During the period of American settlement in the early 19th century, expeditionary medicine preparedness and support became standard concerns for wagon trains. [17] [18] [19]

The Rise of First Aid (Late 19th Century): In the late 19th century, the influence of notable medical practitioners like Friedrich von Esmarch and members of the Venerable Order of Saint John pushing for every adult man and woman to be taught the basics of first aid. This movement eventually led to the institutionalization of first-aid courses and the standardization of first-aid kits, initially within the military and later in all medically austere environments, including expeditions. [20]

Arctic Expeditions

The Jeannette Expedition (1879-1881): The ill-fated Jeannette Expedition into the Arctic Ocean included physician James Markham Ambler. [21] [22] Ambler demonstrated profound commitment to his role during the devastating sinking of the USS Jeannette and the subsequent 1,000-mile struggle across the Siberian ice. He was one of the last members of the final, desperate party to die of starvation and exhaustion, having attended to his remaining companions until the very end. [23]

Robert Peary's Expeditions (Late 19th-Early 20th Century): Explorer and physician Frederick Cook served as the surgeon on Robert Peary's 1891-1892 Arctic expedition. [24] Cook later joined the Belgian Antarctic Expedition, considered the first expedition of the Heroic Age of Antarctic Exploration. [25] Cook also was a member on a controversial expedition to the summit of Denali [26] and an expedition to the North Pole. [27]

Antarctic Expeditions

During the Heroic Age of Antarctic Exploration, spanning from 1895 to 1922, at least eighteen expeditions ventured to the icy continent. These arduous journeys typically lasted between eighteen and thirty months, and the majority included one or two doctors within their ranks. [28] Ernest Shackleton's expeditions, for instance, were consistently staffed with two surgeons. [29]

Dr. Mackay, Edgeworth David, and Douglas Mawson at the South Magnetic Pole on 16 January 1909 Mackay, David, and Mawson at the South Magnetic Pole.jpg
Dr. Mackay, Edgeworth David, and Douglas Mawson at the South Magnetic Pole on 16 January 1909

Notable Physicians:

High-Altitude and Modern Explorations

Michael Phelps Ward was the expedition doctor for the landmark 1953 first ascent of Mount Everest with Sir Edmund Hillary and Tenzing Norgay. Ward's studies on high-altitude acclimatization, oxygen use, and the effects of extreme cold were instrumental in the success of the climb and significantly advanced the understanding of high-altitude medicine. [35]

Scope

Modern expeditionary medicine ensures medical support in austere environments. This may require proficiency in both preventive care and risk assessment to maintain overall team well-being. Meticulous planning may be required in preparation for medical emergencies or evacuation. Expeditionary medicine may require specialized knowledge to manage environmentally-specific conditions and treat diseases relevant to the expedition location, adapting to the specific geographical and biological risks encountered. [36] [37] Also, an integration of non-medical skills into the medical role may be required if the medical provider is also a contributing team member of the expedition. [36]

Interdisciplinary Approach

The expedition medicine provider may need to fill several roles, which requires an interdisciplinary approach to their role in the expedition. This interdisciplinary approach in expedition medicine shifts the paradigm from simply treating a sick or injured person to safely managing a patient within an austere or hostile environment, requiring a fusion of medical, technical, logistical, and human-factor skills. [36] [37]

Comprehensive Risk Management and Prevention

The primary focus of expedition medicine is prevention — a task that requires expertise beyond traditional clinical medicine. [38]

Logistics and Planning are important considerations. Collaboration with expedition leaders, logistics specialists, and mountaineering/field experts may be vital for route planning, establishing evacuation plans, and sourcing appropriate, reliable equipment. This may includes communication strategy, which is often a non-medical technical skill. [36] [37]

Expedition medicine providers must integrate knowledge from environmental physiology (e.g., thermal injuries, altitude sickness, water safety), tropical medicine, and public health to anticipate, screen for, and prevent environmental- and travel-related illnesses. [36]

Clinical Care in Austere Conditions

When an emergency occurs, the expedition medicine provider may need to improvise and adapt.

