It's snowing today in Seattle, but I'm wearing a t-shirt. That's for two reasons- one is that the coffee shop I'm writing from has the heat on high. That and the fact that I've just returned from Antarctica, guiding a mountaineering trip to the top of the Continent's highest mountain. With temperatures lower than -40 f, and windchill values lower than -60 f, today's weather feels pretty balmy.
Mountain guiding was my full-time profession until a few years ago. Life changes (read: two kids) precipitated professional changes that had been in the works for a while. Now I get to use my experience to support the guiding and adventure travel industries via my work at
ObjectiveOur climbing objective was the summit of Vinson Massif, at over 16,000' the high point of the Antarctic continent. It's located in the Sentinel Range of the Ellsworth Mountains, a long, long way from definitive medical care. It's a long way from anywhere! In a worst-case scenario it could be 2-3 weeks from the time of an incident to delivery of the patient to a US-level hospital. The common occurrence of no-fly weather in our basecamp and in the base where we access the continent via a Russian Ilyushin cargo plane coupled with extreme conditions on the mountain make managing medical care a real challenge. 
Concerns: 2003
The last time I guided this trip, in 2003, I felt less than 100% prepared to manage my team's safety. I had a WFR certification, the guiding industry's standard minimum training. Great skill set, but for an expedition this remote it felt lacking. We carried a medical kit that included wound management materials and some Rx elements, mainly for treating altitude-related illness. But I felt pretty exposed. What was I going to do if our team's resources were overwhelmed by a medical emergency? Specifically, my concerns were:

• Level of Medical Training I was concerned that for a remote, extended expedition such as this one I needed more training
• Medical Kit Contents Did I have an adequate kit? What would a remote site medic recommend, for example?
• Emergency Response Plan Or lack of one. My understanding of basic risk management systems was lacking.
• Liability As a guide, my understanding of legal matters that directly affected me was limited. The job carries huge responsibilities- was my employer going to be on my side if things went sideways? 
• Managing and Dispensing Prescription Medications For international trips, carrying specific medications is important- epinepherine, antibiotics, and medications for managing altitude illness for example. But I'm not a pharmacist, an MD, or a lawyer- what were my responsibilities, and how could I know whether dispensing a medication was the best course of action?
• Backup For medical issues, having a second opinion with a higher level of training is invaluable. And during any incident with medical or logistical challenges, I was likely to have my hands full. What if I couldn't reach the team at the office when they were awake or available? 

Serious concerns. I would have my hands full with preparing for and leading the trip, and didn't know of any resource to answer my questions. Moreover, I was guiding a trip at high altitude in Antarctica. Little issues could easily become big issues.  Despite the best guiding practices, and best equipment, things do happen. The conditions in Antarctica leave very little room for error. Challenges include:

• Remoteness Climbing takes place two plane flights and thousands of miles from the closest medical facility
• Weather and Environmental Issues Extreme cold, wind, and altitude are a given and factor into everything you do
• Limited Resources Gear is limited to what you can carry. With up to 120 pounds per person that includes food, shelter, and extreme cold weather gear you have to make hard choices with regards to what you bring. 
• Communications A serious challenge in Antarctica. Yet crucial to access support when needed

Better Prepared: 2008When I departed for Chile to stage for this year's trip, I was in a much different place than I had been in 2003. In effect, I had become one of my own Remote Medical clients! I had put extensive work into preparing effective and functional risk management and emergency response systems into place. I was prepared for a variety of contingencies, had redundant systems in place, and had lightweight yet very solid tools to manage the medical care of my team. I also carried gear that represented potential upgrades that I could pass on to my RMI clients going forward. The end results included readiness, great service for my climbing clients, reduced exposure to legal liability, and peace of mind. Here are some of the specific upgrades I employed for this expedition:

• Risk Management Planning My preparations began with building a solid Emergency Response Plan, a Risk Management Plan, and revising my waiver and medical information forms. Having thes