Health

Ireland’s ‘wilderness doctors’: Treating injuries far away from the hospital

An upsurge of interest in outdoor pursuits means injuries may have to be treated in the wild

‘The most common call outs to mountain rescue is from hill walkers who have slipped.’ File photograph: Getty

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Sylvia Thompson
Sat Aug 29 2020 - 06:00

How do you combine a passion for medicine with a love of being outdoors? It was in answering this question that a small group of health professionals and outdoor enthusiasts came together to start wilderness skills training for doctors in Ireland.

“I was interested in wilderness medicine and I was travelling with my brother from London to Cape Town. We were surfing in a very remote spot of the Namibian desert and a friend of ours had a bad accident. He broke his neck while surfing.

“I was called out of the water to assess him and he was taken by a 4x4 vehicle to the nearest hospital. He made a great recovery but I was struck by the task of assessing a critically ill patient outside of the usual medical setting,” explains Callum Swift, one of the founders of Wilderness Medicine Ireland and a senior house officer in emergency medicine at Tallaght University Hospital.

With Dr Jimmy Lee (specialist registrar in emergency medicine and rock climber), Peter Conroy (paramedic with Dublin Fire Brigade and big wave surfer) and Colm Burke (mountaineer and member of Kerry Mountain Rescue), Swift started weekend long training in wilderness medicine for medical professionals in Ireland.

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Their first courses were held in the Big Style Atlantic Lodge, Killadoon, Co Mayo, in 2019. Their next course, planned first for March then for September, has now been cancelled twice.

“If you are a recreational surfer or a rock climber and you’re a paramedic or a doctor, you come across specific emergencies that require immediate medical care. We bring our [professional] background to austere remote environments. The biggest difference is that you have to make timely decisions without tests or tools,” explains Dr Lee.

Hanging off a cliff

He recounts a personal experience from the summer of 2017 when he was rock climbing in Glendalough, Co Wicklow and a co-climber slipped and dropped 10-15m.

“I had just done my wilderness training but I had to think how I was going to help while hanging off a cliff myself. Emotions and adrenalin were running high. I had to make myself safe, do the primary assessment of the injury and make sure no one did any additional harm to themselves,” he explains.

“The injured person had an open fracture to her left elbow, chest injuries and risk of spinal injury. It was 90 minutes before she was airlifted off the mountain,” explains Dr Lee.

Peter Conroy, who lives in Miltown Malbay, Co Clare, says that the ambulance services are sometimes stretched and the upsurge of interest in hiking and sea swimming throughout the winter months has made him very aware of the risks of hypothermia.

As the co-founder of the Irish Tow Surf Rescue Club, Conroy installs defibrillators, first-aid kits and medical boxes at various points along the coastline. “I’m aware that many sea swimmers need water safety training to learn how to use rescue tubes. Getting into cold water to help someone else – without a rescue tube – can often lead to putting more people in danger,” says Conroy.

Lee adds that often people don’t realise the risks they take on the mountains either and realise only afterwards that they were doing something dangerous. “The most common call outs to mountain rescue is from hill walkers who have slipped,” he says.

Engineer and mountaineer Colm Burke joined the Wilderness Medicine training team when approached by Swift. “The big thing that strikes me about doing the training with doctors is that they have a lot to learn about working in different environments. For example, learning about how the weather exacerbates injuries in that someone could die of hypothermia if not rescued early enough.”

Burke says that when you’re a first responder treating casualties in a mountainous area, you often have to create a temporary shelter from what you’ve got in your backpack before you can start treating the injuries.

“Sometimes, medics who are used to having all the resources of a clinic or hospital aren’t used to dealing with basic tools. They tend to overlook the simpler things like assessing the immediate area to see if it’s safe to treat someone or putting together makeshift stretchers from a bivvy [survival] bag with walking poles.”

The three-day courses in wilderness medicine in Ireland include an ocean-themed day with surf lessons, water rescue drills and talks on hypothermia and ocean safety.

On the second day, the group climbs Croagh Patrick and learns how to immobilise broken limbs, set up temporary shelters and deal with hypothermia on the mountain side.

On the third day, a close to life simulation of an accident is enacted with full participation from all. There are inspirational and motivational talks throughout the weekend.

“We had a lot of people coming to the west of Ireland for the first time on our 2019 courses. They loved the outdoor activities as much as the medical aspects. A lot of people who come are bored, burnt out or depressed and this gives them back inspiration for their career in medicine,” says Swift.

Accredited courses

Wilderness medicine training has taken off around the world in the past five years. There are accredited courses in the UK, Australia and the US. Medics can get continuous professional development points accredited by the Royal College of Surgeons of Ireland on the wilderness medicine training for doctors in Ireland.

Chatting to Swift, Lee and Conroy, you can quickly see that their passion for being outdoors and partaking in extreme sports also offers them time out from stressful work environments.

"All our lives are built around the outdoors. For me and Jimmy, getting outside to surf or mountain bike or climb keeps us happy and healthy. It's a core part of our lives. Being outside with friends is also an antidote to burnout. It's an invigorating and exhilarating experience sharing our knowledge with people on these courses," says Swift. See also wildmed.ie