Assistance on the Antarctic ice

The boots on the ice

For the scientists spending time at the various spread out research stations located around Antarctica, medical facilities can be found at the stations, enabling remote healthcare.

A spokesperson at the National Science Foundation (NSF) – an independent agency of the US federal government that supports science and engineering – explained: “For

US Antarctic Program (USAP) participants, NSF provides urgent-level medical care at our stations. Away from the station the resources are even more limited. Additional support and/or evacuation may be needed for injury or illness that USAP’s onsite medical team is unable to support.”

We also spoke to a representative of the New Zealand Defence Force (NZDF), which has a longstanding commitment to supporting the Antarctica New Zealand scientific institute, as well as international scientific and environmental programmes on the ice, such as USAP. Operation Antarctica is one of the NZDF’s largest regular missions over summer.

“Our Operation Antarctica mission is a complex one that sees groups of personnel surged into Antarctica at different times during the summer season, depending on when they’re needed,” the NZDF spokesperson explained.

“An example of this would be ship offload teams which deploy to the ice to be there when cargo ships come to resupply McMurdo Station,” they added. “The operation is complex because of the many moving parts and the environment we’re working in. The biggest challenge is the environment – given the cold, and weather conditions that can change rapidly. This can affect air operations.

“Our Royal New Zealand Air Force (RNZAF) crews are highly trained to analyse the situation with regard to the weather and the airfield state in Antarctica before making the decision to proceed with a flight.”

Putting a plan in place

The International Association of Antarctica Tour Operators (IAATO) is a member organisation that advocates and promotes the practice of safe and environmentally responsible private sector travel to the Antarctic.

Lisa Kelley, IAATO’s Deputy Executive Director and Director of Operations and Government Affairs, provided an insight into procedures for member vessels. “In addition to IAATO’s vessel tracking system, our Ship Scheduler – a database which has restrictions on time, number of passengers allowed and number of daily of visits to sites around the Antarctic coast – adds another level of safety for IAATO vessels, as IAATO operators know where the rest of the fleet is and, in case of emergency, can be as self-sufficient as possible, using other members,” she said.

“Before each Antarctic travel season begins, we share our Ship Scheduler with the five Maritime Rescue Coordination Centres (MRCCs) with responsibility in Antarctica so they also know where our member vessels are in the rare event of an emergency,” Kelley continued. “If an emergency or the need for a medical evacuation by passenger vessels does occur, IAATO’s Emergency and Medical Evacuation Response Plan (EMER) provides detailed guidance and a checklist for operators. IAATO’s deep field and air operators also have a Medical Evacuation Response Plan (referred to as an Air-EMER), recognising that their air assets are widely distributed over Antarctica.”

The key to any assistance programme in Antarctica is to ensure that there is a rigorous pre-departure medical and psychological screening programme

Antarctic Logistics & Expeditions (ALE) is a leader in polar expeditions and provides logistical services supporting responsible tourism in Antarctica. Martin Rhodes, Medical Director at ALE, provided an insight into the medical issues encountered: “With approximately 600 guests and staff staying at or passing through our Union Glacier Camp (UG) over a three-month season, we have to be able to deal with exactly the same range of medical issues as in an urban setting with additional issues arising from the environment and activities. I’d say 80 per cent of the work is ordinary family medicine, 10 per cent trauma and 10 per cent environmental – e.g. frostbite or polar thigh,” Rhodes explained, adding that effective assistance relies on experience, training and effective communications.

“First and most important: highly experienced doctors use UG as a medical hub from which doctors can move to where they are needed,” he continued. “Second, all response relies on communications. We have excellent comms systems, which are improving all the time. Also crucial is training of other staff to act in support roles, which is especially true of guides, who are required to be Wilderness Field Responder certified, which is the highest lay persons certificate.”

Preparation is everything

For boots on the ground, and for the assistance companies delivering assistance, extensive preparation is crucial. Major incidents can be temporarily managed at basic medical facilities while evacuation is organised.

Preparation includes non-negotiable pre-medical evaluation and solid insurance, as Ingle underlined: “The governments that make up the Antarctic Treaty, as well as research organisations and tourist groups, require different levels of medical tests and approvals before accepting an individual to live or work in the region,” he stated. “Non-governmental organisations and individuals are required to have a high level of travel medical and evacuation insurance. Governments have emergency procedures and basic medical facilities available to manage or triage a major medical incident until the patient can be air evacuated or transferred to a facility in another country, like Chile.”