Core clinical skills must be combined with other skills, such as wilderness survival and search and rescue (SAR) techniques. For instance, treating a fracture requires medical knowledge, but evacuating the patient might require rope skills, technical rigging, and an understanding of terrain from a SAR perspective. [39]

At times, the expedition medicine provider may have limited supplies and diagnostic tools. The expedition medicine provider may need to employ an adaptive approach, borrowing ingenuity from field craft and engineering to improvise splints, shelters, and monitoring devices. [39]

Team Performance and Psychological Wellbeing

Expeditions may be high-stress, prolonged endeavors where human factors are critical. Alterations to normal routines and the stresses associated with physical challenges can trigger pre-existing mental health conditions. Preventive measures include ensuring adequate social support, sufficient sleep, establishing travel-specific routines, adhering to medication regimens, and maintaining good awareness of early warning signs of mental health deterioration. [40]

The expedition medicine provider may act as a key leader in the team, requiring an understanding team dynamics, crisis resource management, and the psychological impacts of isolation, stress, and injury. This draws heavily on disciplines like organizational psychology and team leadership. [39]

Collaborating with physical fitness specialists or using knowledge from sports medicine may be necessary for pre-expedition screening and managing common musculoskeletal injuries, which are often the most frequent reasons for an expedition member to withdraw. [39] [41] [42]

Modern Advancements

Modern technological advances have significantly improved the feasibility and quality of medical care delivered in remote and austere environments. Innovations introduced to overcome the challenges of isolation and limited resources include the expanding use of telemedicine, miniaturized diagnostic equipment, and remote physiological monitoring. [43]

The ability to use telemedicine and virtual consultation in austere locations has increased due to improved global satellite and cellular network coverage. Telemedicine capabilities may allow expedition team members to consult in real-time with specialists worldwide, often using asynchronous or synchronous communication. [44] Notable applications may include real-time trauma triage, remote guidance for complex procedures, and tele-ultrasonography. [45] Telemedicine may help to bridges the expertise gap, enabling expedition team members to perform more sophisticated diagnostics and treatment with specialist oversight. [46]

Technological miniaturization has allowed diagnostic and therapeutic tools to become more lightweight, compact, and durable enough for field use. Portable medical systems, such as handheld ultrasound devices, may provide rapid diagnostic capabilities. Furthermore, wearable technology may allow continuous, non-invasive monitoring of expedition team member vital signs, cardiac activity, and other physiological metrics, enabling the ability to track health status in real-time. [46]

