If you are interested in assisting/employment opportunities, we deploy our own staff first to these areas and accept additional emergency hires based on remote area medical/rescue experience and training. If you are a medical provider, we are currently accepting resumes for Paramedics with aero-medical experience, helicopter rescue and/or SOF 18D qualification, Mid-Level Primary Care Providers and Emergency Physicians.

Please send requests and resumes to employment@remotemedical.com.

We do no accept donations for the relief effort except for employee and medical provider time in certain cases. If you are considering making a donation to support efforts in Haiti, please consider Partners in Health.Our thoughts lie with the people of Haiti and we vow to work as hard as we can to support rescue and recovery efforts there.

For more information on this expedition, visit the First Ascent Blog or the Summit on the Summit Website.

The MCA ENG 1 complements the other services RMI already provides yachting and maritime including 24/7 telemedicine service, medical kit provisioning and medical kit restocking, medical training and certifications, and medical support staff for maritime and offshore. Those stopping in for an exam can also arrange for medical services for their ship or yacht, and pick up orders in person as an added convenience.

Exams are provided by Dr. Michael Cull at Remote Medical's Seattle offices, located at:

4259 23rd Ave W, Suite 200
Seattle, WA 98199 USA

Seafearer Medical examinations can be scheduled by calling the RMI office:  001 (800) 597-4011, or 001 (206)686-4878, or by emailing info@remotemedical.com

Tom Milne

Yachting and Luxury Travel Account Manager
tmilne@remotemedical.com

"One Person in a Little Boat Against the Ocean""Self" photo from USA 724- Chris Tutmark

That's how Seattle-based sailor and yacht rigger Chris Tutmark sums up the Mini TransAt- a single-handed open ocean race starting September 13 that he's competing in following months of preparation, training, and qualifiers.

Spicy

The details of the race are a bit more spicy. Racers sail Mini's, 6.50 meter (21+ foot) high performance boats from France to Brazil. The races average 20+ days in length, and in an average day the competitors get only 4 hours of sleep while crossing the Atlantic, relying on skill and seamanship, with limited support. 

I had the chance to check in with Chris in France a few days before the race and get a short interview before he headed out. His answers provide insight into the planning and psychology that goes into such a venture. As the medical sponsor for his bid, Seattle's Remote Medical International provided him with training and the Classe Mini spec'ed med kit, hence particular interest in that area.

Interview

Tom Milne/RMI: Describe the TransAt in a nutshell

Chris Tutmark: It's one person in a little boat against the ocean. The Classe has strict guidelines limiting outside assistance and gear so that the focus is on seamanship, endurance, and racing skill. Many sailors are attracted to this race for it's purity. 

How do you manage the long days?

CT: Sleep psychologists advise the racers to stay out of serious sleep debt for the first 5-7-day section. Sailors will aim for four hours of sleep out of each twenty-four hour period, with one of those four hour periods unbroken if possible (otherwise short naps when possible). On leg two, most will aim for five hours of sleep every twenty four, with at least one of those hours being continuous sleep. The crux challenge for many racers will occur during the deprivation of the second stage, managing "how much is left", and finding out how to make that equation work. 

Tell us a bit more about racing strategy on the TransAt...

A number of factors must be managed in addition to the physical. Each boat is equipped with a transponder, which shows a competitor the distance to the next port or finish, and each competitor can also see the other boats' distance to those points. That being said, the figure may be misleading- one boat may have a closer relative position, but due to weather patterns (prevailing and current), racers' sleep schedules, currents and other factors, a racer with a greater distance relative to another may actually have an advantage. For example, racers may have preferred strategies for crossing the doldrums, or may make up a new strategy on the spot. 

In the end it's a blend of a race versus the other competitors, managing your own energy reserves, and maximizing individual performance. Days 12-20 are about endurance, pushing hard while your systems are already maxed, and knowing your own and everyone else's personal limits. To be successful you have to be able to maintain that edge without going into the red zone and crashing....

What support systems do race organizers have in place for contingencies/emergencies?

Although this is sailing and racing stripped down to a very pure form, the race organizers are very serious about safety. There are very specific required medical kits on each boat, specific training required of the racers (*TM note- these are the services Remote Medical is providing Chris), and seven support vessels spread throughout the fleet that are within VHF range at all times. Two MD's are on the race (one of them previously finished a TransAt), and a specific telemedicine support service is available to racers and support staff. Each boat carries an ePirb unit that allows them to signal race organizers to alert them of issues that either a) are manageable, b) require outside help or c) require an evacuation.

