Expedition and Wilderness Medicine (7 Oct 2026)

SPEAKER_00 0:00

If you enjoy listening to clinical conversations, why not become a member of the Royal College of Physicians of Edinburgh? Our membership provides you with access to the RCPE educational portal, the live for evening medical updates, and you have options to view the symposia both in person or online. If you would like to learn more about this, please go to the Royal College of Physicians of Edinburgh website.

SPEAKER_02 0:33

Hello and welcome to this episode of Clinic Conversations, brought to you by the Royal College of Physicians Edinburgh Trainees and Members Committee. My name is Jan Engelmorton, and I'm a member of the TMC and a medical registrar in Edinburgh. Today I'm delighted to be joined by Dr. Naomi Dodds to talk about Expedition Medicine. Dr. Dodds is an anaesthetist in Aberdeen, team doctor for the Aberdeen Mountain Rescue Team, Educational Lead for the International Committee of Mountain Emergency Medicine, and Deputy Course Lead for the Postgraduate Diploma in International Expedition and Wilderness Medicine. Welcome, Naomi. Thank you for meeting with me today.

SPEAKER_01 1:11

Thank you so much for inviting me to join you to speak about Expedition Medicine.

SPEAKER_02 1:16

Naomi, to get us started, what is Expedition and Wilderness Medicine?

SPEAKER_01 1:21

Expedition Medicine, if you break it down, so expedition can be defined by the Oxford Dictionary as a journey or a trip by a group of people with a particular purpose. So that could be scientific, research-based, it could be exploration, or it could be just for physical challenge. And therefore, a medic on that expedition is someone who provides medical care to the participants and within that expedition team. And so that's how I would really look to define expedition medicine.

SPEAKER_02 1:50

Thank you very much, Naomi. And then I think as part of that, what are your roles and what are your responsibilities as an expedition medic?

SPEAKER_01 1:59

So that's a really good question. And actually, it's a really kind of wide-ranging responsibility and have some roles within it. And a lot of the roles will take part prior to going out on expedition. So lots in the preparation phase. So as an expedition medic, you would be involved in risk assessing the expedition and putting things in place in terms of minimizing any of those hazards. There'll also be a lot of planning in terms of looking at medical kits that you'd be taking with you, the logistics, where are your nearest hospitals in country and what would happen if someone did need evacuating. There'll also be pre-screening of all the expedition participants, looking at their medical history, seeing if they are suitable for the expedition and if there's anything you need to put in place to try and prevent them becoming unwell or ill on expedition. There's education and training, so training up members of the team so that they do have some basic first aid skills to be able to look after themselves and also look after you as the expedition medic. You might be the only person with a medical background. And then there's the clinical governance and documentation. So as we would do in our normal hospital practice, it's important to document everything clearly that we're doing and have a clinical governance structure to it. So as you can see, there's lots of different parts of expedition medicine in terms of the role, and that's just the medical side. Often there will be non-medical responsibilities as well. So first and foremost, you're a member of the expedition team, and so you might need to be able to do a particular type of activity, whether that be mountaineering or skiing or canoeing, to be able to be part of that team. And also there might be other roles in terms of photography or day-to-day planning of food rations or setting up camp and tents. So it's very wide-ranging the role of the expedition medic.

SPEAKER_02 3:39

Thank you very much, Naomi. That sounds incredibly interesting. And like you said, a lot of clinical and non-clinical problems or presentations that you might be involved with. And like you said, so the non-clinical aspect such as planning and the whole preparation side. It sounds like a lot of logistics is involved, which I guess isn't surprising with expeditions. Can you tell us a bit about your own experience working as an expedition medic and what bits of this broad field you got involved with?

SPEAKER_01 4:10

Yeah, so I guess I've been involved in the expedition industry for about 20 years now. Prior to studying medicine, I worked as an expedition leader and so naturally gravitated towards expedition medicine when I then qualified and later on in my career. And I've been really lucky to be involved in lots of different types of expeditions, from very exploratory expeditions into some of the really remote areas into the Arctic and Greenland, but also some kind of commercial expeditions with big expedition teams, research expeditions to altitude, and some TV and media focused expeditions. And all of those experiences are very different in terms of providing expedition medicine. One of my kind of more recent experiences and probably one of my best expedition medicine experiences was working for the Himalayan Rescue Association out in the pool, where I was based in Frieshead at 4,300 meters on the Everest Base Camp route, running a small high-altitude rescue clinic. And that meant seeing quite a fair number of patients each day, both trekkers and climbers, but also local Nepalese. And it was a fantastic experience just to embrace the kind of culture and live somewhere like that for three months whilst working in expedition medicine.