See also

References

  1. ↑ "What is an expedition doctor?". World Extreme Medicine. Expedition & Wilderness Medicine Posts. 7 October 2021. Retrieved 7 October 2021.
  2. ↑ Grogan, Claire (15 Nov 2016). "Expedition medicine: save lives ... and go places". The Guardian. Archived from the original on 2021-10-21. Retrieved 30 March 2023.
  3. ↑ Imray, C. H.; Grocott, M. P.; Wilson, M. H.; Hughes, A.; Auerbach, P. S. (2015). "Extreme, expedition, and wilderness medicine" . Lancet. 386 (10012): 2520–2525. doi:10.1016/S0140-6736(15)01165-4. PMID   26738718. S2CID   11441616.
  4. ↑ "Wilderness Medical Society: About". Wilderness Medical Society. Retrieved 3 March 2022.
  5. ↑ Cossar, Jonathan (1 March 1994). "Influence of Travel and Disease: An Historical Perspective". Journal of Travel Medicine. 1 (1): 36–39. doi: 10.1111/j.1708-8305.1994.tb00553.x . PMID   9815305.
  6. ↑ Westphalen (1 January 2023). "English Medieval Ships Warfare and Medicine". Journal of Military and Veterans Health. 31 (1): 40. Retrieved 30 March 2023.
  7. ↑ Magiorkinis, E.; Beloukas, A.; Diamantis, A. (16 November 2010). "Scurvy: past, present and future". Eur J Intern Med. 22 (2): 147–52. doi:10.1016/j.ejim.2010.10.006. PMID   21402244.
  8. ↑ "Sea-surgeons Enter the Age of Exploration". piratesurgeon. Retrieved 3 March 2022.
  9. ↑ Lopez, CA (4 October 1976). "Medical Notes on Columbus's First Trip to America". JAMA. 236 (14): 1598–1599. doi:10.1001/jama.1976.03270150032026. PMID   785049.
  10. ↑ Primary Sources: "Raimondo de Raimondi de Soncino, Milanese Ambassador in England, to Ludovico Maria Sforza, Duke of Milan, 18 December 1497, The Smugglers' City, History Dept., University of Bristol
  11. ↑ Skelton, R.A. (2003). "John Cabot". Dictionary of Canadian Biography, vol. 1. University of Toronto/Université Laval. ISBN   9780802031426. Archived from the original on 5 August 2025. a Burgundian and a Genoese barber, both companions of Cabot
  12. ↑ Almazán. "Death and Disease on the First Circumnavigation of the World". Google Arts & Culture. Fundación Elkano. Archived from the original on 22 May 2024. Retrieved 27 September 2025. The following individuals were among those on board the ships that set off from Seville: Juan de Morales, a physician and surgeon who was in charge of all health-related matters for the fleet; and three barbers: Pedro Olabarrieta of Galdakao, Marcos de Bayas of Sanlúcar de Alpechín, and Hernando de Bustamante Carrero of Mérida. The last of these was one of the 18 Castilians who returned on the Victoria.
  13. ↑ Shipton, Martin (23 January 2015). "Did Captain Cook's Welsh surgeon introduce surfing to the world?". Wales. Wales Online. Archived from the original on 29 May 2022. Retrieved 27 September 2025.
  14. ↑ "Rush and the Corps of Discovery". lewis-clark.org. 22 May 2021. Retrieved 3 March 2022.
  15. ↑ Duncan, Dayton; Burns, Ken (1997). Lewis & Clark: The Journey of the Corps of Discovery. New York: Alfred A. Knopf, Inc. pp. 9–10. ISBN   978-0-679-45450-2.
  16. ↑ Ambrose, Stephen (1996). Undaunted Courage: Meriwether Lewis, Thomas Jefferson, and the Opening of the American West. New York: Simon & Schuster. pp. 81, 87–91. ISBN   978-0-684-82697-4.
  17. ↑ "What Pioneers Packed to Go West". Notes From The Frontier. 21 October 2019. Retrieved 3 March 2022.
  18. ↑ "DOCTORS AND DISEASES ON THE OREGON TRAIL". END OF THE OREGON TRAIL. Retrieved 3 March 2022.
  19. ↑ Bethany Nemec (2 April 2019). "End of the Oregon Trail - Doctors and Diseases on the Oregon Trail". Historic Oregon City. Retrieved 16 August 2024. Not many wagon trains had doctors traveling with them, and it was common for trains without doctors to try to stay close to a train that did have one.
  20. ↑ "FRIEDRICH VON ESMARCH—MILITARY SURGEON" . JAMA. 185 (2): 132–133. 1963. doi:10.1001/jama.1963.03060020092035.
  21. ↑ Ambler, Louise (1914). The Private Journal of James Markham Ambler, M.D. United States Government Publishing Office. pp. 1–99.
  22. ↑ Guttridge, L. F. (1988). Icebound: the Jeannette expedition's quest for the North Pole. Shrewsbury: Airlife. ISBN   9781853100062.
  23. ↑ Kelly, Howard A.; Burrage, Walter L. (eds.). "Ambler, James Markham Marshall"  . American Medical Biographies  . Baltimore: The Norman, Remington Company.
  24. ↑ Bridges, E. L. (1948) The Uttermost Part of the Earth Republished 2008, Overlook Press ISBN 978-1-58567-956-0, Appendix II.
