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Anna Woodman

Exile Medics: keeping you safe in far-flung races

by Susie Chan
Sunday 21st August 2016
I have run a couple of races recently in the presence of "Exile Medics”. Firstly in Sierra Leone where hospitals are few and far between, and very poorly equipped. I was there for a marathon. 
The second time I met the Exile Medics was in the Amazon rainforest, Peru. Here the medics manned checkpoints and looked after all the runners. These checkpoints were deep in the jungle. One check point was at the top of a brutal muddy 5000ft climb. It was insanely difficult to ascend as it was so slippery and treacherous underfoot. When I finally made it to the top, I was met by the cheerful professional medics. It was only after the race I discovered the medics had had to go the same route us runners had to the checkpoint, whilst lugging their equipment, water for the runners, and tent. They manned the checkpoint for 10 hours, looking after and cheering weary ultra runners, treating feet, and in my case, making sure I didn't throw my breakfast up. Respect.
The medics travelled with us in this point to point 5 day race, and became the backbone of the race, providing much-needed comfort, banter, and of course, medical care. During the race my husband was struck down with heatstroke so severe he could have died if not attended to quickly and knowledgeably. They treated him for 9 hours, he recovered enough to cheer me over the line and vow to go back to finish the race another year.
I thought I would find out more about Exile Medics, and had a chat with the founder, Dr. Brett Rocos.
Hi Brett, tell us what Exile Medics do
Exile medics is an organisation that delivers medical care to adventure races and expeditions anywhere in the world. We have worked in some of the most challenging and difficult environments on the planet including the Arctic Circle, the desert, and the jungle. In every environment we aim to deliver a standard of care second to none to make sure the athletes and adventurers get home safely. In doing so we aim to set the standard in expedition and adventure race medical care. Our teams comprise doctors, nurses, paramedics and medical students who work together to deliver care to the highest possible standard. Integrated into our service is teaching and training, research and mentoring to make sure that the less experienced members of our team learn the knowledge and skills needed to become expedition medical professionals in their own right.
How did Exile Medics come about?
In 2009, I was a medical officer on a multistage race where the challenging nature of the environment and the event stretched the medical services to the limit. Whilst every patient was safe and well cared for I felt that adventure races would benefit from an organized and strategic approach to delivery of medical support. I also felt that Adventure races presented the opportunity to train medical professionals in the skills needed to become an expedition medic too good to miss. The following year I established Exile medics as a group with the aim of delivering this teaching and training through medical teams comprising senior doctors paramedics and nurses mentoring less experienced staff in the delivery of safe, high quality medical care. Closely intertwined with this was the development of clinical governance and patient safety, which aspects that we continue to work onto this day.

Exile Medics 2
Photo by Mikkel Beisner

How many races a year do you cover? Where are they?
Every year our calendar expands to include more races in more environments, and currently we work on 15- 20 events all over the world. The places of these races takes us are unusual by definition: Adventure racers don’t tend to race in the more accessible locales! We’ve worked in the Arctic Circle, the Namibian desert, Peruvian Amazon, Uganda, Rwanda, Sierra Leone, Brazil, America, Tanzania, Cambodia, Romania and many others. Each event brings with it its own risks and hazards, and we take a careful look at these in our preparations leading up to the event.
What sort of training do the volunteers get to be an exile medic and prepare them for their time with you?
At Exile Medics, we don’t insist on any specific level of training or experience. With Exile Medics is that most of your training is done on the job under the supervision experienced senior clinicians. We believe that there is no substitute for learning on-the- job, just as it’s done in the National Health Service. With the safeguards and support that exile medics is able to give, clinicians of every grade can gain the experience that they need to develop their abilities.That’s not to say the pre-existing courses are not useful. Whilst up until recently we haven’t offered any courses of our own, there are many available that many of our medical staff have completed. Only a willingness to learn new skills and an enthusiasm for teamwork are critical to success in Exile Medics no matter who you are or your clinical profession. 
I can imagine you've had to deal with some tricky situations.. What's the most common problem your staff had had to deal with? 
Simple. By far and away the most common problem that we encounter on any of our events is feet. We have a saying ‘you can’t win on day one but you can lose’ and is almost always boils down to foot care. Every athlete or adventurer at sometime or another during the event suffers with their feet. Blisters, ulcers, wounds, thorns in the feet: these are all reasons why we see athletes and adventurers drop out of their event. It’s really sad to see passionate and capable person fail to meet their goals through something simple as this. We develop new techniques in managing these problems there’s no substitute for preparing prior to your event. With our extensive preparations, we rarely come across any problems that I’d call critical, though of course, we’re able to deal with any that do arise, and we carry equipment to manage nearly every eventuality. We’ve admitted people to intensive care, we’ve had people staying countries after we’ve departed to have intravenous antibiotics, we’ve even have had people go for emergency surgery at a hospital nine hours drive away. The difficulty in managing critical illness is always magnified whilst on an expedition or race, and a lot of preparation goes into planning for how we going to manage these difficult problems. We have a chain of clinical support leading back to the UK, with senior doctors at home available 24 hours a day on the telephone to offer advice. A new development has been the acquisition of satellite broadband, so that we can transmit clinical photos and even short videos back home to get expert advice when it’s needed.

