Dr Matt Wilkes, MSc MRCEM FRCA FAWM Dip Mtn Med

Matt's professional interests lie in remote medicine and extreme physiology. He is founder of the online hub, Adventure Medic, and has been the Lead Doctor and/or Medical Adviser for a number of international expeditions, practiced anaesthesia in New Zealand and Nepal and flown all over East Africa with the AMREF Flying Doctor Service. 

In 2017, Matt spent the post-monsoon season as a volunteer doctor at the IPPG(UK) high altitude clinics at Machermo and Gokyo in the Khumbu region of Nepal. He's passionate about paragliding and is mid-way through a PhD at the Extreme Environments Laboratory, University of Portsmouth; focusing on pilot safety, performance and trauma care following accidents. I first met Matt in New Zealand, and am lucky enough to have shared the odd thermal with him over the years and he has kindly agreed to be interviewed for Surviving the Death Zone.

Matt, thanks for talking to us. You certainly seem to have fitted a fair amount into your career so far! Where does your passion for wilderness and adventure come from? Were you out in the mountains from a young age?

Not at all! I was born in Yorkshire but grew up in flat, flat Cambridge. It was only when I got to university in Edinburgh that I realised what I had been missing. I’ve been trying to make up for lost time ever since.

I am also a pretty lame mountaineer. My first outdoor love was whitewater kayaking, then I got into mountain biking. However, paragliding has trumped them all. Since I got my solo license in 2011, flying paragliders through the mountains has been my focus and my passion.

What were your earliest encounters with wilderness medicine?

Edinburgh University has a great organisation called APEX, which runs altitude science expeditions to 5300 m in Bolivia. Students are both the investigators and the subjects. An international group of scientists and doctors oversee the research, so the standard of work is high. It is a great opportunity for students to develop their fieldwork and research skills.

In 2002, I went as a guinea pig on the second APEX expedition. It was an amazing adventure and started my fascination with the effects of altitude on the body. We also conducted one of the early trials of Viagra’s effects (on the pulmonary system in hypoxia), so it was safe to say that the whole experience left a lasting impression.

Have you found it challenging to fit your expedition and mountain projects around anaesthetics training?  Were you granted OOPE / OOPR time?

Yes and no. My first three years of expedition work were after finishing Core Training in Anaesthesia, so that was a natural break. It was a little trickier the second time round. I had hoped to make an OOPE work but that sadly wasn’t possible. I understood the Deanery’s position - they were perennially short of trainees - but it meant that I left anaesthetics training in August 2016 (at the end of ST4). While not ideal, I left on good terms, with my Final FRCA and Intermediate Level Training Certificate, so I was as confident as I could be that I could reapply in the future. Since then, I’ve been working full-time in extreme environment medicine practice and research, while doing a lot of flying.

Tell me about the Free Flight Physiology Project: how did it come about, and what lessons do you think paragliding can teach us about high altitude physiology?

One of the best aspects of working in wilderness medicine is the opportunity to spend time with people from different walks of life. As I got more into flying, I started to wonder if I could apply the lessons I had learnt from these individuals, and from anaesthesia, emergency medicine and outdoor sports in general, to make paragliding and other air sports a little safer. I approached the task from a few different angles: accident epidemiology, pilot performance and accident management, all under the umbrella of the Free Flight Physiology Project.

To study pilot performance, I was very kindly taken on as a part-time PhD student by Professor Mike Tipton and his colleagues at the Extreme Environment Laboratory, University of Portsmouth. This gave me access to their facilities and, much more importantly, their incredible depth of expertise. I am by no means a natural researcher (they have been very patient) but we’ve done two studies now: one looking at the cardiorespiratory system in normal and acrobatic paragliding flight and the other investigating pilot cognition in the flight environment.

I think paragliding is a great opportunity to study high altitude physiology, as the ascent profiles are unique. Paragliders fly high (up to 8150 m) but over a matter of hours: not the seconds of an explosively decompressing aircraft nor weeks of a trekking expedition. Also, unlike mountaineers, paraglider pilots aren’t exercising heavily and can carry kilos of study equipment, so it is a great opportunity to look at the underlying physiological changes of hypobaric hypoxia.

 

Should all mountain medics have methoxyflurane in their kit bag?

I was in Nepal during the autumn and had the opportunity to use methoxyflurane as analgesia for a suprapubic aspiration. It was 3am and freezing cold at 4,300 m. The methoxyflurane worked well – I was definitely impressed – and I now carry some in my paragliding harness for trauma on the hill.  It definitely has potential as a lightweight, durable, obtainable, easy-to-use medicine for the field and has been used successfully in Australian prehospital care for a long time. However, I would like to see more comparative studies against gold-standard treatments, such as intranasal opiates, before saying it was the best of the bunch. As an anaesthetic vapour, it should also theoretically be less effective in very cold conditions, though that wasn’t our experience in Nepal.

What have you been most proud of in your career so far?

…probably that anyone still calls my haphazard course through medicine a ‘career’?!

To be honest, I think I feel more fortunate than proud. There have been so many amazing opportunities made available to me through medicine. I’ve just tried to make the most of some of them. Having spent some time in parts of the world where people get by with very little, I know that we live at the very tip of the iceberg of human privilege.

What advice would you give to medics looking to pursue a role in mountain  / expedition medicine, either in a research or medic role?

There are so many opportunities at the moment. For students, who are rich in time but not in cash, I would focus on becoming competent in the outdoors. The medicine component will come later. The right moment to go on expensive courses is when you are a doctor, better off financially but with less free time.

Use resources, such as www.theadventuremedic.com and this blog, to gather ideas and make contacts. Pick your moment to go away and try to work with your colleagues and the Deanery, rather than against them. It’s usually better to take two years out rather than one: one year goes in a flash and interviews will get in the way half way through your time out. However, if you are being interviewed 18 months into your time out, you’ll have much more to say and will have accumulated more points. Remember, you cannot be penalised for having time out of UK training, you can only gain experience and points for reapplication.

Then, when you are actually looking at trips, make sure you the right person for the job: get a thorough understanding of the nature of the trip and the participants before accepting and be honest about your own experience. Be at least as good as the clients at the activities you will be undertaking. That way you can keep some head-space free for the medical aspects of the trip.

Be clear about the deal you are being offered: are flights, kit, indemnity and expenses in country included? I believe that being an expedition medic is a job like any other, with professional risks and responsibilities, and as such should include a salary, in addition to kit and indemnity costs. Whatever you choose though, please make sure that you are protected and feel adequately compensated for your work.

On your trip, you may well be asked to treat locals or porters. Think about how you will deal with this before you go and make sure that the organisation is onside with whatever you decide. My view is that you are responsible for the wellbeing of everyone on your trip, including porters.

Last, and most importantly, enjoy yourself!

And finally: I understand you’ve branched out into skydiving now. Is there a Free-Fall Physiology Project on the cards?!

Haha, skydiving is pretty interesting: it’s developed an amazing safety record, inclusive atmosphere and some very good habits - all of which I think can be applied to other forms of free flight. It’s also a lot of fun, though a bit like a rollercoaster – very expensive and not very eco... paragliding still has my heart!

Matt, thanks so much for talking to us. Fly safe!