PHEM Experiences

Guest Blog Post: The Rebel And The Insider

Posted by Jeremy Windsor on Jan 08, 2021 On Mountain Medicine blog

Earlier this year the Faculty of Pre Hospital Care (FPHC) at the Royal College of Surgeons (Edinburgh) updated its guidance on the standards expected from healthcare providers taking part in wilderness expeditions. This has now been linked to the legal framework set out by the Royal Geographical Society’s British Standard 8848. In this post, Dr David Hillebrandt takes us behind the scenes to tells us about his involvement in the drafting of the guidelines. Using these as a starting point, Dr Hannah Lock will then give us her thoughts on what these mean in practise.

“Whilst in many ways these two documents provide a very relevant introduction to the hidden complexities of working as a expedition medic for the first time, for me they present a major conflict of interest. I attended many meetings in Birmingham between 2015 and 2019 when these documents were discussed. Although I appreciated the way the FPHC looked after us and covered our travel expenses, I frequently found two people sitting in my chair. Let me explain! One was the rebel mountaineer – somebody who started hillwalking in 1964, was rock climbing four years later and had joined his first Himalayan expedition in 1978, when he should have been doing his first house job. He had been told that the trip would be professional suicide! The other person was the insider – a semi-retired GP with the odd peer reviewed publication on his CV and a past that had included speaking at international academic meetings on mountain medicine. My interest in pre-hospital care also meant that I was a supportive member of the FPHC which had done so much to raise the standards of emergency care prior to arrival in hospital. 

These two people were conflicted!

On several occasions I found myself nodding along to phrases such as “expedition medicine is becoming a sub speciality” and we are “formalising the practice”. Meanwhile the rebel mountaineer in me cringed and squirmed. If I had been limited by this formalisation I would not have joined my first major expedition. Luckily, every trip since has been with friends and I was present for my climbing skills as much as my medical knowledge. No commercial trips. I could foresee a situation where, by the time a young medic had sufficient medical skills to join an expedition, they would be too old and would not have spent sufficient time keeping their mountain skills up to date. On several occasions I was at the point of dropping out.

Richard Wain-Hobson discussing FPHC business on a new route near Padstow

Why did I stay? The old rebel in me felt that I could only fight the system from the inside. I had to stand up for young expedition medics. Another side of me could see the need for guidance to protect some inexperienced medics joining commercial expeditions with no insight. But two things really kept me in the group. After raising several objections I was invited to write an introduction to the guidance notes. The unopposed acceptance of this convinced me of the underlying sincerity of the group. The second thing was my delight when the person in the next chair muttered quietly to me during an unrelated and rather boring discussion, “Do you fancy a climb sometime?”. A few weeks later we were putting up some easy but fun new routes on an unclimbed sea cliff crag in the South West. The true spirit of the whole project!……

Blog Post continued over at

Mountain Medicine Blog – The Rebel And The Insider (7thwave.io)

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