SPEAKER_02 5:19

That sounds really interesting, Naomi. What would average day look like for you while working in Nepal?

SPEAKER_01 5:27

So usually we would get up. There would be a kind of morning clinic that would start shortly after breakfast, and we were just open for anyone to drop by. So people would come in with various different medical problems. Quite a lot of it was high altitude focused, but we saw a lot of other wide-ranging things as well. And so we would run the clinic during the daytime hours. At three o'clock every day, there was also a lecture that was delivered to whoever wanted to come along, and that would be educating people about altitude illness. So it'd involve a little bit of the physiology of altitude illness, preventative measures, and what to do if you did get sick. And the Himalayan Rescue Association has been around and been setting up these clinics now for over 50 years. And that kind of education and prevention part is really important. And then overnight we were available for emergencies. And so at any point we could get people turning up, a bit like AE, to our clinic or our rescue post requiring assistance and help and assessment. So that's what a kind of general day would look like at the Friche Rescue Post.

SPEAKER_02 6:23

Yeah, it sounds like you're never really off.

SPEAKER_01 6:26

That's right. Yeah, there was a small team of us, so we had a Nepalese cook and someone that would run the clinic, a care worker, and then there would be some doctors. That could be Nepalese or it could be international. And there would usually be only kind of two or three doctors, and so you'd be on a rotation. And so there would be some days off to enjoy the kumbu and the beautiful mountains and some trekking. But it was actually quite busy, and a lot of the time we were working and running the clinic.

SPEAKER_02 6:49

Yeah, that sounds both amazing and I can imagine quite an intense experience. What sort of problems would patients come to the clinic for?

SPEAKER_01 6:59

So the majority of what we saw was altitude illness. So we would see a lot of acute mountain sickness. And we saw a few cases of the more severe altitude illness as well. So high altitude pulmonary edema and high altitude cerebral edema. But I think the thing that we saw the most of was actually just viral and respiratory illnesses. So like everywhere, if you get lots of people together in small hotels and tea houses, then things do spread. So there's lots of coughs and colds and people coming in looking for medication to help with that. And then we would see just normal things that you might see in any kind of AE or hospital in an acute admission department. So things like, you know, local children with croup through to traumatic injuries, head injuries, so anything kind of in between, really.

SPEAKER_02 7:40

Yeah, I can imagine. And you mentioned the team that was there with you. Did you have any support from hospitals, someone who was on call? What was the support structure around?

SPEAKER_01 7:53

Yeah, so that's a really good question. So it does feel quite isolated and very remote up there. But the Himalayan Rescue Association has a really good setup where they have a medical director who's a Nepalese doctor who works in one of the hospitals in Kathmandu. And there was a network of other doctors all based there working in Kathmandu. And we would have a way of communicating with them just to get a kind of second opinion, particularly if it was involving kind of evacuation or treatment, if there are any delays in terms of getting someone to a lower altitude. And that was a really nice support to have. Although that did rely on having internet communication, which there wasn't always. So you did have to be happy and comfortable being isolated and making some of those decisions if you weren't able to contact anyone for a backup or support.

SPEAKER_02 8:35

Thank you very much, Naomi. I guess leading on from that, how do doctors usually get into expedition and wilderness medicine and make it their career or part of their career? And what training is required?

SPEAKER_01 8:51

So a lot of people come into expedition medicine because they are very passionate about being outdoors and about expedition and travel. But in terms of the actual role itself, you need the medical skills. And these aren't always necessarily clinical skills and conditions that you learn about through medical school or any particular specialty training. So usually additional training is required. So doing postgraduate diplomas such as the International Diploma and Expedition and Wilderness Medicine, run by the partner college in the Royal College of Physicians and Surgeons at Glasgow. And then there's all the other competence that's required in terms of being comfortable in the expedition environment that you're going to be working in. And so gaining skills, whether that be in kayaking or climbing or whatever mode of travel and journeying you're going to do, and just being happy in that kind of expedition environment. So you're in the best possible place to then deliver expedition medicine. You had asked about how you could combine it in terms of a career. And I think certainly training and contracts are becoming a little bit more flexible for us in the NHS. And so there's lots of opportunities to take time out of program if you are a resident that can be in the form of kind of OPs, particularly if it's medically relevant, but not necessarily a competence that you need for your specialty training. There's always opportunities for career breaks as well. And so it's really just discussing with your department that you're working within, showing how important these experiences are and what you can bring back to your department that you're going to be working in. Because actually a lot of these opportunities will allow you to develop skills in terms of being more resilient, being more adaptable in your clinical ability. And so they're really beneficial when you bring those skills back to the department. And so it's kind of selling the opportunities. And therefore, I think lots of departments are very supportive of these kind of trips.

