Managing Medical Emergencies in Remote Regions

Written by  Mike Webster May 31, 2010

In remote regions, far from medical care, identifying potential problems early on can help prevent minor ailments from becoming serious emergencies.

At home, coping with being sick is usually pretty straightforward: visit the pharmacy, take the day off work and have a long nap until you feel better. If an illness persists, you might make a trip to your doctor's office or to a walk-in medical clinic, and in dire situations, there is always the local hospital with a 24-hour emergency department.

Things get a lot more interesting when travelling in remote settings or in countries with a less-developed medical infrastructure. In these situations, a hospital could be hours, days or even weeks away. Your ability to recognize early signs and symptoms of potentially serious problems can enable you or your travel companions to leave the field and reach medical care before things become much worse. Being able to identify these “red flags” can also help you to determine when a condition isn’t serious and doesn’t require evacuation.

In the examples below, a situation that is low urgency means that once a warning sign has been observed, you should be fairly concerned and start a safe, controlled trip to reach medical help within a couple of days.  In a moderately urgent situation, you’ll need to speed things up a little and try to reach medical attention within 24 hours. If the situation is highly urgent—the equivalent of a 911 call—all options for evacuation, including by plane or helicopter, should be considered in order to get to medical care as quickly as possible.

It’s important to remember that any time you see a change in a person’s consciousness—confusion, disorientation, loss of consciousness—this is very serious and the situation should be considered highly urgent. Even your friend who had too many margaritas should be considered an emergency case if you can't wake him up.

Similarly, a fever that persists is always a reason to get to medical help within a day or two.  If it’s accompanied by an injury or pain, the situation is more urgent. As always, if there’s a change in consciousness…you know the drill!

Below are some common medical conditions you could encounter while travelling, and important signs to watch for.  They will alert you to the fact that things are taking a turn for the worse and that you need to get to proper medical care.

Problem: SUNBURN

Watch for:
• A drop in body temperature (hypothermia) identified by constant shivering, confusion or disorientation
• Fever: Elevated temperature indicating an infection

Urgency: Low to moderate
Consider a safe and controlled evacuation to medical care within a couple of days, faster (within 24 hours) if it’s not possible to keep the person warm, or if he is running a fever.

Problem: DIARRHEA
(defined as a completely liquid bowel movement)

Watch for:
• Dehydration: If you’re loosing fluid faster that you can drink it, you’re losing the battle
• Non-stop continuation of the condition for more than 24 hours
• The presence of blood (semi-digested blood has a tar-like consistency)
• A persistent fever
• Elevated heart-rate when at rest

Urgency: High
Evacuation should begin immediately. If there is a change in consciousness (person becomes confused, disoriented or loses consciousness), this is a major emergency. All available resources (air evacuation, ground transport, etc.) must be considered to get the person help as quickly as possible. 

Problem: VOMITING

Watch for:
• Vomiting that continues, leaving a person unable to keep food or fluids down
• Difficulty breathing because a person’s airway is partly blocked
• Evidence of blood in the vomit (this may look like coffee grounds)

Urgency: Moderate to high
If a person cannot retain food or fluids because of vomiting, they should get medical help within the next 24 hours. If breathing is affected, there is a change in consciousness, or signs of hypothermia, this is a major emergency.

Problem: GENERAL ABDOMINAL PAIN

Watch for:
• An elevated pulse while at rest
• Constant abdominal pain in anyone who is pregnant
• Constant, unrelieved pain aggravated by movement and touch
• Persistent fever

UrgencyModerate to high
Anyone experiencing significant abdominal pain with an unknown cause that doesn't go away within 24 hours should visit a medical clinic. This becomes highly urgent if the person seems pale with cool, clammy skin, if her heart and breathing rates are elevated while at rest, or if she becomes confused, disoriented or loses consciousness.

Problem: EAR PAIN

Watch for:
• Fever
• Severe pain
• Ongoing dizziness

Urgency: Moderate, but highly urgent if there is a change in consciousness.

Problem: NOSEBLEED

Watch for: 
• Profuse bleeding

Urgency: Low, but if the nosebleed is the result of a head injury that causes a change in consciousness, uncharacteristic behaviour, or the person develops a fever, or there are signs of shock (clammy, cool skin, elevated heart and breathing rates), the level of urgency is high.

Problem: COUGH, COMMON COLD, OR OTHER RESPIRATORY INFECTION

Watch for:
• Significant difficulty swallowing
• Persistent fever
• Bloody sputum (coughed-up mucous)
• Persistent chest pain
• Difficulty breathing

Urgency: Moderate (high if there is difficulty breathing).

Mike Webster a paramedic and the Canadian Executive Director of Wilderness Medical Associates, an international organization dedicated to the education and research of medicine and first aid in remote and unconventional settings.

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