BASMU 2
Revised nov 2014

MEDICAL ASPECTS OF DEPLOYMENTS 
TO POLAR REGIONS

				

                    BRITISH ANTARCTIC SURVEY
MEDICAL UNIT
Purpose

This is intended as a brief guide for anyone who wishes to work for or in association with the British Antarctic Survey (BAS) on deployment, including those who are from other organisations. It introduces some of the medical aspects of Antarctic / Arctic life.  It is not intended as a fully comprehensive guide. BASMU staff are always happy to answer specific questions from individuals relating to any health matters.  
Please read the guide carefully before completing the Medical Examination forms. Your understanding of the philosophy of the BASMU approach to medical matters will help you to supply the necessary information so that your medical fitness can be realistically and fairly assessed.

Contents.							Page
								
1. The BAS Medical Unit.					   3
2. Medical Facilities on deployment.				   3
3. Medical Requirements for Polar Service.			   4
4. The BASMU Medical		.			   6
5. Blood Donation.						   6
6. Confidentiality and your Medical Records.			   6
7. Deployment lifestyle and your health.				   7

Please Note:

If you need to take regular medication for an ongoing medical condition, you must ensure you take sufficient supplies to cover your period of deployment . BASMU should be contacted if this becomes problematic.

To cover your journey  and  the initial period after arrival, ensure you take a small personal supply of sun skin and lip cream (minimum SPF 30). It is also worthwhile taking a small supply of cold / flu relief medications and some sea / air travel sickness tablets.

It is your responsibility to ENSURE THAT YOUR TEETH ARE IN GOOD CONDITION and that your dental health has been checked out by your own dentist before being deployed. Dental issues are one of the commonest causes for medivac from deployment.

Some medical problems may not be obvious to a medical practitioner unless it has been mentioned by the patient. This is particular true of conditions which are recurrent (eg dislocated shoulder) or episodic (eg depression or asthma) where you may be completely well at the time of examination. It is very important that you volunteer such information both on BASMU forms and to the examining doctor,  without reservation. In this way the professionals involved can make reasoned judgements,  so that you and your colleagues are not put in a situation where the issue becomes a problem.  Things which are only a minor irritation in UK can have significant impacts on deployment, particularly in the field, or overwinter.

The British Antarctic Survey Medical Unit (BASMU)

The British Antarctic Survey recognises that the health and welfare of its employees and visitors are vital to the success of operations in the UK, in transit and in the Polar Regions. 

The British Antarctic Survey Medical Unit (BASMU) is based in Plymouth Hospitals NHS Trust.  Permanent staff includes Emergency Medicine Consultants with a special interest in  remote medicine, experienced nursing sisters, and a manager with extensive Antarctic experience.  There are experts, throughout the specialities in the trust, ready to give advice and support. We work in partnership with the Diving Diseases Research Centre (adjacent to the hospital), South Western Ambulance Service, and the Peninsula Medical and Dental School ensures that all aspects of healthcare expertise are immediately available.

At the BAS conference in Cambridge prior to deployment you will have the chance to meet some of the BASMU personnel who will be happy to tell you more about the Medical Unit. Many of you will also participate in a specialised first aid course, designed by BASMU to meet your needs in the field, on ship or on our Bases. First Aid training continues during deployment for everyone, and a few BAS personnel will extend their skills at a course run in Plymouth to provide advanced first aid, either to assist our doctors, or for deep field ops.

We provide a doctor at Rothera, Halley and South Georgia, and on the ships whilst south. They have undergone special training to enable them to provide healthcare in difficult situations. Within the Emergency Department of Derriford Hospital, the Trust’s main centre, are highly trained and motivated doctors who provide 24 hour emergency support for our doctors in Antarctica.  

BASMU provides a medical screening service to BAS, and deals with issues that arise during deployment. Your routine medical care is provided by your normal doctor, not BAS .

It is essential that you remain registered with a General Practitioner (GP) in the UK (or your country of origin if not UK). Any medical treatment or follow up on return from deployment, needs to be through your GP, in your normal residential area.

BASMU does not provide private health care for BAS personnel in the UK . In the course of screening we may come across incidental conditions, or conditions that require treatment to facilitate deployment. These will be arranged through your GP.

