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Dr. Will Duffin - Joint Medical Director of WEM

In August, we brought you a Guest Blog from Mark Hannaford, the founder of World Extreme Medicine. This month, it’s the turn of another of the key WEM faculty members… introducing Dr Will Duffin.

Hello everyone, I’m Dr Will Duffin and I’m a GP in Devon in the UK. I’m the Joint Medical Director of World Extreme Medicine (WEM) and the Lead Medic for the US CBS TV show ‘Survivor’ - for Seasons 43, 44, 46 and 48, which is also through WEM. 

Extreme Medicine is healthcare that is delivered across the full spectrum of remote, austere and challenging environments. This includes high mountains, deep oceans, jungles, deserts, polar, low earth orbit and refugee camps… the list is endless. 

Being a part of the wider Extreme Medicine community through WEM has been a portal into new worlds of possibility and opportunity in my medical career as an NHS GP. It’s a huge privilege to treat patients in a remote setting. You get to do proper ‘hands on’ medicine that truly tests your clinical skills, risk management and decision making. Even basic techniques and principles done well can transform patient outcomes. That’s the big reward.

I graduated from Bristol Medical School in 2008 and completed my GP Training in Cornwall, UK in 2016. In between, I spent 18 months in Australia to gain as much emergency department experience as I could, whilst doing Wilderness Medicine Courses. 

I landed my first expedition gig 12 years ago when I was post-FY2 (Foundation Years follow on after qualifying as a doctor). I covered a Kilimanjaro Trek after another doctor dropped out at the last minute. Once I had this under my belt, I was able to leverage this experience to get the next trip. So, I soon found myself providing regular medical cover for various commercial and charity sector expeditions. 

These expeditions have taken me all over the world: Kilimanjaro, the Peruvian Andes, the Himalayas, Northern China, Eastern Europe, Myanmar and Madagascar. One highlight was working as the private doctor for a Luxury Trans-Siberian Train! Though I became frustrated having to constantly wrangle annual leave to go away, so I made the switch to being a freelance (locum) GP, which has given me the flexibility I need. 

I joined WEM in 2018 after responding to a Facebook Ad for the ‘Survivor’ job. I was invited to a selection weekend in the Peak District, which is when I first met Mark Hannaford WEM founder and CEO and Dr Joe Rowles, WEM’s other Medical Director, and it all went on from there. 

Early on, I was given the opportunity to lead on the content for the annual World Extreme Medicine Conference and our various podcasts and webinars. Through doing this, I have met a colourful cast of characters; other extreme medics who are as audacious as they are inspirational! We have a lot of fun at the conference every year, learning from one another. 

(Note from the RSM team – the conference is highly recommended and well worth a visit!)

Here is a snapshot of a typical day when working in my role as Lead Medic for the US CBS TV Show 'Survivor' that is filmed on a remote Pacific island.


The basic premise of the show is 18 contestants battle it out over 26 days to be the ‘sole survivor’ and win one million US dollars.

 

I start the day at 07:00 in our island clinic seeing and treating local and international crew before they head off to work. The bulk of this is primary care; dealing with minor injuries, wound care, diarrhoeal illness and a sprinkling of tropical medicine.

 

We’ve had plenty of challenging cases – including extreme bradycardia due to Ciguatera poisoning and a memorable shark bite. You just never quite know what’s going to walk through the door next, which always keeps our WEM team on its toes!

 

At 09:00 I attend a whiteboard meeting with the challenge team, camera crew, producers and director, in which we preview what’s being filmed that day. Then at 10:00 I’ll check in with the contestants individually in a tent on the side of set, before we then shoot the ‘challenge’ (typically, an obstacle course with some puzzles). Our team is always ready on the side of set ready in case any medical issues arise.

 

The afternoons are made up of meetings, clinic work, the odd visit by boat out to the Tribe Camps and a chance for some downtime. At 18:30 we shoot ‘Tribal Council’. This is when one of the contestants is voted out of the game by their tribe. It’s fun to follow the game as it unfolds in real-time, and I’ve enjoyed learning how the different stories and creative elements come together. Every day is mapped out on a timetable, (the ‘call sheet’) so everyone knows where to be and when. 

