Remote Medicine: A Textbook For Trainee And Established Remote Healthcare Practitioners

Contents
About the Editors
About the Authors
Foreword
Preface and Acknowledgements
Chapter 1 Remote Medicine: History, Development of the Concept and Research
	Introduction
	Development of Remote Medicine in the North Sea
	First-Aid Training
	Communications
	Medical Co-Ordinating Centre
	Evacuation
	Research and Audit
	Development of Remote Healthcare for the Antarctic
	Case Study 1
	Case Study 2
	References
Chapter 2 First-Aid for Industrial and Remote Settings
	Introduction
	Determining Priorities
	Approach to a Casualty
		Unconsciousness
			Recovery position
		Fainting
		Epilepsy
		Diabetes
		Stroke
		Head injury
	Levels of Unconsciousness
	Respiration and Respiratory Failure
		Respiratory failure
		Choking
		Drowning
		Chest injury
	Mouth-to-Mouth Breathing
	The Heart, Circulation and Circulatory Failure
		Circulatory failure
		Heart attack
	Wounds and Bleeding
		The ring pad
		Pressure points
		Internal bleeding
		Bleeding from special sites
		Wounds
			Puncture wound
			Foreign bodies in wounds
	Accidental Amputation
	Burns
		Immediate management of a burn
		Chemical burns
	Fractures
		Classical features of a fracture
		Management of a fracture
	Eye Injuries
		Chemical burns of the eye
		Welders flash and snow blindness
	Poisoning
		Swallowed poison
		Inhaled poison
		Injected poisons
	Shock
		Causes of shock
		Diagnosis of shock
	References
Chapter 3 Preparation for Disasters in Remote Places
	Introduction
	The Major Incident Plan
	Training
	Casualty Clearing Area
	Provision of External Medical support
	Reference
Chapter 4 The Psychological Response to Major Trauma in Remote Locations
	Introduction
		What is “trauma”?
		“We must do something”
	Myths about Disasters
	Self-care in the Trauma Zone
		Those at risk?
		What steps can we take to help ourselves?
	How Communities and Individuals Cope with Major Adversity
		Military conflict
		Disasters
		Community reactions
		Individual reactions
	Grief
		A constellation of reactions to loss
		Adjustment to loss
		Pathological grief reactions
		Cultural influences
		Management
		“Ambiguous loss”
	Post-Traumatic Psychopathology
		At risk factors
		Predictors
		Resilience
		Post-traumatic stress disorder (PTSD)
		Additional pathologies
		Children and adolescents and trauma
	Interventions
		Aims
		A stepped model of care
		Psychosocial interventions
	Conclusion
	References
Chapter 5 Communications and Telemedicine
	Historical Development
	Development of Medical Communications and Telemedicine in Aberdeen
	Development of Medical Communications and Telemedicine in the Middle East
	References
Chapter 6 Acute Surgical Problems
	The Acute Abdomen
		Abdominal pain
			Colic
			Peritoneal pain
			Referred pain
			How to conduct a rectal examination
	Management of the Acute Abdomen
	Fluid and Electrolyte Therapy
		Basic maintenance therapy
		Replacement of electrolytes
		Fluid requirements during illness
		Monitoring fluid and electrolyte therapy
	Bibliography
Chapter 7 Diagnosis and Management of Medical Emergencies
	Introduction
	Assessing the Acutely Unwell Medical Patient
	Common Medical Complaints and Presentations
		Chest pain
			Pulmonary thromboembolism
			Pneumothorax
			Musculoskeletal chest pain
			Palpitations and syncope
		Respiratory problems
			Asthma
		Upper GI bleed, inflammatory bowel and liver disease
			Upper GI bleed
			Inflammatory bowel disease
			Alcohol related hepatitis
		Diabetes, DKA, and HHS
			Hyperosmolar hyperglycaemic state
	Common Neurological Presentations
		Headaches
		Seizures
		Stroke and transient ischaemic attack
		Stroke classification
	Poisonings and Toxidromes
	Sepsis
	Ambulatory Care Systems, Pathways and In-Home Management Services
	Telehealth and Communication Strategies
	Transfer Decisions
	Remote Clinician Resilience
	Summary
	References
Chapter 8 Remote Healthcare and Psychiatric Emergencies
	Introduction
	Differential Diagnosis — Is this Actually a Psychiatric Illness?