Medical Facilities in Antarctica.

The medical provision whilst on deployment is extremely limited, and cannot deliver the standard and extent of services that people expect in the western world.
At Rothera , Halley and South Georgia, and on the Ships when they are South, we provide a BASMU medical officer. These doctors are trained over a 6 months period to provide remote healthcare. They have the back up of the senior medical staff in Plymouth, which is supported by the specialists with Plymouth Hospitals NHS trust. At each base and on ship there is a limited supply of medicines and medical kit for single handed medical practice, tailored to conditions that we expect to see in a screened remote working population.

Medical facilities in the Arctic
Such facilities are few and far between among Arctic location field work sites. Limited first aid provision is supplied at Ny-Alesund on Svalbard with a small hospital facility at Longyearbyen. Arctic research vessels have similar limited capabilities.

Medical Requirements for Polar Service.

BAS is naturally a risk averse institution. It has a duty to provide a safe environment for the science programme to be delivered, whilst looking after the welfare of employees, in a cost effective way.

Therefore at BASMU it is our job to identify possible medical risk, to attempt to mitigate the risk, and to prevent the potential risk to BAS, who make the judgment as to whether that level of risk is acceptable or not.

The majority of medicals are passed without further comment. In a relatively small number of cases we may contact the individual for more information, or advise that they contact their GP for treatment or intervention.
In the very rare case where we believe that a medical matter precludes polar service, the decision will not be taken lightly.

Why is the medical so rigorous?
The impact of medical events in the polar regions are significant.
•	The individual may suffer, as there is a lone doctor, and limited medical resource.
•	Medivac may be impossible due to weather, remoteness or winter.
•	Some roles are directly responsible for others safety.
•	An individual becoming unwell may indirectly put the safety of others at risk.
•	Medivacs often interrupt or cancel planned normal activity.
•	This may lead to whole programmes being cancelled.
•	Changing travel logistics normally incurs huge costs.

Whilst we will attempt all best efforts to affect rescue, at times, medivac is impossible and we have to consider the safety of the rescuer. For this reason we do not do medivac in the winter

There is a perception that as the weather in the summer at places such as Rothera can at times resemble a mild winter in Scotland, that we should not be so rigorous. However it is the remoteness to secondary medical help, and the journey involved to get there that influences our medical decision making.

You should already have seen a guide as to which conditions may cause a problem (sent with your initial medical form).  In case you have forgotten, the information is repeated below. None of these is inevitably going to preclude service, and individuals are welcome to discuss problems with BASMU doctors at any time. A brief discussion prior to your application for a post may be of mutual benefit if such an issue arises. 

A guide to conditions that may cause concern

Conditions that will usually preclude service	Conditions which may preclude service.

Cardiac (Heart)  and circulation problems
Angina & Heart Attacks. *					
Leaky Heart valves & Rheumatic Fever			Previous Heart Surgery*
Uncontrolled High Blood Pressure				
Heart Rhythm Abnormalities	                                	Treated abnormal rhythms*.
Heart Failure						Severe varicose veins
Arterial Disease						Previous Frostbite*
							Severe Reynaud’s disease*
							Previous leg thrombosis*.
							Previous clot on the lung*.
Respiratory (chest) problems
Recurrent “burst” lung (pneumothorax)*			Single episode of pneumothorax*
							History of  moderate or severe Asthma*
Cold induced asthma*					
Chronic Bronchitis or emphysema*
Active Tuberculosis

Gastrointestinal problems	
Active stomach / duodenal  ulcer				History of these ulcers*
Liver Disease						
Pancreatitis 						Previous exploratory abdominal surgery*
Hernia* Untreated)					Severe piles*
Recurrent (inflammatory) bowel disease*

Genito- urinary problems
Recurrent Kidney Stones					Renal colic*
Kidney failure						Recurrent kidney infections*

						 
Neurological Conditions
Epilepsy or fits (on treatment)				Previous fits clear for > 3 years*
Brain Haemorrhage in past*	(non traumatic)		Previous brain surgery*
Unexplained episodes of loss of consciousness		Severe  ME*
					
