Mass Casualty Incident Response in Antarctica

Isolated environments combined with austere circumstances sometimes call for extraordinary measures, and in particular call for planning in advance for situations of multi-casualty incidents. Many, if not most, austere settings are in outdoor or frankly wilderness settings. Anyone who spends considerable time in the outdoors is going to sooner or later encounter a group of individuals in need of assistance in a setting of limited resources. This could be a scout troop suffering sunburn, multiple persons stung by a swarm of bees, a group of people struck by lightning, or a carful of people in a vehicle swamped and trapped in a flood. A winter camping expedition might be overcome by an unanticipated storm that generates victims of hypothermia. At the ends of the earth, the risks may be greater and multiplied by the very difficult logistics of rescue and evacuation.

Christopher Mills, MD and colleagues recently published a very interesting article entitled “Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica” (Western Journal of Medicine 2011;12(1):37-42). This excellent review addresses the complications of multiple environmental and operational challenges, and highlights that response strategies for seriously ill or injured persons often call for aeromedical evacuation. People who visit Antarctica may not be fluent in the language of the rescuer(s), and tourists bring unique problems that include lack of medical fluency and inadequate preparation. If a mass casualty incident were to occur, it would need to be very well coordinated, because there is likely an increased risk of failure to every aspect of the rescue and evacuation solely because of the environmental constraints. I agree with the authors that at the current time, military forces have the greatest capacity for mass air evacuation. In Antarctica, failure to maintain shelter means failure to maintain warmth, so hypothermia and frostbite are frequent additional risks.

This article is a good review article not only for those contemplating a stay in Antarctica or near the North Pole, but for anyone who will be in relative or complete isolation in a very cold environment, such as on a mountain or deep in the backcountry.