Back home I have two kids (aged 2 and 5) and I find that being away from home for longer deployments is hard. It’s particularly tough on my wife while I’m away, as she has to juggle being a consultant paediatrician with single parenting. ‘Survivor’ does shoot on a predictable schedule each year, but most other work in the TV/film industry comes up with incredibly short notice, which can lead to some tricky marital negotiations! But it’s all about getting the balance right. I am very selective about what I take on, so that I don’t neglect my roles as a husband and a dad as I hate missing important family events like birthdays and anniversaries. Sometimes, unfortunately this goes with the turf.

 

There is nothing more satisfying than a successful medevac. It’s often a bit ‘messy’ - you do learn to embrace this - but I love seeing the team switch into gear and perform.

 

Getting a patient ‘in-extremis’ from a wild location to definitive care safely and effectively is a feeling like no other. We have needed to medevac numerous crew and contestants via boat, land and helicopter over the years, and I’ve dealt with head injuries, shark attacks, sepsis, cervical disc prolapse, Achilles tendon rupture, cardiac sounding chest pain and kidney stones.

 

Contestant medevacs have the added challenge that they are filmed and potentially broadcast to a large audience. Over time, I’ve learned to ignore the cameras and focus on the medicine and the patient. But at first, it can be disconcerting to be working with a camera pointing right at you.

 

On expeditions and film projects medical contact can be infrequent. Therefore, skill fade is a big problem and these are the top three things that have helped me:

 

1.      Regular, targeted CPD – e-learning, reading journal articles, attending courses. I’ve recently completed PHTLS, ALS and RTACC which are all simulation-based and extremely relevant.

2.      Keeping up the day job. Getting plenty of patient contacts as a GP back in the UK, as well as being a GP in ED, helps me maintain my clinical skills. 

3.      Team simulation – I’m a big believer in simple, low stakes, low fidelity micro-sims during any down time. I think this is something we should all be doing as often as possible.

 

Here’s an article and Instagram video that help to explain more: https://worldextrememedicine.com/blog/extreme-medicine-posts/train-hard-fight-easy-the-benefits-of-in-situ-wilderness-simulation-training/


Self-care is a vital component of being an effective medical practitioner in any setting (extreme or otherwise) and it’s so important to know how to clear your head. I’m a firm believer that we all have a duty to put back in what the day takes out of us, so that we can bring our best to each and every patient encounter.

 

When I’m on an expedition or film project, I try to make time for a few minutes each evening of meditation and journaling. This helps me to process and regroup. I’ll typically take a pair of trainers and some swimming shorts with me wherever I go. A run and/or wild swim is pure therapy. If space allows, I also like to pack a small travel guitar; that’s a great release too.

 

A humble pair of nitrile gloves is always stashed in my pocket. When responding to an incident the first thing I do is take a moment to put these on. This serves three functions: it’s essential PPE; it gives patients confidence that I know what I’m doing; and it’s also my ‘thinking time’ while I do my scene survey. The main pitfall here is when your palms are sweaty, and the adrenaline is flowing, they can be an utter pig to get on! (Pro tip: always go for ‘powdered’ gloves!).

 

We do a lot of boat transfers between islands and during ocean-based challenges on ‘Survivor’. These are small, fast RIBS and open boats. By far the most common ailment I treat under these conditions is sea sickness and I’m a big fan of buccal or oral prochlorperazine (Stemetil) it’s effective and versatile. In the US, Dimenhydrinate (Dramamine) seems to be a popular choice, so I have a stash of both on my person ready to dispense. 

 

In terms of my favourite reference book or app, please can I have four?

It would be a toss-up between the BNF, MDCalc, JRCALC and Auerbach’s Field Guide to Wilderness Medicine – I couldn’t live without these! (see links at the end of the blog).

It’s hard to pick just one piece of great advice that I’ve been given. I’m a bit of a magpie; always hoarding nuggets of wisdom from those around me. Here’s one from my WEM colleague and Space Medic (and newly appointed Virgin Galactic Science Astronaut) Dr Shawna Pandya that really resonated with me is this: ‘If you’re not experiencing rejection then you’re not playing in the right league!’ You can follow Shawna here https://www.instagram.com/shawnapandya/?hl=en.