Degenerative N.M. conditions							
Significant Neuro Deficit secondary							
to Trauma						
Metabolic Conditions
Most diabetes						Mild type II diabetes if well  
							controlled (exceptional)*
							Other “endocrine disorder”*
Cushing’s Disease					Thyroid disease
Addison’s Disease
Obesity (severe)* BMI >35

Musculoskeletal conditions **
Untreated Slipped disc*					Recurrent back pain*	
Lower Limb Amputation*					Severe knee problems*
Recurrent dislocations *(untreated)				Unstable joint*
Rheumatoid Arthritis*					Frequent Gout*
Ankylosing Spondylitis*					
Cancer and Haematological Disorders
Most cancers	Treated cancer with low risk of  recurrence*
Clotting or bleeding disorders
Warfarin Medication					Treated leukaemia*
Bone marrow disease					Treated Hodgkin’s disease*

Gynaecological conditions
Current Pregnancy					Pelvic inflammatory Disease*
							Ovarian disease.*

Dermatological conditions
Blistering Skin diseases					
Severe psoriasis*

Mental Health Problems
Current psychiatric Illness					Depression
Previous severe mental illness				Self harm
Schizophrenia						Previous drug / alcohol problems*
Manic depression
Personality Disorder
Current Drug or alcohol abuse

*  The decision will depend on many different factors and will be made on an individual basis.  With all of these conditions it is much more likely that you would be able to go to the Antarctic for a short summer trip than to overwinter.
** These conditions will be assessed in relation to the capacity to undertake activity/work in the anticipated environment.   

The BASMU Medical
The BASMU medical has two parts. The BASMU 3 is a detailed questionnaire for you to fill in. The BASMU 4 is for an examining doctor to complete. This may be one of our doctors in Cambridge, or a doctor local to yourself depending on circumstances. The medical is rigorous, as we want to try and mitigate as many preventable medical risks as possible. This only rarely precludes deployment, but more usually we find a way to facilitate your deployment.
ALL medical papers are reviewed by senior medical staff at BASMU, and the level of fitness is decided on an individual basis, considering amongst other factors, the geography, role and length of deployment. Clearly the level of fitness for a short base bound deployment will be different to that expected for a deep field party or over wintering contract.

Blood Donation.
We cannot provide a blood bank transfusion service for bases or ships. We depend on BAS personnel being prepared to donate blood for a colleague in an emergency situation. This is a very rare occurrence, and would be under the direction of senior medical officers in the UK.
If you are over wintering, then you will be approached to have your blood screened, to provide a “blood donor pool” for the wintering team, and the summer only staff. This is explained more fully in the blood donor policy, and at the predeployment first aid conference.
Occasionally we may ask individual summer only staff to undertake blood donor testing to maintain a viable blood donor pool.

Tuberculosis
Tuberculosis (TB) is a very serious disease which has the potential to spread in a closed community. We are attempting to keep the ships bases free of TB , please ensure that disclosure is full with regard to any contact with active TB.

Confidentiality and Your Medical Records.
All information about you and your health held by BASMU is confidential (as you would expect with any health records).  Because of the nature of Polar service, it is sometimes necessary to involve non-medical senior staff in BAS in the care and evacuation of personnel.  This is only done when logistics demand it for the safety of you or your colleagues.  Information is then passed to a very limited number of people in the BAS Directorate, HR or Operations departments on a strictly “need to know” basis, to assist with planning.  All the individuals who may be involved sign an undertaking to respect the confidentiality of such medical information.  
A comprehensive policy on medical confidentiality has been agreed and is available on request.
Medical communications between BASMU and BAS (Cambridge), Polar Station and ships (all secure locations) is by means of telephone, email and Fax. Sensitive messages are encrypted.

All medical information is subject to various laws in respect of your rights of access to your personal details. 
You have the right under the Access to Medical Reports Act 1988 to see any report supplied by your General Practitioner to BASMU, before it is despatched.  The doctor will let you know it is ready and you then have 21 days in which to arrange with the doctor to see the report.   The consent form for release of this information is part of Form BASMU 3. You can refuse to give permission for BASMU to approach your doctor, but we hope you will not feel the need to do so.   You are asked to indicate on this form whether you wish to see the report.
You also have the right to see all medical records held by BASMU relating to your healthcare since 1991.  BASMU office can supply the necessary application forms. A statutory charge of £10 is made for copies of this information, which must be supplied to you within a set period.  
Your doctor can request copies of all (or relevant parts) of your BASMU medical record. This will be forwarded to your doctor directly by either fax or mail as appropriate.

