Primary Care in Extreme Environments: Medical Clinic Utilization at Antarctic Stations, 2013-2014

Surgical training strategies for physicians practicing in an isolated environment: an example from Antarctica. International survey of 13 countries with active winter stations

For 60 years, human presence in Antarctica has required particularly demanding medical skills. Nevertheless, the preparation of physicians working in this extreme environment remains unknown and deserves clarification. This study aimed to summarise data on the surgical training given to physicians by different countries. In April 2020, we conducted a questionnaire-based study of 14 countries wintering in Antarctica. Responses were descriptively analysed. Regarding the profiles of physicians recruited by the wintering countries, 30% to 55% were non-surgeon doctors compared with 45% to 70% for surgeons depending on the year. Of the 13 countries answering the questionnaire, nine organised practical surgical training and six used theoretical material. All countries reported practical training for dental surgery, while only five countries provided training in four other surgical specialities (orthopaedic, digestive, thoracic, and ear, throat, and nose). All 13 countries reported using a telemedicine system. These results revealed heterogeneous training strategies among the recruited physicians, reflecting the difficulties of practice on this extreme continent. Future work may assess the effectiveness of each strategy. A better understanding of surgical epidemiology and a detailed referencing of the equipment available at the bases would help better define the contours of surgical care in Antarctica.

Patterns of illness and injury on Antarctic research cruises, 2004-2019: a descriptive analysis

BACKGROUND

Before the impact of the coronavirus disease 2019 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future.

METHODS

The clinical conditions seen in those presenting for care on six small-vessel scientific cruises to Antarctica were analysed.

RESULTS

Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow-up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person-days at sea. The total consultation rate was 23.5 per 1000 person-days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person-days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations.

CONCLUSIONS

Pre-cruise advice for travellers planning small-vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.

Evaluating Health Impact at High Altitude in Antarctica and Effectiveness of Monitoring Oxygen Saturation

Background

The Japanese Antarctic Research Expedition (JARE) has been conducting research activities in inland Antarctica, which is extremely cold dryland covered with a thick ice sheet. This environment may cause a health disorder called acute mountain sickness (AMS). To improve the safety of expedition members, we evaluated the impact of extreme environmental conditions on human health and the effectiveness of monitoring of hypoxia for the early detection of AMS.

Methods

In total, 9 members from JARE 59 were studied. Dome Fuji Station (Dome F), located 3,810 m above sea level (ASL), was the destination of the research party. We analyzed daily AMS scores (higher values correspond to more severe AMS-related symptoms), physiological findings, and percutaneous arterial blood oxygen saturation (SpO₂) during the inland activity. We also determined the factors related to AMS scores.

Results

The average AMS score on arrival at Dome F was significantly higher than that at the departure point (560 m ASL). The average SpO₂ level was significantly lower than that at other points. The SpO₂ level correlated negatively with the AMS score in Spearman's rank correlation. Generalized estimating equations analysis showed that the AMS score was negatively associated with SpO₂ level and positively associated with age.

Conclusion

Hypoxia is a contributory factor to AMS which we can easily assess by measuring the SpO₂ level with a pulse oximeter. SpO₂ monitoring is a potentially useful health management tool for members in inland Antarctic expeditions. In addition, our results are helpful for understanding physiological responses and health issues in extreme environments.

Disease and injury statistics of Japanese Antarctic research expeditions during the wintering period: evaluation of 6837 cases in the 1st-56th parties - Antarctic health report in 1956-2016

This study aimed to evaluate disease and injury trends among wintering members of the Japanese Antarctic Research Expedition. Obtained information is indispensable to the advancement of medical system and research. Summation was performed based on medical records of reports prepared by each expedition over the period 1956–2016. The clinical department’s classification methods of the names of injuries and diseases varied among expeditions, but the names were integrated following the same classification. Of 1734 members (29 women), 6837 disease or injury cases (4 cases/person) were recorded. The rates of cases were as follows: surgical-orthopaedic (45.3%), internal medical (21.7%), dental (11.6%), dermatological (8.4%), ophthalmological (5.8%), otorhinolaryngological (5.3%), psychiatric (1.6%), and urological (0.1%) cases. There was no major change in rates by type of medical case in each expedition. This analysis made it possible to prepare medical facilities, content of physical examinations to select members, training of physicians before departure, preventive hygiene at sites, and medical research themes.

Remote Health Care at U.S. Antarctic Stations: A Comparison with Standard Emergency Medical Practice

BACKGROUND

The three U.S. Antarctic research stations' medical facilities exist in an isolated, harsh environment, typical of many such facilities throughout the world. Emergency physicians frequently staff these medical facilities; however, most who are considering this have many misconceptions about the stations and about the scope of medical practice that exists there.

