This trend is easily identified in a variety of different areas: there has been substantial growth in the number of qualified scuba divers over the last 30 years, with current worldwide estimates exceeding 14 million; the number of climbers each year on Mount Everest is increasing exponentially, while the number of deaths has remained relatively constant; and almost 700 potential astronauts have signed up for Virgin Galactic’s future suborbital flights, which is more people than have ever flown to space in human history. Thus, more and more people are exploring dangerous environments and in doing so, placing themselves at greater risk for medical illness and injury. However, the nature of these illnesses and injuries are as unique as the environments in which they occur, much different from the common medical problems faced by physicians every day around the world.
The average physician is trained by a medical education system that is designed around the concepts of treating illness and injury as they are related to a “normal” environment. However, when one considers an “extreme” environment, it quickly becomes apparent that the type of medicine for which most physicians are trained may not apply. Extreme environmental medicine requires a paradigm shift for physicians: in extreme environments, patients experience problems that result from a combination of issues related to abnormal anatomy, physiology, and/or the environment itself. This change in the general medical approach to problem solving is not part of the standard medical curriculum and as such, most physicians are not adequately prepared to face the unique challenges in extreme environmental medicine.
In order to manage these types of challenges, extreme environmental medicine physicians must consider a number of factors. First, the types of medical issues encountered by patients in these environments can be unique, such as decompression illness, acute mountain sickness, snake envenomations, etc. Second, whilst in the extreme environment, there will likely be a significant paucity of resources available on hand that can be used at the time of the medical emergency. Third, given that most of these environments are very remote, there will be an inherent lack of access to definitive care (e.g. a hospital) in a timely manner. Fourth, these extreme environmental medicine physicians may have to display substantial clinical autonomy, as consultations with other medical experts may not be possible. Finally, depending on the nature of the environment, evacuation and transport of ill or injured patients may be a necessity.
Training physicians to provide high quality medical care despite all of the challenging factors listed above can be a difficult undertaking. Historically, most of the expertise was developed from experience. However, there are now a few formal educational programs in this area, such as the Fellowship in Extreme Environmental Medicine at the George Washington University. Given the fact that humanity’s need to explore will continue to drive individuals into more and more extreme environments in larger numbers, this field of extreme environmental medicine is very likely to grow.
Over time, it will be these extreme environmental medicine physicians who will be well poised to help support humanity in its continued exploration of the Earth and beyond.
Dr. Kris Lehnhardt
Physician and Assistant Professor
Emergency and Aerospace Medicine
George Washington University