RMI CONNECT™ and Nobody’s River

Remote Medical International is a proud sponsor of Nobody’s River (NBR), an all-women expedition on one of the world’s greatest and least known free-flowing rivers, the Amur. Last December, NBR Co-Founder and RMI Instructor Amber Valenti, PA-C, asked us to provide telemedicine, medical equipment, and supplies for the journey. Prior to their May 31 departure date, we activated NBR’s RMI CONNECT membership and created and delivered a customized medical kit. NBR has now been on the river for forty-two days, documenting the Amur through images and scientific data. Thankfully, they have yet to contact RMI CONNECT for medical consultation, but our Medical Coordination Specialists have been tracking NBR’s journey from the Global Coordination Center in preparation for a potential call. 

The team is traveling from the headwaters and the birthplace of Genghis Khan all the way to the Pacific Ocean Delta via horses, packrafts, kayaks, ferries, and trans-siberian trains. Before leaving the country, Amber compiled a list of planning and packing advice for international trips. Here is what she had to say:

Whether you are preparing for a three month international expedition or an overnight trip into the backcountry, planning for unexpected injuries and illness can be daunting. You cannot plan for everything, and you certainly cannot take everything with you. Instead, you must find that fickle balance between preparedness and the inherent limitations of any remote setting. As a remote site physician assistant, I know I will never have everything I need or want in a remote setting. But I have learned through trial and error, as well as the wisdom of others, how to plan more accurately for my trips and avoid common pitfalls. Here are some critical things to consider when planning for international trips and creating effective remote site medical kits:

5 Things to Think About Before Leaving the Country

1)  Medical Contingency Plans

• Communications Assets: satellite phones, cell phones, radios, internet, tin can and string, etc.
• Transportation Assets: Local ground and air options for evacuation
• Evacuation Routes: maps, Google earth, etc.
• Evacuation Assets: people, equipment, training, etc.
• Necessary Contact Information: medical director, telemedicine provider, nearby medical facilities, travel insurance company
• Definitive Care: options for nearest reliable hospital for various types of injuries and illnesses

2)  Risk Assessment

• The things that many travelers fear most (shark attacks, massive weather events, tropical diseases, etc.) rarely kill or injure travelers. Heart attacks, motor vehicle accidents, and all of the things that harm people the most during every day life are also the most common causes of death and injury abroad.
• Gastrointestinal problems like diarrheal illness, respiratory problems such as the common cold, and skin disorders account for more than 3/4 of complaints abroad. So, plan accordingly.
• Do a risk assessment for every single trip even if it is just a mental one. Consider environmental, political, and health risks each time. These three categories will remind you to cover all your bases.
• The CDC yellow book is an awesome resource for tropical and travel illness research, and it can be found for free online.

3)  Immunizations

• Before considering location-specific immunizations, first make sure you are up to date on your routine immunizations. These include polio, tetanus, diphtheria, and pertussis, hepatitis A & B, and MMR.
• Consider typhoid in any country with higher risk of diarrheal illness (basically anything other than the developed world).
• Consider specific immunizations for your location and activities. Ex: meningitis, yellow fever, Japanese encephalitis, rabies, cholera (not available in the US), and tick borne encephalitis (also not available in the US).

4)  Travel Insurance

• When dealing with a death or serious illness, the last thing you want is a financial burden. International medical evacuations can cost upwards of $300,000. Travel insurance is affordable and worth every penny. I will not travel without it.

5)  Paperwork

• Bring a copy of the following documents: medical licenses and training certifications, travel insurance certificate, paperwork for any medications you are carrying, basic health information for all travelers, liability and “permission to treat” forms for any professional trips, and paper or forms to document any care you provide. I typically keep a notebook in my first aid kit unless I am working with an organization that has their own forms. You can always document officially afterwards.

7 Tips For Effective Remote Site Medical Kits

1)  Know how to use everything in your kit

• If you or someone on your team cannot use it proficiently, it is a waste of space and a liability to yourself and others.

2)  Customize your kit

• Adjust supplies according to every activity, every group, and every mission.
• Consider ages of participants, health conditions, and risk factors
• Consider potential environmental exposures and common injuries for your location/activity

3)  Balance common things with rare but serious injuries and illnesses

• It’s tempting to bring a worst case scenario kit with tons of extra equipment, but always remember, that ibuprofen, bandaids, and Imodium are equally crucial.

4)  All equipment should be irreplaceable or have multiple uses

• Example 1: Gloves can be used for BSI, CPR protection, and occlusive dressings.
• Example 2: OB tampons with no applicator can be used for both menstruation and epistaxis.

5)  Carry simple drugs with minimal adverse drug effects (ADEs) and few contraindications

• The more versatile the drug the better.
• Medications that have high risks of adverse effects are not ideal because it is difficult to deal with these side effects in the remote setting.
• There is no replacement for carrying an Epi-pen and some Benadryl. Allergic reactions are common, and these supplies can save a life.

6)  If you can improvise, you can minimize

• A t-shirt cut in a spiral works great as a replacement for an ace wrap, and with a little training you can splint with just about anything. If space is at a premium, trim out things you can replace through improvisation.

7)  Replace supplies every time you use them

• There is nothing worse than missing critical supplies because you forgot to restock.