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As long as there have been expeditions, there has been expedition medicine. Whether it was Dr. David Livingstone treating his exploration party with quinine as they traveled up the Zambezi, Meriwether Lewis receiving medical training from Dr. Benjamin Rush, James McIlroy amputating frostbitten toes during Ernest Shackleton's Imperial Trans-Antarctic Expedition, or Dr. Jose Antonio Cajazeira treating Theodore Roosevelt on their Brazilian River of Doubt journey, expeditions and medicine have demonstrated a natural tendency to intersect.
In spite of this long and colorful history of medicine on expeditions, defining “expedition medicine” is no easy task. A medical professional providing medical care on an expedition might need to be a high-altitude expert one day and a tropical medicine expert the next. Exposure to envenomations, animal attacks, parasitic disease, and environmental extremes all may occur while traveling through remote areas on expeditions. It is this diversity of practice, and this intersection of medicine and nature, that initially draws many individuals to expedition medicine, and yet, when attempting to assimilate these varied topics into a single functional text, it is just this diversity that creates difficulty.
The editorial team has selected topics for this text that represent both the depth and the breadth of this expansive medical discipline. We recognize that even as individuals are drawn to different geographic environments, readers will use this text for different purposes.
Becoming ill far from home is a risk shared by all participants in expeditions. Even though it is impossible to completely eliminate the occurrence of illness, the risk can be reduced through a combination of behavior modification, immunization against vaccine-preventable diseases, and pharmacologic disease prophylaxis. Immunizations are a safe, reliable, and cost-effective component of this three-part approach. With proper preexpedition evaluation and planning, appropriate immunization is often easier and more reliable than behavior modification or pharmacologic disease prophylaxis. Immunizations fall into three categories: routine, required, and recommended.
Routine immunizations are those administered in childhood and/or at regular intervals during adulthood. Measles vaccine and tetanus vaccine are common examples. There is some variation in routine immunizations among countries: as an example, while Bacille Calmette- Guerin (BCG) may be included in the routine immunization schedule in certain areas of the world, it is not in the United States. Similarly, varicella immunization has become part of the routine immunization schedule in the United States but not in other areas of the world. Routine immunizations are listed in Table 4.1.
Required immunizations are those that are necessary for entry into certain countries. Yellow fever vaccine is required for entry into many countries. Meningococcal vaccine is required for entry into Saudi Arabia during the annual Hajj and Umrah pilgrimages. Prior to any expedition, it is important to check updated information about required immunizations for the country or countries of the expedition and those entered in transit.
Historically, participation in expeditions was limited to explorers, scientists, the very wealthy, and the occasional free thinker or lost soul brought along for logistical support. During the past several decades, there has been a dramatic shift in this demographic with participation no longer the purview of a privileged few. Today, individuals of all ages, from a wide variety of cultural, professional, and socioeconomic backgrounds regularly participate in expeditions and “expedition-type” activities. Several factors have contributed to this change. Development and advances in equipment have increased participation in such activities as backcountry skiing and snowboarding, flat and whitewater kayaking and rafting, mountain biking, mountaineering, orienteering, rock climbing, scuba diving, and trekking. In addition, safe, efficient and affordable travel has extended participation in these activities to the far reaches of the globe. Combined with economic prosperity, these factors have helped fuel the multibillion dollar adventure travel industry providing easy access to expedition and expedition-type activities for a large number of individuals.
During the past several decades, there has also been growth in the popularity of endurance events including marathons, triathlons, multiday bicycle rides, ultramarathons, and ultra-triathlons. Increased participation in these activities has resulted in a larger number of events being held each year with greater diversity in the type of events held.
More recently, the growing popularity of adventure travel, endurance events, and expedition-type activities has given rise to “expedition-type events” that combine aspects of all of these. Adventure racing or multisporting is perhaps the most popular and fastest growing example.
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