Deployment , Lifestyle and Your Health.
 
Living in the Polar arena whether over winter or for a shorter time can be physically and psychologically demanding.   As well as the obvious problems of cold, dangerous terrain and physical isolation, there are some other problems of which you need to be aware. 

Physical Fitness
 Working in the cold or at altitude increases this need. Be sure you are fit enough to cope. Even if your job does not involve particular physical exertion, life on the base is active, and both on base and ship you may be expected to help out with general base duties, or to disembark by rope ladder etc etc

Food 
 BAS’ food is of generous quantity and generally very good quality. The diet is as well balanced as is possible although the choice of what you eat is of course your own.  It is important to eat a balanced diet, to perhaps exercise some restraint if your weight is increasing, and to take the vitamin supplements that are freely supplied. Serious obesity will  preclude deployment under BAS. To monitor weight we use a measurement called the Body Mass Index (BMI). A BMI of greater than 30 is considered to be too high. BMI is however only part of the equation, and we will also measure your waist to hip ratio, to detect the more dangerous “abdominal obesity”. 

Alcohol 
Alcohol is available to buy on ships and bases, and its value in social interaction is recognised. You need however also to be aware of the very real dangers of excessive drinking on deployment. 
You must be able to muster at all times, when on base, or ship. If you are too drunk to muster, then you may pose threat to yourself, or to potential rescuers.
•	 Getting drunk poses risks to yourself and others.
•	 Alcohol causes vomiting and increases the risk of asphyxiation from inhaled vomit.  
•	Alcohol increases the risk of injury and hypothermia. 
•	Alcohol may lead to disruptive behaviour that is unacceptable in a small closed community. 
•	Alcohol causes careless behaviour, which may risk the safety of the whole community. 
•	Excess alcohol is linked with several major medical illnesses. 

 BAS requires that you adopt a sensible approach to drinking, keeping within safe limits, avoiding binge drinking, as guided by the BAS Policy on Drugs and Alcohol.  The responsibility is yours and sometimes may require considerable self discipline.

Smoking 
Areas to safely smoke are very limited. This is largely due to the nature of the base construction, or being on a working ship, which coupled with the very dry Polar atmosphere leads to fire risk. However, as everyone is aware, smoking is bad for your health and the most important lifestyle decision you can ever make is to stop (or never to start) smoking.  

Isolation especially in winter means very close contact in a small space with your companions. The environment is unique, and can be stressful.  Please try to adopt a mature approach to relationships.  When others get to you try to talk it through without rancour.  The BASMU doctor or Base Commander can sometimes help when there is a problem in relationships within the group. 

Pregnancy 
We have a policy that means that we prevent people going south who are pregnant, and remove anyone who falls pregnant from our bases or ships. This is due to the medical risk of early pregnancy ( ectopic pregnancy, bleeding, increased susceptibility to seasickness etc) and the potential complications of late pregnancy. We also consider the emotional impact on the individual of adverse outcomes of pregnancy whilst deployed, and on their ability to do their job. Therefore we strongly advise to avoid actively trying to get pregnant before deployments, and take all precautions to avoid pregnancy both during and prior to deployment.

In every respect, in a small community such as the one you will be in, each individual can contribute much both constructively and destructively within the group.  Be prepared to take responsibility for your health and your actions at all times. Try to make a positive effort to enhance the well being of the whole community.

Lifestyle issues will be addressed more fully in briefing conferences prior to departure and the BASMU team will try to give individual guidance on any lifestyle problems you may identify.

 And Finally………….
Good Health, Good Luck and enjoy your time with BAS.  Moderation in all things is a good motto!

We hope this guide has been helpful.  If you have any queries, suggestions or comments feel free to contact  + 44 (0) 1752 315220 and talk to someone in BASMU.