  25. ↑ Cook, Frederick A. (2014). Through the First Antarctic Night, 1898-1899. Cambridge University Press. p. 231. ISBN   9781108076746 . Retrieved 28 January 2022.
  26. ↑ Bryce, Robert M. (December 1997). "The Fake Peak revisited" (PDF). DIO. 7 (3): 41–76. ISSN   1041-5440. OCLC   18798426.
  27. ↑ Henderson, Bruce (2005). True North: Peary, Cook, and the Race to the Pole. W. W. Norton and Company. ISBN   978-0-393-32738-0. OCLC   63397177.
  28. ↑ Guly, HR (1 July 2012). "The Role of the Expedition Doctor: Lessons From 100 Years Ago". Wilderness & Environmental Medicine. 23 (2): 170–174. doi: 10.1016/j.wem.2012.02.011 . PMID   22656665.
  29. ↑ "Shackleton's Crew - MEET THE MEMBERS OF THE BRITISH ANTARCTIC EXPEDITION 1907-09". nzaht. Archived from the original on 2023-02-02. Retrieved 30 March 2023.
  30. ↑ "Shackleton Online - Meet the pioneers - Alister Forbes Mackay". Scott Polar Research Institute. Department of Geography, University of Cambridge. Retrieved 16 August 2024.
  31. ↑ Shackleton, Ernest (1911). The Heart of the Antarctic. London: William Heinemann. p. 210.
  32. ↑ "Letter written to Professor Edgeworth David by Lieutenant Nobu Shirase". The Australian Museum. Retrieved 16 August 2024. Seizo Miisho, Physician
  33. ↑ Crane, D. (2005). Scott of the Antarctic: A Life of Courage, and Tragedy in the Extreme South . London: HarperCollins. pp. 413–416. ISBN   9780007150687.
  34. ↑ Preston, D. (1999). A First Rate Tragedy: Captain Scott's Antarctic Expeditions. London: Constable. p. 211. ISBN   9780094795303.
  35. ↑ Fox, Margalit (25 October 2005). "Michael Ward, 80, Doctor on '53 Everest Climb, Dies". The New York Times. Retrieved 11 January 2018.
  36. 1 2 3 4 5 Bledsoe, Gregory; Manyak, Michael J.; Townes, David A. (3 November 2008). Expedition and Wilderness Medicine (1st ed.). Cambridge University Press. p. 772. ISBN   978-0521868730.
  37. 1 2 3 Shaw, Marc T M; Leggat, Peter A (September–October 2003). "Life and death on the Amazon: illness and injury to travelers on a South American expedition". Journal of Travel Medicine. 10 (5): 268–71. doi:10.2310/7060.2003.2694. PMID   14531979.
  38. ↑ Dallimore, Jon; Anderson, Sarah R.; Imray, Chris; Johnson, Chris; Moore, James; Winser, Shane (9 January 2024). Oxford Handbook of Expedition and Wilderness Medicine (3rd ed.). Oxford University Press. p. 912. ISBN   978-0198867012.
  39. 1 2 3 4 Imray, C. H.; Grocott, M. P.; Wilson, M. H.; Hughes, A.; Auerbach, P. S. (19 December 2015). "Extreme, expedition, and wilderness medicine". The Lancet. 386 (10012): 2520–5. doi:10.1016/S0140-6736(15)01165-4. PMID   26738718.
  40. ↑ Loganathan, Shanghavie; Middleton, Jo; Heath, Jason; Cooper, Maxwell (March 2025). "Brief interventions for travel advice". InnovAiT: Education and inspiration for general practice. 18 (3): 166–172. doi:10.1177/17557380241305989. ISSN   1755-7380.
  41. ↑ Cooke, FJ; Sabin, C; Zuckerman, JN (2000). "A Study of the Incidence of Accidents Occurring during an Arctic Expedition: Another Important Aspect of Travel Medicine?". Journal of Travel Medicine. 7 (4): 205–207. doi:10.2310/7060.2000.00061. PMID   11003734.
  42. ↑ Nicol, ED; Dhillon S., S (December 2005). "Expedition medicine". BMJ Military Health. 151 (4): 264–271. doi:10.1136/jramc-151-04-08. PMID   16548343.
  43. ↑ "Developing Wearable Sensors for Remote Physiological Monitoring in Arduous Environments". wem academy. Retrieved 3 March 2022.
  44. ↑ Ting, Louise; Wilkes, Matt (1 March 2021). "Telemedicine for Patient Management on Expeditions in Remote and Austere Environments: A Systematic Review". Wilderness & Environmental Medicine. 32 (1): 102–111. doi:10.1016/j.wem.2020.09.009. PMID   33423896.
  45. ↑ Pian, L; Gillman, LM; McBeth, PB; Xiao, Z; Ball, CG; Blaivas, M; Hamilton, DR; Kirkpatrick, AW (2013). "Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings". Emergency Medicine International. 2013: 1–9. doi: 10.1155/2013/986160 . PMC   3568862 . PMID   23431455.
  46. 1 2 Davis, CB; Lorentzen, AK; Patel, H; Cheung, D; Wright, A; Lemery, J; Penninga, L (1 June 2022). "The Intersection of Telemedicine and Wilderness Care: Past, Present, and Future". Wilderness & Environmental Medicine. 33 (2): 224–231. doi:10.1016/j.wem.2022.02.012. PMID   35459612.
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