Navigating the Extremes: Opportunities in global wilderness emergency medicine

My name is Dr. Sarah Spelsberg, and I am one of the Emergency Medicine residents at UNC Health Southeastern. I have had the honor and pleasure of spearheading numerous multidisciplinary medevac missions in the Aleutian Islands/Bering Sea as well as serving as the Medical Lead in Project NEPTUNE 100, an ambitious underwater research endeavor. The combination of being on-call on land and ready to jump in an aircraft with a patient or scuba dive to the patient’s side has provided me a unique and dynamic perspective on the approach to healthcare delivery. How many doctors get to scuba dive to their patients?

The Aleutian Medevac Challenges

My experience in the Aleutian Islands showcases the intricate and demanding nature of medevac operations in isolated settings. The region’s harsh weather conditions and logistical hurdles, such as apocalyptic weather, limited commercial flights, and overburdened Coast Guard and National Guard resources, often necessitate creative problem-solving and rapid decision-making. My work involved coordinating multi-modal evacuation strategies using helicopters, boats, and fixed-wing aircraft to transport patients with severe injuries and medical conditions, including burns, impalements, and stroke-like symptoms, to tertiary care. I have flown with patients past the Northern Lights and actively erupting volcanos – all over the icy Bering Sea!

I also had to rise to the challenge of navigating a pandemic in an isolated region. I realized we only had three ventilators for 12,000 people. Not having enough ventilators was a terrifying prospect if COVID-19 came to our island. This deeply concerned me. I went to the hardware store and purchased plumbing supplies and - after tinkering and testing - I was able to split each ventilator to take care of two to four patients.

Project NEPTUNE 100: An Undersea Adventure

As the medical lead for the historic Project NEPTUNE 100, the responsibility of overseeing the health and well-being of Dr. Joseph Dituri, also known as Dr. Deep Sea, during his 100-day underwater mission was both extraordinary and challenging. This Guinness World Record breaking project saw Dr. Dituri living underwater for 100 days in the Jules Undersea Lodge in Key Largo, Fla. The mission aimed to educate young minds, promote ocean conservation, and study the physiological and psychological effects of prolonged compression on the human body – like being in a hyperbaric chamber.

Throughout the mission, I conducted regular health assessments, including vital signs, ECGs, EEGs, and pulmonary function tests, often making underwater scuba dive “house calls” to draw blood and collect other samples, and to ensure Dr. Dituri’s well-being. The project highlighted various medical challenges, such as managing a cracked tooth, orthopedic injuries, upper respiratory infections, urinary tract concerns, a corneal abrasion, and potential decompression sickness, all while operating on a shoestring budget.

The day Dr. Dituri came to the surface concerned me the most. No one has ever stayed that deep for that long before. There were no dive tables to guide us on a decompression stop protocol. Dr. Dituri has a PhD in physiology, so he was the one who designed the surfacing protocol. We did a quick assessment of him at the shore and released him to speak with the extensive media presence that had gathered in the Florida Keys for the historic event. We later did a more thorough assessment and he passed with flying colors!

Medical Innovations and Findings

One of the Project NEPTUNE 100 mission’s significant accomplishments was its contribution to medical science. The team’s findings indicated that sustained underwater living could lead to decreased inflammatory markers, reduced cortisol levels, increased testosterone, improved liver and kidney function, and increased telomere length. These results were officially presented at the World Extreme Medicine (WEM) Conference in Edinburgh, Scotland, showcasing the potential health benefits of hyperbaric environments on chronic disease processes.

Educational Outreach and Future Endeavors

Beyond scientific research, Project NEPTUNE 100 had a profound educational impact. Dr. Dituri engaged with over 5,000 students via Zoom and a few lucky students got to visit the habitat in person, inspiring the next generation of explorers and scientists. The project exemplifies some of the ways we are caring for the citizens of Robeson County, advancing medical knowledge through research and innovation, and fostering a spirit of curiosity and learning among young people. Project NEPTUNE 100 lead to me being interviewed on Science Friday on NPR - which is my favorite radio show, CNN, FOX, BBC, and a variety of other media sources.

Looking ahead, I, together with my colleagues at UNC Health Southeastern, will continue to push the boundaries of medical practice. I am already planning the next adventures, which may include further expeditions in extreme environments such as the outer reaches of Alaska or even space missions. I am testing wearable biometric monitoring devices in extreme environments including military F16 pilots and competitive free divers. My work embodies the adventurous and pioneering spirit that defines expedition medicine and emergency medicine, and it has fundamental applications for healthcare in general. I believe that pushing your boundaries in extreme environments leads to innovative decision making in emergency situations thus improving our delivery of healthcare for all. We bring this creative thought process home with us. This year, I was named Director of US Operations for the nonprofit group World Extreme Medicine and now serve as Editor of the Expedition Medicine Column for the Wilderness Medical Society.

Conclusion

The emergency medicine team at UNC Health Southeastern is at the forefront of a rapidly evolving field of Wilderness Emergency Medicine, demonstrating resilience, innovation, and dedication in the pursuit of medical excellence in the most challenging environments. These efforts not only contribute to global healthcare advancements and innovations in healthcare delivery in austere environments, but also inspire communities and future medical professionals. Through our experiences, we highlight the critical role of adaptability and resourcefulness in delivering healthcare beyond the conventional settings, truly making the impossible - possible.