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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.
With an increase in visits to remote and dangerous locations around the world, the number of serious and fatal injuries and illnesses associated with these expeditions has markedly increased. Medical personnel working in or near such locations are not always explicitly trained in the management of unique environmental injuries, such as high-altitude sickness, the bends, lightning strikes, frostbite, acute dehydration, venomous stings and bites, and tropical diseases. Many health care professionals seek training in the specialty of wilderness medicine to cope with the health risks faced when far removed from professional care resources, and the American College of Emergency Medicine has recently mandated that a minimum level of proficiency needs to be exhibited by all ER physicians in this discipline. This book covers everything a prospective field physician or medical consultant needs to prepare for when beginning an expedition and explains how to treat a variety of conditions in a concise, clinically oriented format.
A consensus panel of Emergency Physicians with experience in international health has published a recommended curriculum for a formal fellowship in International Emergency Medicine. This article reviews the current International Emergency Medicine (IEM) fellowships available to residency-trained Emergency Physicians in the United States.
Every allopathic Emergency Medicine (EM) residency program in the United States was contacted via e-mail or telephone. Programs that reported having an IEM fellowship were asked detailed information about their program, including: (1) the number of years the program has been offered; (2) the duration of the program; (3) the number of fellows taken each year; (4) the number of fellowship graduates from each program and their current practice patterns; (5) how the fellowship is funded; and (6) whether a Masters Degree in Public Health (MPH) is offered.
All 127 allopathic EM residency programs responded. Eight (6.8%) of these programs offered IEM fellowships. Of a total of 29 graduates identified, 23 (79.3%) were employed in academic medicine. All of the fellowships offered formal public health training and were funded by a combination of clinical billing and project-specific grants and scholarships. All IEM fellowships described a curriculum that reflected the previously published recommendations.
Opportunities in formal training in international health are increasing for graduates of EM residencies in the United States. The proposed curriculum for IEM fellowships seems to have been implemented and graduates of IEM fellowships seem to be applying their training in international projects.
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