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The Expedition Committee is meeting with expeditionary medicine practitioners to put together the Cowboy Coffee interview series to learn more about the ups and downs of expedition medicine. For this edition of Cowboy Coffee, David Wilson caught up with Dr. Henderson McGinnis. Dr. McGinnis has a long history in expedition medicine ranging from his experiences in the military as well as a whitewater rafting guide for private and commercial expeditions. When Dr. McGinnis isn’t on the river, he is an Associate Professor of Emergency Medicine and the Wilderness Medicine Fellowship Director at Wake Forest University School of Medicine.

How did you first get involved with expedition medicine and how would you recommend a newcomer get started in expedition medicine?

It was actually wilderness medicine and expeditionary medicine that brought me to medical school. It was my time in the military and working as a commercial raft guide that gave me my first exposure to expedition-style medicine. I remember thinking it was going to be super easy: I’d go to medical school and learn to do everything I need to do medically out in the wilderness so people will invite me on these trips and I’m going to have a great time. Then you realize that medical school and residency are super busy. You don’t have the time to get out and do all of these expeditions. But you have days here and there… and the skills you really need for success in expedition medicine aren’t taught in medical school or residency. They’re skills you learn by handling yourself in a wilderness environment. Everyone wants to learn how to build a traction splint out of Nalgene bottles, paracord, and some toothbrushes, but the skills that are most important are basic wilderness life skills: providing yourself with shelter, knowing how to stay warm and dry, and navigating your terrain. These are skills that you can work on when you have a free day here and there and that will make you more capable on expeditions.

What types of expeditions are you involved with?

Before anything else, I was in the military, and that’s its own area of expedition medicine. When I was getting out of the military, I had never been on a commercial whitewater rafting trip, but one of my partners in the military had been a river guide before the army and said, “We should start a rafting company.” So I said, “Okay!” We bought rafts, he taught me how to be a guide, we got our certifications, and started working. We weren’t great businesspeople and our company went under, but we both continued working for other companies as raft guides. I worked as a raft guide on the weekends throughout undergraduate school and the first two years of medical school. Nowadays, my expeditions are in private groups and we mainly apply for permits on rivers out West.

How often are you on an expedition? What do you do when you’re home?

I try to go on at least one expedition each year that has a special meaning for me. It’s not always a multi-day river trip. I’ve had really meaningful expeditions going out camping and visiting National Parks with my kids. Fortunately, for the last several years my group has been pretty lucky to get permits for some incredible rivers. We all apply for similar dates and cross our fingers that someone will get a permit. This year, we have three permits that’ll give us two weeks out on the river. When I’m not out on an expedition I try to do day trips here in the Southeast when possible and do everything I can to stay in shape for when I get on the river.

Could you tell us about any near misses or big learning moments you’ve had?

On one of our Grand Canyon expeditions, we were pulled off at one of the few spots with access to clean water and to check for mail. Another group was there and someone from that group came up to me and said, “They told me you’re a doctor…”; this can be a terrifying thing to hear. He showed me a bandaged hand telling me he had smashed it in an oarlock the night before. He had what looked to be an open fracture. I offered to clean it out and told him he should hike out from here and his trip is over. He said that wasn’t an option: this was a trip of a lifetime for him and he had to finish. When you’re practicing medicine on an expedition there are certain decision points where there isn’t much margin for error and you need to make more conservative decisions. We were at a point with road access but in a few more hours we would be a week from having that same access. I told his group my concerns, gave him a course of antibiotics (now I pack two courses of antibiotics in my medical kit), and watched him paddle down river. His group ended up taking out a day or two early because he had started to have some fevers and was feeling pretty under the weather. From what I understood he ended up having emergency surgery as soon as he got home.


How do you prepare for each expedition?

Once I know the where, when, who, and weather of the expedition, I can start packing. Based on those things I can prepare my medical kit anticipating the potential illnesses and injuries. Of course, there’s always an element of medical screening before an expedition. On a commercial expedition it’s very easy: We have people fill out forms and ask them what medical conditions they have. In private groups it can be tougher. For most expeditions, I’m the de facto medical person, and I know some of the people very well, but others not quite as well. They may have some medical things they are not comfortable sharing with me. What I’ve started to do is have each person write down on a piece of paper their past medical history, current medications, allergies, and an emergency contact person, then put the paper in an envelope and seal it. We keep those envelopes in our group medical kit so that we have it in case of emergency, but it allows our group to maintain some privacy. I also let everyone know ahead of time that if anyone has any questions or wants to talk about what they need to bring from a medical standpoint we can talk offline. That gives someone with asthma enough time to go to their primary doctor and get a course of steroids and extra inhalers just in case.

Are your participants generally well prepared? What do you do to get them ready?

I feel like the first time you go anywhere new people are simultaneously overprepared and underprepared. They bring a ton of stuff, but none of the right stuff. I always err on giving as much information as possible to let people be honest with themselves and their level of fitness to take on these expeditions. In addition to the “medical screening” we talked about, for any trip longer than ten days I always recommend that everyone has had a physical in the last year and has been to the dentist in the last six months.

What’s been your best trip? Worst trip?

I always think the next trip will be the best trip. My first Grand Canyon expedition was incredible and my last Grand Canyon expedition was really meaningful because we had a memorial service for a good friend of ours who had died. When I was younger, I thought that to be a great trip it had to be an epic, weeks-long journey out West, but as I’ve gotten older, I appreciate every daytrip or overnight as an opportunity to recharge.

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