Review Oxford Handbook of Expedition and Wilderness Medicine

Thrud

Richard Proenneke
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Review Oxford handbook of Expedition and Wilderness Medicine 2ndEd


This book weighs exactly 440g and has a nice plastic cover which means you will be able to wipe the blood off easily.

It is a pocket sized book and is billed as “Indispensable guide for all travellers to wild and remote places” That would certainly cover a trip to visit Bloffy in Albany.

The print is small and if you lost your reading glasses it wouldn’t be much good to you apart from a tinder source.

There are just over 800 pages and about 25 colour illustrations, it cost $65.

Written by experienced doctors, the chapters cover the following:

Expedition Medicine 15 pages of general data including the relative risk of dying (Everest 1:7 to 1:83, after surgery 1:250, Himalayan trekking 1:7000 and jogging 1:7700 (another excuse for me not to jog))

66 pages on Preparations. This includes everything from medical kits to insurance, immunizations, pre-existing conditions and is fairly comprehensive. The section on essential expedition medical skills is sensible

30 pages on caring for people in the field, including kitchen hygiene, latrines, drug admin, diet and a section on organising a healthy base camp. A lot of useful information for us bushcampers.

Obligatory chapter on Ethics and responsibilities including assessing your environmental footprint.

Chapter 5 is on Crisis management, emergency response plans, moving patients, missing people and death (probably only after eating some of Doc’s cooking)

Chapter 6 is tiny but very useful it includes history and examination for non-clinicians, clinical measurement and illness assessment forms.

Chapter 7 is getting into the meat of trauma along the lines of Airways breathing circulation, but also has bits on blast(sadly possible these days) and lightning(should have read that one….)

Chapter 8 really deals with non-traumatic emergencies; convulsions, chest pain, choking, hypothermia and is well illustrated and sensible.

Chapter 9 is skin; containing pieces on wounds/lacerations. (I know all that stuff!!!), burns , insect bites and some general stuff, which might save you a trip to a dermatologist (instant saving of $250)

Chapter 10 is head and neck, dealing with important topics such as head injury as well as eye problems, lacerations (I’m looking at you Uneekwahn), ear and nose issues

Chapter 11 is devoted to the tooth fairies and has info on pre-expedition dental care, fillings, missing crowns and other dental injuries with a diagnostic chart, which again might save you a trip to the dentist even if you’re not on an expedition!

Chapter 12 deals with chest issues; rib fractures, heart attack (when my missus finds out how much I’ve spent on knives) asthma and chest infection

Chapter 13, unlucky for some is abdo pain, well written and sensible. Including something very important; acute scrotal pain (again once the missus finds out…)

Chapter 14 is limbs and back; sprains, fractures of arms/legs pelvis. Tendon injuries, dislocations although the descriptions on how to reduce shoulder dislocations don’t have any drawings, which is an oversight; instead they use technical jargon which may limit it’s usefulness. How many of us know how to put an arm mid-prone and then externally rotate?

Chapter 15 is a big one on infectious disease. Of more use after the event, but still quite interesting with some useful links and info about tropical illness

Chapter 16 is an important chapter on psychological and psychiatric problems: including post traumatic stress disorder, psychological reactions, breaking bad news (that might help me with the missus) and a piece on surviving kidnapping

Chapter 17 is on risks from animals, this includes trauma from big things (elephants, crocs etc) a section on venomous creatures. Agin, I think there is a little too much emphasis placed on trying to identify the snake; although in fairness, they do state you should not attempt to catch or kill the snake.
Illustrated bit on bandaging suggesting 50-70mmHg pressure.
Marine animals; not much to say as the treatments are all supportive.

Chapter 18 is on plants and fungi; This is one of the odd chapters; they have a picture of an edible mushroom vs a Death cap. The implication is that it is simple. I think this is very wrong; don’t eat fungi. Period.

Chapter 19 is about anaesthesia in remote locations. There is a nice bit on local anaesthesia, which can easily be followed (assuming you had the happy juice), but most of this is specialized information. Sensibly at the beginning of the chapter it suggests you avoid anaesthesia if possible. (As a general principle I would try and avoid at all costs anyway, even if I wasn’t in the jungle….)

Chapter 20 On cold climates and injury. Worthwhile reading especially for our Eastern States chums, but hypothermia is an issue even in WA.

Chapter 21 is on high altitude medicine (anything over 2500m) so it can happen here.

Chapter 22 on inland and coastal waters; pages on environments,rescue, immersion and drowning, canoeing, white water rafting, medical problems in small craft, and kayaking

Chapter 23 Offshore has advice on medical kits and emergency stuff

Chapter 24 Underwater; decompression etc

Chapter 25 Hot, dry environments: surviving dust storm, heat illnesses, acclimatization and workload calculations. Fluid and electrolytes etc.

Chapter 26 Hot, humid environments: tropical forest: risk assessment, insects, staying healthy, navigation, campcraft, water and sanitation

Chapter 27 Caving: You have to be mad!

Chapter 28 Medical kits: This has sensible advice on personal (to my mind slightly small) and team kits, extra meds as well as extra materials for special skills


So, overall would I recommend this book? Yes, but it should be realised that reading it will not mean you should attempt to do some of the things in the book unless in extreme circumstance. It is a well thought out book and has been revised since it’s first edition. Some sections are easy to follow and others require a deeper understanding of the terms and language of medicine. For the price of a tank of petrol I think it is well priced. There are clear flow charts and diagrams which help with some of the diagnostic and management algorithmns. I won’t carry it with me, but I will reference it.
 

oncedisturbed

Les Hiddins
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Another good addition to consider is the latest addition of the SAS Survival handbook which covers very similar topics and also now includes the addition of Urban Survival and is released in standard size, pocket and app formats.
 

Aussie123

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Sounds like it has a chapter on everything !

although Ch 17 "Marine animals; not much to say as the treatments are all supportive." ... is not quite right?
I believe there are treatments for some stings including heat, vinegar and pressure immobilization - of course you need to know which are for which, but that's the point o a reference book
 

Thrud

Richard Proenneke
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Sorry Aussie, I was generalising a bit on this chapter. To be specific it covers sea snake bites; as you suggest, compression. Fish sting there is anti veneme for stonefish. Sea urchin, octopus, cone she'll, bristle worms are covered. Ingestion of toxins do have some specific treatments, but overall the treatments that can be administered in the field are really mostly supportive as you indicate to relieve symptoms and prevent progression.
 

Aussie123

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Sorry Aussie, I was generalising a bit on this chapter. To be specific it covers sea snake bites; as you suggest, compression. Fish sting there is anti veneme for stonefish. Sea urchin, octopus, cone she'll, bristle worms are covered. Ingestion of toxins do have some specific treatments, but overall the treatments that can be administered in the field are really mostly supportive as you indicate to relieve symptoms and prevent progression.
no probs. I was thinking the book didn't say much on those topics, but I was pretty sure there were treatments available for some stings.
We traveled across the North with a bottle of vinegar, a thermos of hot water, and a compression bandage ... just in case !

It sounds like a good read
Thanks for all the detail
 
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