SPEAKER_02 10:38

Yeah, it definitely sounds like a great opportunity to develop leadership skills and develop organizational skills as well as, I guess, like you described, working relatively independently and having to develop quite solid decision making, I would imagine. Is there anything else that you would like to expand on in this area?

SPEAKER_01 11:02

I think expedition medicine doesn't really fit within any particular specialty. And I think for all of us, we all come from different backgrounds and different specialty training, but we all have to do additional courses and postgraduate education in order to do expedition medicine. And so I think don't be put off. I think there's this view that maybe people come from kind of emergency medicine or general practice backgrounds, but certainly any doctor can pursue a career in expedition medicine. It's just that additional training and CPT that you do outside of what you're normally comfortable with.

SPEAKER_02 11:33

Thank you very much, Naomi. I also wanted to ask the question about how expedition medicine has changed over time. When some people hear expedition medicine, it conjures up the image of safari helmets. And I just wanted to ask about where the field is now as compared to where it was in the past.

SPEAKER_01 11:56

Yeah, so I think that's a really interesting question. And I think, you know, in times gone by, it was very much exploratory, and it was about kind of rich people coming into areas where maybe there were poverty, and often there would be some element of trying to then help the local population. But I think we have now a much better understanding of the ethics surrounding expedition medicine in terms of being much more respectful to those local communities, respecting their religion and their norms. And also this change in that we would often be happy as a good Samaritan to provide emergency medical cover to the local population. But often we're not there to try and provide care for chronic conditions. And it's about empowering those people to seek help in their local healthcare systems and linking in with those local healthcare systems to be able to facilitate that for when we leave that country. And so our primary role is really the expedition team members that we're traveling out with. I think that's been a different focus potentially from expeditions time's gone by.

SPEAKER_02 12:59

Thanks very much, Naomi. I think this ethical aspect, I would say, of travel in general is, I guess, something that we are increasingly conscious of. Absolutely. I know that you worked quite a bit with TV and media, and I would be really interested to hear a bit more about that.

SPEAKER_01 13:18

Yeah, so that's yes, a very different type of work in the expedition environment. And so media and TV work can come in all shapes and sizes, from more documentary-based work to quite large-scale reality TV and production companies. And so your role will be providing care to everyone involved in that kind of expedition TV set, from your producers to your cameramen to maybe the local porters that are helping move equipment to if you're doing reality TV, possibly kind of contestants or celebrities that are, you know, on the other side of the camera performing. And so I've had opportunity to experience quite a lot of these different types of media work. And I think some of it was probably some of the more challenging expedition work I've done. Because I think you have not only the kind of medical aspects to consider, but also it's the media side as well, in terms of what looks good for production and being able to empower those people to do their roles and do their job. Because often these production companies have a lot of money invested in these projects. And so you want to try and make them as successful as possible and support them in doing that. So yeah, I think it's not as glamorous as it's made out to be necessarily the TV work, though. It's definitely some of the kind of harder work that I've done, the most challenging and most demanding.

SPEAKER_02 14:31

Yeah, I can imagine what looks good on TV isn't necessarily always safe, really interesting. Can you share any details of the type of media work you were involved in? Don't know how many details you can give.

SPEAKER_01 14:44

Yes, it's not a top secret. Yeah, so some of the work has been involved in creating documentaries up in Greenland. So that was filmed for a four-part series for BBC Scotland. And that was looking at a kind of expedition team that were out there kind of with ski and Polk travelling in the mountains within Greenland. And then from that through to working on quite a large set for a reality TV programme that was being filmed out in Fiji for the Australian Survivor, which had a cast and crew of over 300 people. So that was very time consuming in terms of the medical provision that I had to deliver. So you've got kind of two extreme ends of the spectrum to give you an example of the type of work that you could be doing.

SPEAKER_02 15:26

Yeah, that's brilliant. And how do you find work as an expedition medic? Because I imagine it's a very sort of offer-based system. Or how do you find work as an expedition medic?