Kane highlighted the importance of pre-departure medical screening: “The key to any assistance programme in Antarctica is to ensure that there is a rigorous pre-departure medical and psychological screening programme. This ensures that clinical emergencies are prevented. The majority of research bases and vessels will have onsite medical facilities and doctors, nurses and health technicians,” he said.

Worrell agreed that the importance of preparation cannot be overstated. “The largest difference with caring for individuals in remote locations is the degree to which preparation is needed.

With a location like Antarctica, preparation is everything,” he explained. “Firstly, the itinerary of the group is essential, as is their proximity to any medical facilities in Antarctica, and how they would be transported to them in an emergency. Mapping the extraction points during the clients’ itinerary is crucial, as is knowing which modes of transport would be the most appropriate.”

Worrell continued: “Antarctica has several airports, airstrips and heliports. Some only operate in the summer and all are affected by the weather conditions at the time of the evacuation. As it is likely that many medical evacuations will require multiple modes of transportation and considerable journey times, it is best to have carefully considered this in advance of an actual emergency occurring. Pre-trip planning also allows for a team to be augmented as necessary by medical staff. This usually occurs in very remote locations like Antarctica, where local medical facilities are few and far between.

“We advise not only on the qualifications of the accompanying medical personnel – whether a nurse, paramedic or doctor – but also the equipment and medications that they’d need to bring,” he added.

The advent of telemedicine was pioneered in remote settings such as Antarctica, and this is still used widely today, especially during the over-winter period

Technological necessities

Another important element in providing adequate assistance is technological provisions. Continually evolving telemedicine is widely deployed in Antarctica, providing an invaluable link between medical personnel operating in Antarctica and specialists elsewhere.

“An important additional support in this setting is the provision of topside or reachback services,” commented Worrell. “Topside enables the in-field medic to rapidly consult with a senior physician by a variety of technologies, sanctioning treatment when needed, giving emergency advice, or offering a second opinion. As the UK’s General Medical Council stresses that clinicians must not practise in isolation, this topside support is important from several perspectives.”

Kane agreed: “The advent of telemedicine was pioneered in remote settings such as Antarctica, and this is still used widely today, especially during the over-winter period. Due to the immense isolation and psychological pressure involved in spending a winter in Antarctica, being able to access teleconsultations with psychologists and therapists is an essential part of South Pole medical care.”

Impact of Covid-19

NSF’s spokesperson reflected on the challenges presented by the Covid-19 pandemic: “In the first few years we had to drastically reduce our operations and participant populations. Due to the remote location and limited resources, we have continued to consider Covid-19 in our annual planning.”

NZDF’s spokesperson said that it was similarly impacted: “During the pandemic, deployments to Antarctica were limited to prevent the spread of the virus there. When NZDF personnel deployed in support of Antarctica NZ, they followed Antarctica NZ protocols, which included testing and a two-week quarantine period prior to deploying to the ice. NZDF Covid-19 prevention protocols that continue today include vaccination, testing and self-isolating if exposed to the virus.”

Covid-19 and cruise ships became closely associated during the height of the pandemic, and, with many cruise ships taking passengers on Antarctic adventures, what happens when a passenger becomes a patient?

Its extreme environment, infrastructure, basic medical provision, and distance from countries with definitive care, mean that international assistance will always be particularly complex

Ingle explained: “Cruise ships to Antarctica are another issue, since you have tourists with varying levels of fitness to travel – and cruise lines have a habit of disembarking ill passengers at remote destinations. This leaves the insured patient with an assistance company which must try to extract that patient to the nearest healthcare facility. And more tourists visiting a remote and dangerous location will increase the issues faced by the assistance companies, travellers and tour companies.”

Antarctica will always be visited by tourists and scientists alike, thanks to its unusual environment. It is this unique environment that makes it a breathtaking place to visit and a crucial research destination – but it’s a double-edged sword as this same environment presents significant challenges when it comes to assistance. Providing that extensive training and robust preparations are in place, these can be handled by the experts on the case.

“Although Antarctica offers some challenges also present in other remote locations, its extreme environment, infrastructure, basic medical provision, and distance from countries with definitive care, mean that international assistance will always be particularly complex,” said Worrell. “Whether visiting the continent for tourism, research or business reasons, assistance companies can effectively care for clients following thorough planning and experience.”

Ingle concluded: “The best assistance companies combine medical expertise, experience with global contacts on the ground, logistical awareness and specialists who understand complex situations and how to create a timely solution. Because time and the distance to care is always against you and the patient.”