Austere Environments – Antarctica

Transfers in austere environments are so challenging they are sometimes even impossible. Here, Dr Zdenek Bares, an intensivist with extreme environment experience, discusses his time in the Antarctic region and these difficulties. While this is one example of an extreme environment, there are analogous issues in deserts, the ocean and even in space…

Antarctica Is Massive…

• It is a continent larger than all European countries combined and bigger than Australia.

Antarctica Is Extreme…

• It is cold – not only due to its proximity to the pole, but also due to really high altitude! Some bases lie up to 4000m above sea level, which makes the stations even more difficult to access.
• Polar day during Antarctic summer and polar night during Antarctic winter.
• It is far from the other continents, the surrounding oceans are often uneasy to navigate, with unpredictable icebergs and ice cover, and there is a very sparse population. You can imagine the challenges for medical evacuations!

Antarctic Bases

• The bases are widely distributed in Antarctica. There is a geographic predilection with hotspots, where the majority of bases are.
• Nine permanent bases exist at King George Island with an airport, good telecommunication options and access by ship or plane.
• There are currently about 90 active bases, of which only 42 operate permanently all year-round. These usually differ significantly between seasons, with the Winter population being about 25% of the Summer population.

Population totals:

Winter: 1144

Summer: 4225

Medical Equipment & Staffing

• This is widely variable from rudimentary expedition equipment to well-equipped hospitals with a medical team allowing for minor surgical and dental procedures.
• Interestingly the most common minor emergencies in healthy crews in Antarctica are dental. On the year-round bases at least one doctor will be present all year round and able to perform a wide variety of emergency procedures.

Austere Environment Medical Goals

• Assistance with selecting participants in good health.
• Optimisation of any health issues prior to expedition.
• Treatment of minor emergencies in situ.
• Treatment of dental emergencies in situ (often one dentist for multiple bases, limited time spent at a base or present on vessels in proximity).
• Stabilisation of major emergencies and transfer to definitive treatment off Antarctica – often very difficult in Antarctic Winter (20 airports in Antarctica, numerous heliports).

Challenging Seasons

• Weather is much more extreme during Antarctic Winter and there are pronounced differences between areas. It is more extreme closer to the South Pole.
• The psychological impact on crews is much more pronounced during Antarctic Winter (ESA Antarctic missions).
• During the polar night it is prohibitively cold to spend time outside the base and there are fewer people in general.

Some of the bases like the Concordia, Vostok add high altitude with chronic hypobaric hypoxia on top of the isolation. Transfer of patients from permanent bases closer to the South Pole during Winter is extremely problematic and often trickier than emergency evacuation from the International Space Station!

• Problems are frequently because of the extreme cold with wind chill – often under -100 C. They also arise from hazardous weather, low visibility and a difficult approach.
• Flying is overall much more difficult due to the lack of radio approach, no light apart from moon and aurora, low contrast, short runways, cold detrimental to avionics and difficult take-offs.

There is a need for specially trained pilots and bespoke airplanes, which makes it very difficult to aid an air transfer team in case of trouble.

…This means that even with today’s technology a transfer may be just impossible or too dangerous to attempt if conditions are bad.