SPEAKER_01 15:42

So a little bit of it is sometimes networking and being in the right place at the right time. Some, particularly the TV work is often very short notice. So you have to be very available at short notice for potentially a prolonged period of time. So that's quite difficult to fit in potentially with other NHS work or training contracts. Sometimes there's opportunities that are shared on websites like Adventure Medic, where people will be looking for expedition medics to go on their expeditions. So that would be another good place to look. And it's really important to also just with friends and colleagues that do expedition medicine, a lot of it is kind of word of mouth and finding out about good companies or organizations to work for and then approaching them and seeing what opportunities they have and what trips are available. Yes.

SPEAKER_02 16:24

And then a question I have is how did your work as an expedition medic in these challenging environments impact your training and your NHS work in a sense of bringing back those skills from these environments and how you apply them to the NHS setting and the hospital setting?

SPEAKER_01 16:50

So I think there's a lot of these opportunities that have given me the ability to develop skills that I wouldn't have otherwise normally done within my NHS work. I think particularly looking at things like leadership, but also being a lot more kind of dynamic with my decision making, being quite adaptable, maybe when my favorite piece of equipment isn't available in the hospital. I can use something else. I've been in situations within expedition medicine where you've obviously got very limited equipment and resources, and therefore you're more resilient and adaptable in terms of working with what you do have available to you within the NHS. And I think there's lots of the non-technical skills just in terms of communication, situational awareness that for me I've really developed through my expedition experience and then brought them back into my NHS work. And particularly I'm at the end of my training and just about to finish. And a lot of these qualities are things that health boards are looking for in consultants when you're coming to consultant interview. So a lot of these experiences I've been reflecting upon and speaking about at interview. And I think that gives you something different than maybe other people that have just worked within the NHS system maybe haven't had those opportunities to develop in these different areas.

SPEAKER_02 17:59

Brilliant. Thank you very much, Naomi. And potentially leading on from that, when you work for an expedition, do you usually get paid?

SPEAKER_01 18:09

That's a really good question. And actually, historically, expedition medics haven't always been paid, but there's been a real push in the last kind of 10 years to make companies aware of the benefits and why they should be paying expedition medics. It's maybe 20 years ago, people would go for a bit of a free trip. But ultimately you have responsibilities and that should be recognised, and also all the additional training people are doing within expedition medicine. And so now more and more is a push to pay medics, and along with covering costs, so for covering things like the additional indemnity that might be needed. And so it's having those kind of discussions with the companies that you might be working for to find out what the arrangements are before you commit and sign yourself up for any of the trips.

SPEAKER_02 18:53

That makes sense. And obviously, an additional skill that maybe a lot of medics don't have in terms of negotiating salaries and working conditions in that way. Thank you very much, Naomi. So for people listening to this episode who love the outdoors, who love travelling, who love the mountains or the jungle or the desert and want to make this part of their medical career. What would be your top tips for someone listening to this who is interested in expedition and wilderness medicine but who isn't sure where to start?

SPEAKER_01 19:30

So I think first and foremost, you need to be comfortable with that expedition environment that you're going into. So whether that be the mountains, the jungle, the desert, it's spending time in those environments to become comfortable. And only when you're comfortable in those environments can you provide good expedition medicine because you don't want to be cognitively overloaded just being in that environment. You need to have the right headspace to be able to do medicine in the first place. And so my biggest top tip is for people to go and travel to those places that you're hoping to go and work in to get good at whatever activity that you're going to do. And actually sometimes developing other qualifications, whether that be doing the Mountain Leader Award or similar qualifications in kayaking or skiing, it means that you're a really valuable member of that expedition team, not only as a doctor, but you can also form part of that leadership team as well. And so just going off and doing those things and having your own experiences before you think about working in the expedition medicine setting. And then just bolting on those medicine competencies on top of those expedition skills. And I think the Faculty of Prehostal Care have brought out some really nice guidance which highlights some of the kind of key skills that are required for expedition medics. And I think it's really useful to have a little look at that, see where your ability and skill and competence currently is, and use that as something to inspire you to look at other ways that you can develop and maybe look at some of your weaknesses and how you can strengthen your ability and experience in those areas.

SPEAKER_02 20:59

Fantastic. Thank you very much for speaking to us today.

SPEAKER_01 21:04

Thank you very much for inviting me to join you for the podcast.