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Caving in Quang Binh province in Vietnam puts the expeditioner at increased risk of accident or injury. Although the base camp in Son trach is in a thriving small town with good road links to major towns with hospital facilities, the working area for the expedition is remote and harsh country. The quick response of a rescue team and helicopter rescue from remote valleys is very definitely a thing of the future in Vietnam. With this in mind the expedition realised that self sufficiency would need to be the name of the game and organised its medical and first aid equipment and personnel with this in mind.
The team was strong on rescue experienced cavers with underground rescue controllers from British cave rescue bodies present. Added to these skills the expedition members included several people with first aid skill and one registered nurse. There was no doctor on the team but arrangements had been made for phone consultation with a UK GP with cave rescue experience. Reliable phone coverage, however, was not available in most of the working areas.
The medical equipment was gathered together in the UK and organised with two things in mind, injury or illness. The objective dangers of expedition caving do not need great mention here. Suffice to say Quang Binh caves are remote, sharp, often loose, and often involve lengthy swims. This year’s trip saw the exploration of vertical systems also. The fist aid gathered to cover injury whilst exploring these caves included gear for fixing wounds, dealing with pain, and covering the onset of potential infection on the grounds that evacuation to a medical facility would be lengthy. Added to the risk of caving injury, being in remote tropical rainforest brings medical risks including illness, malaria being just one of the potential problems, insect stings and bites and infection, the list goes on. To cover as much as possible within the skill levels of the team, the expedition gathered a small pharmacy of medications including antibiotics, malarial treatment and diagnostic kits, treatment for severe allergy and anaphylaxis and anti anxiolytics.
The next problem was how to organise the kit.
This was done by having 3 fairly comprehensive kits designed for field use, these included the equipment alluded to above. The physical size of these kits (a waterproof “Darren” drum) made them impractical to take underground but very practical to have at a jungle camp. Underground kits were much more basic and packed into small nalgene bottles that people would actually take underground with them. Back in Son Trach was a base camp kit with IV sets for fluid resuscitation in case of severe problems and a stock of medical expendables.
To cover the fact that few people had extensive medical knowledge, each field kit included very clear and concise instruction on the uses of the medications written for us by a UK GP. We also carried at base, the excellent RGS Expedition Medicine Edited by David Warrell and Sarah Anderson 2nd edition 2002.With the preparation done, and the caving started, it was not long before casualties started coming in! Fortunately there were no serious injuries or illnesses but few people escaped some sort of medical or first aid problem. There were, of course, the near misses which are best discussed amongst mates over a beer or two!
Starting with injury, we had a caver suffer a very deep laceration to the base of the little finger, down to the bone and extending laterally, done by stumbling onto a razor sharp limestone block The victim was given great first aid by one of the jungle guides (cold weak tea to wash out the wound, the tea of course having been well boiled before being bottled for the jungle trek) and needed wound toileting and deep suturing on returning later that day to Son Trach., plus a precautionary course of antibiotics. Another unfortunate caver had a stal curtain break and fall onto his hand causing a small deep cut that was patched up with steri-strips. The same person took a fall, causing extensive bruising and minor laceration to his bicep. He sounds unlucky, but the fall could have been much worse as he landed on his back on a sharp ridge after a 10 foot fall but the big tackle sack he was wearing took the impact.
An over-social session with the jungle porters and their rice wine saw a fall from a hammock and a minor, if messy, head injury.
An innocuous move whilst caving put one man out of action for a week with lumbar spasm and pain.
Added to the injury list, most cavers suffered minor bumps and bruises and aches and pains associated with the nature of the trip and the high average age of caver.
Illness wise, minor complaints took a toll but there were no major worries. There were 4 cases of gastritis with severe vomiting that resolved in 48 hrs or so, one chest infection requiring antibiotic cover, 2 cases of fungal foot infection, one severe enough to prevent caving for 3 days. One unlucky caver developed moderately extensive rashes on each trip into the forest, possibly sweat rashes rather than allergies but frustrating and itchy none the less.
Everyone had their share of scratches, leech and insect bites but it was notable that there were none that developed into anything other than minor skin infection. Possibly this is a happy side effect of the team taking doxycycline as malaria prophylaxis.
Overall there was enough going on medically to cause ongoing interest and minor disruption of the caving plans. Fortunately most of this was minor in nature and should leave no lasting problems, although there will be a few scars.
One of the reasons that the issues that arose did not cause greater problems was the prior planning that went into the medical kit. To this end thanks go to Drs Angela Hare and John Burton for their input.