	Acute Confusional States
		History and examination
		Management
	Psychoses
		Schizophrenia
			Positive symptoms
			Negative symptoms
		Hypomania and mania
			Hypomania
			Mania
	Depression
		Cause
		Symptoms
		Red flags
		Agitated depression
	Suicide
		Management of suicide risk
		Management of a successful suicide
		Management of the Acutely Disturbed Patient
	Bibliography
Chapter 9 Remote General Medical Practice
	Section 1 — The Approach to General Medical Practice
		Introduction
		Illness Behaviour and Influences to Consult
		Contrasting General Practice and Secondary Care
			The consultation
				1. Discover why the patient is bringing an issue to your attention
				2. Define the clinical problem
				3. Address the patient’s problems
				4. Explain the problem to the patient
				5. Make effective use of the consultation
				6. Achieve reasonable outcomes
		Conclusion
	Section 2 — A Clinical Approach
		The Extended Scope of Primary Care
		Clinical Attributes Guide
			1. Generic attributes
			2. Emergencies
			3. Dermatology
			4. Ear, nose, and throat
			5. Medical issues
			6. Obstetrics and Gynaecology
			7. Ophthalmology
			8. Paediatrics and child health
			9. Mental health
			10. Musculoskeletal problems
		Conclusion
	References
Chapter 10 Delivering Pharmaceutical Services in Remote Locations
	Introduction
	Traditional Pharmaceutical Service
	Legal Aspects
		Introduction
		UK medicines regulatory system
		UK medicines legislation
		Medicines Act licensing system
		Marketing authorisation (previously known as product licence)
		Wholesale Distribution Authorisation [WDA(H)]
		Legal classification of medicines in UK
	Management of Medicines at Remote Locations
		Selection of medical conditions to be catered for
		Selecting inventory list medicines
	Written Instructions
		Medicines which may cause sedation or impair judgement
		What can go wrong with the system
	Procurement, Supply & Logistics
		Supplier selection
		Shipment to site arranged by remote site company
	On-Site Storage of Medicines
		Sickbay general arrangements
		Ambient medicines
		Cold-chain medicines requiring storage between +2 °C and +8 °C (35°F to 46°F)
		Dealing with temperature excursions
	Pharmaceutical Waste
	Reference Sources
		British National Formulary (BNF)
		Electronic Medicines Compendium (eMC)
	Importance of Assessing Medicines Brought On-Site by Personnel Before Selecting a Medication
		Assessment of medication
	Prescribed or Purchased Medicines which Raise Concerns
	Supplying Medicines to Individuals on Remote Sites
		Supply of an over the counter medicine in a manufacturer’s original pack
		Dispensing medicines
		Labelling of dispensed medicines
		Dispensing a POM in a manufacturer’s original pack
		Dispensing a quantity of medicine from a manufacturer’s original pack into another container for a patient to take away from the sickbay
		Producing labels on a remote site
		Containers
	Records
	Training
	Bibliography
Chapter 11 Occupational Health in Remote Environments
	Introduction
	Health Risk Assessment
	Health Plan
	Who is at Risk?
	Occupational Health Services
	Staffing
	Occupational Health Benchmarks
	Fitness for Task
	Health Surveillance
	Absence Management
	Non-Occupational Hazards
	Health Interfaces
	Summary
	References
Chapter 12 Industrial Medicine and Remote Healthcare in Russia
	Introduction
	The History of Industrial Medicine in Russia
	Problems of Industrial Medicine
	Organization of the Healthcare System at Remote Sites
	Telemedicine: History of Development and Current State
	Conclusion
	An Illustration of New Ways of Working in Remote Healthcare
	References
Chapter 13 Work and Experience of an Oil Industry Remote Medical Practitioner
	Introduction
	Remote Healthcare and Offshore Medics
	Remote Health Practitioners in The Oil Industry: Scope of Practice
	Remote Health Practitioners Training
	Skill Decay
	Technology
	Secondary Roles and Potential Role Conflict
	Safety Management
	References
Chapter 14 Hyperbaric Medicine and Diving
	Introduction
	Tunnels and Mines
		Diving
		Free swimming divers
		Bounce divers
		Saturation diving
		Effects of atmospheric pressure on the body
		Gases in the body
		Gases are in the blood
	The Dysbaric Illnesses
		Barotrauma (pressure injury)
	Preventing Barotrauma
	Decompression Sickness (The Bends)
		Symptoms of decompression sickness
		Management of decompression sickness
	Effects on Divers of Gases at Pressure
	Other Diving Problems
	Management of Diving Injuries
	References
Chapter 15 Environmental Medicine: The Physical Environment — Heat and Cold
	Introduction
	Cold
	Maintenance of Body Temperature
	Conditions Caused by a Cold Environment
		Frostnip
		Frostbite
		Cold burn
		Chapped hands and lips
		Chilblains
		Trench foot
	Hypothermia
	Conditions Caused by Heat
	The Heat Illnesses
	Hyperthermia Associated with Fever
	References
Index