Medical diagnosis in extreme environments

Malaria is not a disease you’d expect Antarctic expeditioners to suffer from. But it makes sense when many expeditioners holiday in the warmer climes of South-East Asia before departing for Antarctica.

Despite rigorous screening of expeditioners to ensure they are fit for Antarctic duty, acute and chronic medical conditions can develop during their stay. Being able to diagnose and monitor conditions such as malaria, peptic ulcers, influenza, meningitis, gastrointestinal bleeding and pregnancy, is a critical part of the lone doctor’s role at Australia’s Antarctic and sub-Antarctic stations.

The Australian Antarctic Division Polar Medicine Unit has refined methods to help station doctors diagnose a range of diseases and conditions over the past 50 years. Being able to perform pathology tests on site and generating timely results that help in making clinical decisions (“point-of-care testing”) are important factors in providing quality medical care in Antarctica. This expertise now provides an effective and efficient model for medical care in other remote and extreme environments, including space.

Polar Medicine Unit Deputy Chief Medical Officer, Roland Watzl, and Chief Medical Officer, Dr Jeff Ayton, recently described this model in A Practical Guide to Global Point-of-Care Testing, published by CSIRO Publishing late last year.

The book covers management of point-of-care testing services and their use in diagnosing different medical conditions and diseases, and in different settings (such as hospital, paramedic services and sports science).

In their chapter, Point-of-care testing and extreme environments — the Australian Antarctic Division, Drs Ayton and Watzl consider how to design a point-of-care test system, given issues such as the effect of a harsh environment on medical equipment and supplies, limited technical support and restricted supply — constraints that exist in both space and third world countries. They also provide a list of robust tests that reduce diagnostic uncertainty when used alongside a customised diagnostic handbook, and examples of how these tests have been used.

“Our system provides capability on the ground at research stations, in the field, on ships and on aircraft,” Dr Watzl said.

“Most importantly, a point-of-care result is never interpreted in isolation, but always used in clinical context, preferably over time to allow analysis of trend. The tests aim to support the clinical impression, but never to replace it.”