What are the most common medical incidents open-ocean sailors face?Sunset near Penmarc'h

The most common incidents include: sprains- wrist, knee and ankle; skin infections, due to the wet conditions, difficulty of proper hygeine, humidity and tropical conditions later in the race, and the fact that the racers' immune systems are compromised due to the extended physical demands of the TransAt. That being said, our required medical kits are capable of handling more serious issues as well.

What attracted you to the TransAt?

I like the simplicity. Much of my life as a sailor has been as part of a crew, which has been great. This race will present a different (although no lesser) type of satisfaction- all decisions, good and bad, will be my responsibility alone. For some people this race is part of a "bucket list", for others it can be a stepping stone to different solo open ocean races, such as the Vendee Globe. I see myself doing more of this type of racing, and helping establish and support these types of events in North America.

What will you do once the race is over?

I'll take a shower and get some sleep! After that, I'll be getting the boat packed up. I will be selling USA 724 after the race. This entire venture has been essentially self-financed, so plan be having the boat delivered to a prospective buyer either in France or North America after the race. I will have over a week in Brazil to wrap things up and decompress before flying back to Seattle.

Any final thoughts?

I have been struck throughout this process by the camaraderie the fleet and this group of sailors displays, it is phenomenal. There are eighty five boats, and everyone is helping each other. Yes, it is a competition, but it is also an amazing venture that we are sharing in. The bonds are very strong.

Chris and the other 84 competitors depart from La Charente France en route to Salvador Bahia Brazil Sunday, Sept. 13. Follow the updates, including current positioning, on the official race site- 

More about Classe Mini: http://www.classemini.com/

Official 2009 Mini TransAt site: http://www.transat650.org/en/

Chris' Blog: http://usa724-mini.blogspot.com/

Tom Milne helps clients in yachting, expeditions, destination resorts and expatriate communities with medical support in his work at Remote Medical International. A WEMT and international mountain guide himself, Tom has managed expeditions from the Amazon to Antarctica. For more information or questions, contact Tom at +1 (206) 734-3427 or tmilne@remotemedical.com.

RMI Legal Counsel Phong with Emily (Project Manager for the Medical Support Group) and Bryce (shareholder) at the INC 500 celebration.

Integrated Operations Director Christine Avakian recalls the days of RMI when Chris (to her right) and Andrew (CEO) shared a desk and phone in a small 100 square foot office.

While at the party last week, I was taken aback by the friendships, teamwork and focused execution that has become a cornerstone of the RMI culture and it is a privilege to work with such a competent and interesting group of people.

It was also an opportune time to recall our history and truly appreciate what we have become.  During a toast, Christine Avakian, the third employee hired at RMI, recalled the time when I shared a desk and a phone with Chris Kenney (Director of the Equipment & Supply Group) in a small 100 square foot office.  With operations in 6/7 continents and all of the major oceans, it is easy to forget where we started and that it wasn't all that long ago.

It has truly been an honor to work both with our staff and our clients.  We will continue to move along with the mission of providing peace of mind for our clients operating in the worlds most austere and extreme places. We will also grow only as fast as we can effectively deliver our products and services at the level of quality that you can count on from us.

Thank you for helping us get there.

Kind Regards,

Andrew

RMI Instructor Kate Earle acclimitizing with the locals near Mt. Muztagh AtaWhen one thinks of two-humped Bactrian camels in Central Asia, one might imagine them as docile beasts of burden plodding along golden sand dunes. Well, not on this day. Somehow I found myself evacuating a 17 year-old male with altitude sickness in the shadow of Mt. Muztagh Ata's (24,758 ft.) glaciers on the back of a camel that was anything but docile. The camel bellowed, stomped, and actually broke free of its nose ring while crossing a treacherous glacial river (with my patient on his back) as if to announce that he would like to go back to the desert.

Before I sound ungrateful to the camel's aid, let me mention how necessary and grateful I actually was (and am). That morning, one of my students woke me up in my tent before dawn with projectile vomiting, ataxia, and a severe headache. By the time the sun rose and illuminated a landscape of white canvas nomadic tents, yaks, camels, and melting glacial streams, the male patient was lying heaped on the ground. It became evident that an evacuation would be necessary. Like all medical emergencies, I calmly inventoried my resources: five camels, two local guides, two cell phones with spotty coverage and nearly exhausted batteries, Diamox, a telemedicine subscription, and ten other bewildered and scared looking students. "It could be worse," I thought. It was no sooner that I said this when the hail began to fall. Suddenly the camp site looked less like a site for sleeping and more like an angry snow globe meets and even angrier pinball machine. I reminded myself that unexpected weather in the mountains can just as unexpectedly stop and after about 30 agonizing minutes, it did.