Exile Medics 1
Photo by Mikkel Beisner

Can you tell us about some times when your medics have had to go above and beyond?
I begin every briefing with every medical team with the phrase ‘we are not the weak link in the chain’. Being responsible for the health and well being of adventurers or athletes in some of the most hostile environments around means that we’re often the first up, the last to bed, the last people standing. This goes beyond delivering medical care, and includes the overall well-being of every participant including the race staff. You often see exiles handing out water, helping cook food, moving bags and luggage, answering questions and acting as tour guides. Every exile medic gives 110% on every trip and no job is too small. If I have to pick single incident, it would be early in our history when we had to leave one of our doctors behind in South America to make sure that three participants that needed to be admitted to hospital at the end of an event received appropriate treatment. We left him at the airport with his flip-flops and hand luggage- surprisingly this didn’t seem to phase him at all. Everyone recovered fully, but it relied on my own mum to collecting our Exile from the airport and taking him home!
Do you run yourself?
I'm always inspired by the athletes that I meet on the events that I work on. They are the most inspiring people around, and in fact its words of encouragement from athletes have kept Exile Medics developing through its early years. I don’t run myself (I like to think of myself as a cerebral athlete), but it’s not from lack of encouragement from athletes that I meet.
What would a typical trip involve?
For an individual Exile, there’s plenty of opportunity to get involved in the preparatory stages as well as delivering care on the ground during the event. Typically, we will advertise for medical professional six months prior to the start date of any event. This means that people are able to fit the event into their work schedule. Exiles are selected from the pool of applicants by a small committee, who balance the requirements of the race and the seniority of clinicians to assemble an appropriate team. Once selected, Exiles are then asked to complete some documentation, which establishes our working relationship and are obliged to pay a small administrative fee. This administrative fee is part of the legal arrangement between the individual and Exile Medics. The exile then needs to arrange professional indemnity, Visas, vaccinations, and their own personal equipment. All medical equipment is provided for them.For some events, we are able to meet the cost of flights either partially or in full. Others require individual medics to purchase their own flights to and from the location.
There is such a range of locations for events that there’s always one that is both interesting and affordable to anyone who wants to be involved in this field of medicine. Once medics arrived in the field we have a few days where we will arrange a medical kit and conduct over medical briefings including speaking to runners and participants about any relevant health risks. Occasionally we’ll become involved in visiting charity projects or delivering some training to local First Aiders, but generally our time is spent looking after the runners and race crew. It’s a busy timetable, and there’s not always a lot of time to look after ourselves which is why you often find Exiles eating, drinking and sorting themselves out at all times of the day or night, and in some odd locations!
Finally, if anyone reading this wants to join, how can they find out more and what qualifications do they need? 
Firstly, interested people should visit our website at www.exile-medics.co.uk where there are lots of articles about how to become involved, tutorials, briefings, kit lists, photos, and information about all the forthcoming events. Secondly, future exiles should look at our Facebook group at ‘exile medics network’ where we post forthcoming opportunities and have discussions about all things Exile.
Race Directors who are looking for professional, safe and high quality medical care for their event should contact Brett at brett@exile-medics.com, and we can talk through their plans and see how Exile Medics can help.

About The Author

Susie Chan

Susie Chan is an endurance runner, who runs all sorts of races from 1 mile to 100 miles and beyond. Her favourite races are multistage ultras. Find her on Twitter @susie__chan Instagram @susie_chan_ or read about her races on her blog www.susie-chan.com

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