OBJECTIVE

This article illuminates how Antarctic medical practice is comparable with and dissimilar to other emergency medicine experiences and highlights information that any emergency physician-applicant to an isolated medical position should learn prior to accepting the position.

DISCUSSION

Antarctic medical care both parallels and differs from typical emergency medical practice in many ways, including the patient population, facilities, supplies, equipment, clinical duties (e.g., providing out- and inpatient medical and dental care, performing laboratory tests and imaging), and nonclinical duties (e.g., disaster planning, teaching, food service inspection, and public health officer). Climate-related limitations on medical evacuation epitomize the stations' isolation. Medical practice may be complicated by ethical issues common in other small isolated settings, such as a lack of privacy and confidentiality. Clinicians considering an isolated practice opportunity should ask basic questions to learn as much detailed information as possible prior to taking the positions.

CONCLUSION

Medical practice at U.S. Antarctic stations, as at many remote health care facilities throughout the world, has similarities to standard emergency medical practice. Even so, significant differences result in a steep learning curve. Any clinicians considering practicing in these locations should carefully evaluate the practice and the environment in advance of any deployment.

Antarctica challenges the new horizons in predictive, preventive, personalized medicine: preliminary results and attractive hypotheses for multi-disciplinary prospective studies in the Ukrainian "Akademik Vernadsky" station

Background

Antarctica is a unique place to study the health condition under the influence of environmental factors on the organism in pure form. Since the very beginning of the scientific presence of Ukraine in the Antarctic, biomedical research has been developed for the monitoring of individual biomarkers of winterers and medical accompaniment in Antarctic expeditions.

The aim of the study was to analyze and discuss the retrospective data of long-term monitoring and observations in Ukrainian Antarctica station “Akademik Vernadsky,” providing multi-scale biomedical information with regard to conditions of a perfect isolation from technological and social influences and under extreme environmental factors.

Methods

Medical and biological studies have been performed with the participation of all 20 Ukrainian wintering expeditions. We surveyed 200 males aged 20–60 years (mean age 37 years). Extensive medical examinations were carried out before the expedition, during the selection of candidates, and after returning, and particular functions were monitored during the entire stay in Antarctica. The medical records were analyzed to study the reaction of the human organism on phenomena like “Antarctic syndrome,” dysadaptation, anxiety, desynchronosis, photoperiodism, influence of climatic and meteofactors like “Schumann resonance,” infrasound, “ozone hole,” and “sterile” environment; important aspects of its role on human health were precisely studied and discussed.

Results

The examinations showed the multi-level symptoms of the processes of dysregulation and dysadaptation, as functional tension in the sympathetic-adrenal system rights, especially during urgent adaptation to the Antarctic (1-month stay at the station) and, to a lesser extent, after returning from an expedition to Kyiv. At the initial, adaptation to the conditions of the Antarctic levels of urinary catecholamines (epinephrine, norepinephrine, dopamine, DOPA) increased compared with the start of the expedition (23.2 ± 4.3 and 53.3 ± 5 2 mmol/l, p < 0.001; 67.1 ± 12.3 and 138.3 ± 16.9 mmol/l, p < 0.01; 1749.6 ± 476.5 vs 7094.6 ± 918.3 mmol/l, p < 0.001; 129.6 ± 12.3 and 349.9 ± 40.6 mmol/l, p < 0.001, respectively). In the blood serum of 100 % of the expedition, we found an increase of oxidative stress markers—the level of TBARS increased by 41.2 %, i.e., the activation of free radical peroxidation. Thus, in 80 % of the participants, we observed a reduction in the activity of the SOD antiradical enzyme vs 58 % in the controls. Changes in brain electrical activity after a long stay at the Antarctic stations showed increasing delta rhythms, signs of CNS protective inhibition, likely due to hypoxia. We found changes in the concentrations of microelements (iron, copper, zinc, etc.) in the blood of winterers after the expedition. The polychrome-adaptive method of correcting the changes of the psycho-emotional state in a monochrome Antarctic environment was successfully applied.

Conclusions

The preliminary results of the retrospective study and our own observations of the fundamental physiological mechanisms of the negative influence of extreme environmental factors on an organism in the absence of man-made origin factors allow the determination of many mechanisms of “pre-pathology” processes which promise to develop the pathogenetically based pro-active prevention methods for a number of common diseases to set prospective interdisciplinary research in predictive, preventive, and personalized medicine.