Extreme Medicine Read Online Free PDF Page B

honor and the greater glory of God and country was cast into sharp relief by the catastrophe of the Great War. A new era of exploration was born, one that relied less upon the mettle of men and more upon the systems of protection that we were able to engineer to protect them. It is worth noting that after Scott and Amundsen’s parties first arrived at the South Pole in 1912, no human set foot there again until 1956. And when they did, they arrived not in sleds driven by ponies or dogs but in aircraft.
    â€”
    T ORVIND, A NNA, AND I are walking along Mortimer Street; they have been lecturing about their experiences to an audience of doctors at the Royal Society of Medicine in London. They feel that this retelling of the story is important to change people’s practice and expectations in the face of such extreme hypothermia.
    There is a question I must ask Anna. If she’d had the choice at the time of her resuscitation at Tromsø—given the extraordinarily long period for which her heart had been arrested, knowing that the overwhelmingly likely outcome would have been death or a lifetime of disability—would she have chosen to let the team proceed?
    â€œYes,” she tells me after a short pause, “because you never know.”
    We continue our stroll through London. There is a point where water is rushing from what looks like a burst water main, flowing across the paving stones. Anna quickens her pace, breaking into a jog. For a moment, I wonder if this is one of those unexpected aversions that develop after a traumatic event. She was, after all, trapped under the ice, sinking into running water. Torvind says nothing. Perhaps it’s something he’s seen before. I am intrigued, briefly horrified, that this might be a sign of vulnerability or weakness.
    I am still pondering this when a taxi runs through the sizable puddle that has collected in the gutter, drenching my feet and trousers. And I realize that, after she was entombed and frozen in an Arctic stream and endured the lowest recorded temperature of any cardiac arrest survivor in medical history, the only reason Anna’s running is because she’s smarter than me.

Second World War burn victims at the Queen Victoria Hospital in East Grinstead. The strips of flesh used for surgical reconstruction of their faces were kept alive by anchoring them to blood supplies at two locations. For these men the skin was bridged to the face from the forearm or chest.
    (Reproduced by kind permission of the Guinea Pig Club)

FIRE
    H ow much of that has to go in the vehicle?” asks the pilot, pointing at the mass of tubes, cables, monitors, and machines that surround my patient.
    â€œAll of it,” I tell him. The intensive-care side room looks cramped. Its contents must somehow be transferred to the roof of the hospital and crammed into the back of a medical-evacuation helicopter.
    The pilot sucks air through his teeth, doing the mental arithmetic. It’s a warm day; the air is thin. His engines can generate only so much lift. The more weight we have to carry, the shorter the range of the helicopter and the more hazardous the takeoff.
    â€œHow much has to be in the cabin with us?” he asks.
    â€œAll of it,” I repeat.
    More air-sucking sounds.
    â€œHow much do you weigh?” he asks, looking me up and down.
    â€œAbout 155 pounds,” I tell him.
    â€œHow about her?” he says, nodding indelicately at the nurse.
    The man in the bed before us was caught in a house fire and is badly burned. The trauma team estimates that perhaps the full thickness of skin over as much as 50 percent of his body has been destroyed by fire, though it’s hard to be sure. Underneath the char and the blisters, it is difficult to know what remains viable. Time is ticking by. Keeping him stable has taken all our efforts, and we are at the end of what we can offer here in this general intensive care ward. To give him the best chance of