Death in Antarctica

To the Editor: Lamberth stated in his case report that Antarctic tourist ships should be equipped to provide life support, as well as better screening and education of Antarctic tourists.1

I recently travelled to both the Arctic and Antarctic as a medical officer on small ships, caring for seven passengers injured in a helicopter crash in the remote Russian Arctic and a 12-year-old with diabetic ketoacidosis in the Drake Passage, as well as numerous people with minor ailments. To compare these ships with large tropical cruise liners is unrealistic.

Ships' medical supplies are selected with an appreciation of the casemix. A study of 16 Antarctic trips in 1997 and 1998 found that most problems were respiratory tract complaints, acute soft tissue injuries and complaints, sea sickness and dermatological problems.2

Few major incidents have been reported, and equipment for advanced life support is tailored to this. Paralysing agents and ventilators are not supplied. A single doctor with no nursing staff cannot safely care for a ventilated patient for 72 hours, as suggested by Lamberth, and the additional staff needed for this would be a huge additional expense for a very rare occurrence. While some ingenuity and adaptability may be required, the equipment supplied is adequate for the vast majority of events.

Safety and preventive medicine are very much part of the ship's doctor's role. Most doctors give a brief lecture as part of the initial briefing of passengers. Seasickness, appropriate medication and safety on the ship are usually part of this.

The passengers are predominantly elderly and, in my experience, many are fulfilling a long-held ambition to travel to the polar regions. Reputable companies require a fitness-to-travel assessment from passengers' general practitioners before the trip is confirmed. This assessment is tailored to potential problems in remote regions.

I believe that excluding people from the wonders of polar travel on the basis of age or previous coronary artery disease would be a terrible shame, while accepting that there will always be a risk in travelling to remote locations. Having shared in the 90th birthday celebration of a woman with chronic obstructive pulmonary disease in the Arctic, I hope that I will still be able to enjoy such experiences at that age.