Malcolm Roberts was thousands of miles from the nearest hospital once he suffered serious gastrointestinal bleeding. Might a team of doctors make it with time to conserve him?
In so late April 2015, Tim Nutbeam to be smuggled onto a airplane carrying a huge bag of blood to attempt a rescue mission in Antarctica. It to be the beginning of winter when the continent is draped in practically total darkness and extreme cold, no to cite frequent high winds. Due to the danger conditions, there are normally no reserved flights throughout the 6 months the winter.

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But Nutbeam, a consultant in emergency medicine based in the UK, walk ahead v the journey, join by a pilot and engineer.

Their mission to be to save the life the a critically okay worker on an Antarctic base. Malcolm Roberts, an technician for british Antarctic Survey, had actually suffered a massive gastrointestinal bleed in ~ the Halley study Station work before. He was countless miles far from the nearest hospital.

Roberts had lost a most blood yet had endured the very first 24 hours. If they acquired to him in time, there was a opportunity that he would live – yet there to be many obstacles that could prevent castle from conserving their patient.

The flight to Halley would certainly take around 24 hours with one protect against to refuel in Rothera, another base on the Antarctic peninsula, before making the exact same journey back, an interpretation they would certainly be flying for around 48 hours straight. And also on the method back, they would have actually to deal with a medical emergency at the exact same time, having actually had small sleep or rest.

Saving the patient’s life was difficulty enough. However on optimal of that, exactly how would Nutbeam have the ability to handle the mission psychologically?

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Initially, the wasn’t also meant to go on the trip. Nutbeam was supposed to it is in the back-up medical professional on the mission. Once the emergency emerged he had flown into Punta Arenas, a town close to the southernmost guideline of Chile. The setup was that he would be stationed there to help after the airplane landed.


But when a volcano erupted phibìc of where he was, whatever changed. The lead physician was waiting for a connecting trip in Santiago but all flights to be cancelled. At the exact same time, there was a rarely break in weather across the Drake Passage, the body of water between southern Chile and also Antarctica, where visibility is regularly poor. “I all of sudden realised the I would be going,” says Nutbeam. “It was too good an opportunity to wait.”

Nutbeam admits that every little thing happened so conveniently that he didn’t think much about the potential risks at the time. Instead, he remembers feeling excited about getting to walk to Antarctica and also do the rescue.

Extreme personalities

There have actually been few medical evacuations during the Antarctic winter. In 2016, one ill worker was airlifted native the southern Pole mid-winter – once there space 24 hours of darkness – while an additional patient rescue took place from the main US study base in 2010.

According come Nathan Smith, a psychology researcher in ~ the UK’s college of Manchester, civilization who take component in too much expeditions often are urged by the chance to carry out something that no many human being do. “They are often highly trained for this reason it’s an possibility to check their skills out and also do a task they haven’t excellent before,” the says.

Certain personality varieties are far better able to attend to the stress and anxiety of excessive expeditions. Research study has presented that world who are less neurotic carry out better. “What we see is that world in high-risk jobs are not conveniently anxious and when they are, they room able to control it quite well,” claims Smith.

Conscientiousness also play a role. A research looking in ~ the personality traits of human being willing to take a parabolic flight, for example, discovered that conscientiousness allowed them come cope better with too much demands. This goes versus the usual notion that world who take component in extreme activities are adrenaline junkies. “What we discovered is that people typically spend a lot of time de-risking,” states Smith. “They carry out a lot to avoid having actually an adrenaline rush because to them the signals a threat.”


Nutbeam and also his team had to it is in diligent to attend to the difficulties they faced during the long journey. Throughout the trip, because that example, Nutbeam had to screen the temperature of the bagged blood, ensuring that it continued to be within a narrow optimum range. The prior of the plane, whereby the team was huddled, was retained warm, but it was about -10C in ~ the back. “I had to shot and uncover a sweet point out to placed the blood and also had to check on that every hour,” he says.

The team landed in Halley simply as dawn broke and also had around an hour and also a half to retrieve Roberts prior to it would be as well dark to take off again. It was -30C without the windchill factor. Nutbeam took a snowmobile come the station where he effectively performed what is believed to be the first Antarctic blood transfusion ~ above Roberts and also transferred him to the plane. Meanwhile, the engineer kept the plane’s engines functional, since if they got too cold they wouldn’t be able to start increase again.

Nutbeam claims that nothing to be meticulously planned due to the unpredictable circumstances. His strategy was to “wing the in an informed way”.

After interviewing expeditioners, Smith and also his colleagues found that extreme planning to be less crucial than having actually confidence in one’s skills. “Then it comes down to being flexible and adaptable and being able to adjust to the case as it unfolds,” he says. “There are many things you can’t regulate so gift able to accept that is yes, really important.”

Sleep deprivation

Even a mix of expertise, conscientiousness and confidence can not make up for maybe the best challenge: the excessive sleep deprivation the the 48-hour flights. Nutbeam states that that slept for about four hours over the food of the mission. “I simply wasn’t functioning together a human,” that adds.

Microsleeps – rapid bouts that shut-eye that can last in between a portion of a second and 30 secs – can assist the body recuperate. “The brain finds means to capture up on sleep in short bouts if it can not otherwise achieve the sleep the needs,” claims Hans van Dongen, the manager of the Sleep and also Performance Research center at Washington State university in the US.