The complications didn't end there, regretfully. I was guiding a group of predominately North American students along the Silk Road and we had just begun our high altitude trek in the snowy Pamirs along the China / Pakistani border. Due to severe ethnic riots and conflict, China had shut down outgoing cell phone calls, text messaging, and Internet in Xinjiang province. Furthermore, border checkpoints and police checkpoints would slow any effort to get out of the mountains via the infamous Karakorum highway.

K2, the camelMeanwhile, the patient got sicker. The local Kirghiz nomads earnestly attempted to coax him to eat sour yak yogurt (a traditional remedy for AMS). The telemedicine doctor and I finally broke through on the telephone line and confirmed administration of 250mg of Diamox and immediate descent. It was deemed the strongest, most sure footed camel (affectionately named "K2" with his white color and icy "don't mess with me" attitude) would be the camel for the job.

But how does someone with poor balance and coordination manage to balance on a camel over steep and rocky terrain at a pretty good pace? We tied the patient loosely to the camel's front hump with a quick release knot and assigned two people to spot either leg of the patient and another two to spot the Camel on particularly steep parts of the descent. The local guides and I took turns leading K2 by the nose and enjoying the relief that K2 was acting patient and reliable and that every step to lower altitude was a step closer to stabilizing and improving our patients condition.

As a Wilderness Medicine Instructor, I constantly remind students there are unpredictable variables that can occur in a remote emergency. As the evacuation progressed, I smiled silently to myself thinking that somehow, this long and complicated morning was a mere test. Limited communication, challenging environmental factors, limited resources... remote medicine is about pulling out the stops and making it work. It is about adapting creatively to the situation at hand and giving up on the "ideal" situation. You have what you have. Critical moments can't be spent wishing you had taken another route, had a better phone battery, or were not trekking in a police state during severe political unrest. As I led K2 (the desert camel) through melted snow, we both breathed quickly to compensate for less barometric pressure and O2 per breath, I realized there is something to be learned from a misplaced camel at altitude. Be adaptable. Be steady. Patient, camels, and support work their way towards lower altitudesRemember that you carry much of what you need within yourself to deal with any environment and any emergency. Maybe you would rather be in the desert amidst rolling sand dunes instead of this oxygen deprived and cold hail storm, but guess what? You aren't! So you better make the best of it. Who would think that a camel at altitude could teach you such a simple but critical lesson about wilderness medicine? Especially one that spits and bellows.

These are lessons I will bring home to Seattle after six weeks of managing AMS, dehydration, heat illness, and orthopedic injuries while guiding students through some of the most dramatic landscapes on earth along North West China's Silk Road. Wilderness medicine skills go far beyond splinting and bandaging. They are the skills that help you manage the situation when four policemen armed with machine guns come into the yurt at midnight and are yelling in a language you don't understand. They are the skills that allow you to stay calm when a student is taken by ambulance to a Swine Flu Quarantine hospital for spiking a fever in Beijing at the time of a global pandemic scare. They are the skills when you suddenly find yourself in the middle of a lightning storm at the top of the highest sacred Tibetan peak where seconds count and the wrong decision could be disastrous. My experiences this summer have only reconfirmed my commitment to training people in these critical skills and I look forward to returning home to do it.

First, however, I am off to ride a horse across part of Mongolia's empty desserts, snow capped mountains, dramatic gorges, and grasslands to continue to live wilderness medicine as a philosophy as much as a practice.

RMI Instructor Steve Guthrie (center) poses with his new ice axe and two Marine Corp students.Every individual ice axe is customized primarily by the Marine that will present the award. There have only been 2 occasions where this award was presented to anyone outside of the Marine Corps. The first was to the U.S. Army 10th Special Forces Groups Mountaineering School. The second, and the only time it has every been awarded outside of the military, was to Steve.

Michael Truax, who presented the award, stated, "It is important to recognize the effort outside agencies make to facilitate our training. Steve, and RMI, definitely went out of it's way to make sure we were taken care of."

Steve tells us.. "I am deeply honored in receiving this award. It reflects not only individual achievement but also the excellence of the program and the hard work and dedication of everyone at Remote Medical International."