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.

INTRODUCTION

You are making flight arrangements for that special trip: an exotic locale, an adventure tour, or a scientific expedition. The immediate excitement has been tempered by sobering thoughts of health and safety. You have searched the Internet for travel advisory information about your developing world destination. The travel agent may have been to the area but probably stayed in a nice hotel in the capital city, not in the tent or hammock you will call a temporary home. You have been advised to sign up for travel insurance. You are inundated with confusing choices about insurance, and there is very generic advice about the site – drink only bottled water, get immunization for hepatitis and meningitis, have a tetanus shot within the last 10 years, eat only well-cooked food. Your local physician has little experience with travel medicine. Information about local health resources is nonexistent or unreliable. Geopolitical information resources say the area is reasonably stable, but there has been sporadic violent insurgent activity in the northern regions for years, and travel is advised with caution. Bird flu has been reported in the adjacent country. What should you do to prepare for your travel safety?

RISK ASSESSMENT AND INSURANCE

International travel, once a daunting proposition reserved for those with significant financial means, has now become commonplace with approximately 50 million annual travelers from industrialized countries to the developing world.