However, microsleeps reason lapses in attention that influence performance – if they happen while driving frequently resulting in car crashes for example.

During the long flight earlier to Chile, Nutbeam was so tired that he had trouble recalling clinical knowledge and making choices. And that posed some major dangers, offered that Roberts’ problem required consistent monitoring and there were necessary medical decisions to it is in made. Around Rothera, for example, they required to be flying high to pass the tall hills below. Roberts, however, had a short circulatory blood volume as result of his bleed, which affects exactly how long he can tolerate high altitude there is no the require for much more blood.

“I essential to do a decision around Malcolm’s care and just can not decide,” says Nutbeam – one unfamiliar sensation because that him. “I am usually pretty realistic in mine approach and also don’t struggle with decisions.”


Sleep also plays a function in regulation emotions and can impact mood: the emotionally centers in the mind are less connected when a human hasn’t had sufficient rest so it’s more difficult to manage one’s feelings. Together a result, sleep-deprived human being can be overly grumpy or giddy, says Von Dongen.

And this would certainly be an additional an obstacle to Nutbeam’s decision make when, at a later suggest in the flight, Roberts endured a stroke. Nutbeam had actually to give him much more blood as well as fluid and also medication to stabilise him. “I remember feeling rather emotionally overwhelmed,” states Nutbeam. “He must have actually been feeling terrible yet was very stoical.”

Understanding the results of sleep lose can aid people cope, says Smith. “People have the right to prepare because that it and think about how it might shape their decision-making,” he says. Nutbeam claims that the knows the he is much less tolerant when he’s tired, which could have helped.


Nutbeam was likewise fortunate to have a devoted team that assisted to save his sleep-deprived mental in check. In enhancement to the team board the plane, there was a remote support network keeping a near eye on your journey native afar. 

During stopovers, as soon as they were able to communicate, colleagues abroad educated the team of weather conditions to assist ease the logistical decision making.

Nutbeam likewise had continual debriefs v his boss in the UK about treatment and what to do in assorted circumstances.

When the aircraft landed in Rothera, for example, Roberts had one more gastrointestinal bleed. There was a physician there to help. Yet Nutbeam didn’t desire to leaving Roberts, even though he to be exhausted.

A call from his boss in the UK placed things in order. She told Nutbeam to let the neighborhood doctor take over so he can get some sleep: he to be the only one that could look after Roberts during the remaining flight. “It was the finest advice in the world,” says Nutbeam. “Otherwise ns think i would have stayed v him and been even much more tired and psychologically broken for the final leg the the journey.”

Tense cases can be simpler to manage when there are others around. “Being in a dangerous environment surrounded through competent people who space supportive is a great way of mitigating stress,” claims Smith.

It all counts on the team dynamics, though: if world aren’t may be to occupational well with each other it can have a an unfavorable impact on the functioning of the group. Personality properties – in certain agreeableness - can regularly predict who will be a great team player. “People that have to work in small groups in risky setups tend to be good at getting on v people,” claims Smith. “They are good at communicating effectively and maintaining team function.” 


After the last flight indigenous Rothera, the aircraft landed in Punta Arenas, Chile. Roberts was moved to a hospital wherein he was properly treated. Yet Nutbeam no feel favor the mission to be over yet. “I really didn’t want to allow Malcolm go,” the says. “I wanted to go with him come the hospital also though I could hardly string a sentence together.”

Expedition groups often have similar reaction as soon as they return. After having actually lived with an intense suffer together, over there is a feeling of empathy among those who were there, claims Smith. That can likewise be difficult to interact what that was favor to civilization who weren’t present so there is a propensity to be attracted to those who shared the experience.

Nutbeam had the ability to visit Roberts regularly at the hospital and also there was a day-to-day meeting around his recovery which slowly helped him readjust.


According come Smith, human being often reflect ~ above what happened and also what could have taken place for about three mainly afterwards. After ~ playing vital part in a mission, people may feel favor they have actually no purpose when they return however finding something meaningful to do can ease the transition.

“Writing a report or placing your experience right into a story is really helpful psychologically,” says Smith.

New varieties of training could aid too. Civilization working in extreme environments, such as astronauts or military workers, carry out a lot of simulations together preparation. However according to Smith, it’s rare to have actually training the focusses top top the psychological facets of a mission. “It appears a little like absent a trick,” he says. “There is a many that might be done to equip world with tactics to resolve these environments.”

In a sense, the rescue was just a much more extreme variation of what emergency room doctors encounter every day.

As a transaction strategy, Nutbeam proposal mentally rehearsing occasions beforehand as soon as well-rested. “This can prepare her mind for the insult of sleep deprivation,” that says.

Upon reflection, Nutbeam isn’t persuaded that he would take component in such a mission again. He had mentally ready himself to be the back-up physician so hadn’t analysed the risks affiliated beforehand. Currently he realises the there to be a far-reaching chance the they can have been stranded or suffered harm. “It’s nice come reflect ~ above a successful rescue but there is a need to take into consideration all the methods for the to go wrong and also was the risk justified,” that says. “I’ve still no quite gained my mind roughly that.”


Tim Nutbeam talked around the expedition for the first time at the World excessive Medicine conference in Edinburgh in November 2018. Sandrine Ceurstemont is a freelance scientific research and modern technology writer.

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