BASMU 5 Revised Oct 2020 

NOTES FOR EXAMINING DOCTORS

Thank you for agreeing to do this medical. We are not asking you to make the judgement about the fitness of an individual for deployment. The medical team at BASMU will make the decision based on the information that you provide. 
The British Antarctic Survey Medical Unit (BASMU) is employed to provide the medical service for the British Antarctic Survey (BAS). BAS is a government agency that enables science to be done in the Polar Regions. With regard to medical screening it is BASMU’s job to ensure that the deploying population is fit to do their job, and to live in the environment to which they are being deployed.
BASMU is based in Plymouth, and the medical support is provided by senior medical staff from the Emergency Department, on a part time basis, and where necessary specialists from within University Hospitals Plymouth NHS Trust are consulted. 

If you have any questions/concerns please discuss the case with the BASMU medical officers on 01752 315220. Alternatively, the doctors, Matthew Warner, Anne Hicks, & Dave Farrance, and can also be contacted via our secretaries in the Emergency Department on 01752 437629.

BASMU Screening
•	All personnel who are to be deployed with BAS are screened; this includes many personnel who are non BAS, and/or international visitors.
•	Most people are deployed only for the summer (a few weeks to 5 months), however those who are going for winter are normally deployed for 20 months, and so have a more thorough medical.
•	Where possible we try to facilitate deployment south, but we have to consider not just the individual, but the impact on others safety.
•	The screening papers are kept within BASMU, and not available to BAS staff, although BAS staff will forward them unopened to BASMU.

Limitations of Environment
•	Antarctica is the coldest, highest, windiest and most isolated place on earth
•	The atmosphere in most areas is extremely dry, and UV levels are also extreme at times.
•	In the Arctic most work is undertaken in summer, but conditions are often still severe, and medevac options limited.
•	The ships are sailing in some of the most challenging seas in the world, and may be hampered by adverse weather, sea or ice conditions
•	There are occasional flights in the summer to Rothera, and Halley
•	Access to South Georgia, Bird Island and Signy is only by ship.
•	Even in “summer” medivacs can be delayed for days/weeks by adverse weather.
•	Field parties are often delivered to a remote location by plane, and left with no independent transport. 
•	All personnel, regardless of their job are required to partake in base support life (some of which is very strenuous) and must be able to muster independently in the event of an emergency, so there is an expectation of baseline fitness.  

Medical Provision
•	There is a doctor present on the Ships when in the Southern Ocean, Rothera, Halley and South Georgia.
•	The doctors have access to support via BASMU and Derriford ED.
•	Where there is a doctor, there is a surgery with minimal equipment and drugs to cope with common emergencies, and common conditions.
•	Field parties will not have a doctor with them, but a simple field medical box.
•	The doctors have pre-deployment training, to make them fit for purpose.
•	Their ability as a lone doctor in a remote location to care for a sick patient is extremely limited.
•	Individuals are cautioned regarding the obvious ceilings of care prior to deployment.

Medical Support

•	Whilst the weather on base may not be that challenging in the summer, the logistics are.
•	The nearest “DGH” style hospitals are Falkland Islands and Punta Arenas (Chile). In summer we may be able to facilitate this in 2 days or up to 4 weeks. 
•	In winter, medivac is impossible from Rothera and Halley, for about 5 months.
•	In the Arctic a medevac often requires multiply flights in order to reach a medical facility.

Impact of Medivacs

•	There are no non-essential staff deployed, therefore having to remove someone will impact on many other people’s lives, cause programmes to be stopped, or base functions to cease.
•	Transport is so limited and timetables and weather windows so variable, that a single medivac may have huge knock on effect on the whole season.
•	It may put rescuers at risk.
•	The financial cost is not just in the individual transport costs, but in finding replacement staff, failed science projects etc.

Pressure to “Declare Fit”

•	For some individuals this opportunity may be once in a lifetime. It is essential that this doesn’t affect their presentation of their symptoms. Please bear this in mind when taking their medical history.

A guide to conditions that may cause concern

Conditions that will usually preclude service
Decisions will depend on many different factors and will be made on an individual basis. 	
Conditions which may preclude service.
These will be assessed on an individual basis and in relation to the capacity to undertake activity/work in the anticipated environment.   
	
Cardiac & Circulation problems

Angina & Heart Attacks
Leaky Heart valves & Rheumatic Fever
Previous Heart Surgery
Uncontrolled High Blood Pressure
Heart Rhythm Abnormalities	
Heart Failure
Arterial Disease	

Treated abnormal rhythms
Severe varicose veins
Previous Frostbite
Severe Reynaud’s disease
Previous leg thrombosis
Previous clot on the lung
	
Respiratory (chest) problems
Recurrent pneumothorax
Cold induced asthma		
Chronic Bronchitis or emphysema
Active Tuberculosis

Single episode of pneumothorax
History of moderate or severe Asthma	

Gastrointestinal problems
Active stomach / duodenal  ulcer
History of these ulcers
Liver Disease
Pancreatitis
Untreated Hernia

Previous exploratory abdominal surgery
Severe piles
Recurrent (inflammatory) bowel disease

Genito- urinary problems

Recurrent Kidney Stones
Kidney failure

Renal colic
Recurrent kidney infections
	
Neurological Conditions

Epilepsy or fits (on treatment)
Non – traumatic Brain Haemorrhage in past
Unexplained episodes of loss of consciousness
Degenerative N.M. conditions	
Significant Neuro Deficit secondary	 to Trauma

Previous fits clear for > 3 years
Previous brain surgery
Severe  ME
	
Metabolic Conditions
Most diabetes
Cushing’s Disease
Addison’s Disease
Obesity BMI >30	

Well controlled mild type ll diabetes (exceptional)
Other endocrine disorder
Thyroid disease
Obesity (severe) BMI >30

Musculoskeletal conditions
Untreated Slipped disc
Lower Limb Amputation
Recurrent dislocations (untreated)	
Rheumatoid Arthritis
Ankylosing Spondylitis

Recurrent back pain
Severe knee problems
Unstable joint
Frequent Gout	
Cancer and Haematological Disorders
Most cancers
Clotting or bleeding disorders
Warfarin Medication				
Bone marrow disease

Treated cancer with low risk of recurrence
Treated leukaemia
Treated Hodgkin’s disease	

Gynaecological conditions
Current Pregnancy	

Pelvic inflammatory Disease
Ovarian disease
	
Dermatological conditions
Blistering Skin diseases
Severe psoriasis		
Mental Health Problems
Current psychiatric Illness
Previous severe mental illness
Schizophrenia
Manic depression
Personality Disorder
Current Drug or alcohol abuse

Depression
Self-harm
Previous drug / alcohol problems	

		
The decision will depend on many different factors and will be made on an individual basis.  With all of these conditions it is much more likely that you would be able to go to the Antarctic for a short summer trip than to overwinter.
Some conditions will be assessed in relation to the capacity to undertake activity/work in the anticipated environment.