n6pse
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DXpedition Unsung Heroes.
Posted: 26 Aug 2015 10:54 AM PDT
https://n6pse.wordpress.com/2015/08/...unsung-heroes/
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 Johnsons-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
Peripheral Edema
Dislocations
Motion/Sea Sickness
Dehydration
Sun burn
Diarrhea
Sprains
Constipation
Bone Fracture
Heat exhaustion
Less common but more critical issues:
Angina and CHF symptoms including shortness of breath, legÂ* 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.
Bug bites
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 Ive also sewed lacerations, injected frozen
shoulders, buddy-taped broken toes, and treated flare-ups of gout�
Alan-K6SRZ adds “I would advise any doctor accompanyingÂ* 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.Â*
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 youre planning a DXpedition that takes you far from the resources of
modern medicine you should be fit, aware of the risks youre taking, and
trust in your luck.Â* 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.Â* But
once they start to vomit, the value of the remainder of their pills is
nill.Â* Best is to use the scopolamine patches:Â* TransDerm Scop.Â* 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.Â* 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).Â* Ive not encountered this but I always bring urinary
catheters w/ me just in case.Â* I usually have a med administered by an IM
shot for those w/ intractable vomiting. Anecdote:Â* 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:Â* Ive 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!Â* 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:Â*
heat & moisture can cause skin & nailbed infections.Â* Ive drained abscesses
numerous times on DXpeditions. In cold places:Â* feet kept in wet socks
inside boots can cause trench foot.
Orthopedics: Things Ive seen on past trips:Â* shoulder dislocation, wrist
fracture.Â* These can usually be dealt w/ on site.
Mundane but significant:Â* Nonspecific viral infections/flu-like illnesses
can take a lot of team members off-line & especially impact phone ops who
are liable for laryngitis.Â* Unfortunately, no magic bullet for these
problems.
AEDs: I find these problematic.Â* On the one hand, on DXpeditions, we
usually have an older aged group of hams, some of whom may have already had
stents placed.Â* In the real world (ie:Â* 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.Â* He might require a ventilator and/or
other high tech support.Â* On a DXpedition to a place a weeks 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.Â* 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 dont
want to appear to be providing inferior care for their team.Â* 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.Â* And, after
such a team member is so treated, where is the catheterization lab?Â* How
does he get the stent he likely needs?Â* 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-K6SRZÂ*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?
Credits:
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