 

There are some great opportunities out there for medics, but they aren’t always easy to find. You’ll need to be a self-starter. You will need grit. The inevitable setbacks along the way will test your character.

 

My advice? Find your own niche. Ask yourself what do your interests and skills align with? What really makes your heart sing? Perhaps that’s Dive Medicine, maybe it’s working in Conflict Zones or Conservation Medicine and One Health? It helps to have a focus (at least to start with). Seek out relevant courses and start to build up your knowledge and experience. The WEM extreme medicine courses are a great starting point https://worldextrememedicine.com/extreme-medicine-courses/.


Google companies, NGO’s and organisations that do the kind of thing you’re interested in, find a contact and start firing out emails (and lots of them!) It's a numbers game so you need to be persistent. Put yourself out there, don’t wait for others to come to you.


Each one of my mentors has at some point told me to keep going, which is sound advice because finding those unique opportunities takes time. You will face rejection, but remember you are always growing, always learning. Be kind and courteous and give others a leg-up wherever you can. Eventually doors will start to open for you.


Luck doesn’t just happen. Luck = preparation + opportunity (+ luck!).

 

Finally, I’d have to say let other people go for the easy stuff. Don’t be afraid to fail and always follow your heart.

 

Good luck and I’ll see you out there!

Huge thanks to Dr Will Duffin for this pretty awesome blog and we hope you’ve enjoyed it as much as everyone at Red Square medical HQ.


We’re fascinated by the world of extreme medicine as it’s part and parcel of what we do every day in our maritime world. If you’d like to find out more about Dr Will, please use these links and make sure you check out the incredible WEM conference in November.

 

 

Book and App References:

 

 

James Griffiths - Guest Blog

by Rachel Smith • 6 November 2024
Welcome to our latest guest blog where we’ve been chatting to James Griffiths, General Manager of Ocean Operations for Scenic Group and finding out more about what happens behind the scenes in order to keep a fleet of luxury expedition ships running. Here’s what James told us… As General Manager of Ocean Operations, I’m responsible for the operations of our fleet which includes four ships in service with around 850 colleagues. I currently live in Mumbles, near Swansea in the UK, but due to the nature of my work I spend a significant amount of time living in Croatia. Prior to this role, I spent many years working at sea and worked up through the ranks to Captain and over the last 15 years, my main focus has been on polar expedition travel. I hold a master mariner certificate of competency in addition to a degree in engineering and a post graduate diploma in law. Part of my job is to work with our medical service provider (Red Square Medical) to ensure that our ships are offering medical services that are appropriate for their deployment, and this can often be to some of the most extreme and remote locations around the world. It’s extremely varied, though during the COVID-19 pandemic, I came ashore when our operations paused for a significant period of time. I was fortunate enough to be given the opportunity to lead the restart of our Ocean Operations, which included setting up everything from a company to manage the ships, to selecting our crewing, medical, helicopter and submarine partners and providers, amongst many other things. Our areas of operation, and the nature of our cruises (expedition), plus having aircraft and submersibles onboard some, do mean additional elements involved in the management of these ships. You could say that this current position is more of a happy coincidence than one that I actually planned for! In some ways this is a great positive - I do think it’s possible to plan a little too much and then be disappointed if things don’t go quite the way you had imagined. But there’s no danger of that here!

Paramedic on tour - Simon Lawton heads to Mexico

by Rachel Smith • 3 October 2024
Back in February 2022, we brought you one of our very first guest blogs from Simon Lawton, a Paramedic who has swapped out his ambulance for a Superyacht! You can read the original blog here: https://www.redsquaremedical.com/superyacht-paramedic-a-guest-blog-from-simon-lawton Over the last 2+ years, we’ve followed Simon’s career, and some of you may even recognise him as he does put a Red Square Medical instructor hat on from time to time. But, as for all healthcare professionals, Simon has to keep his skills up to date. So, we asked him to tell us a bit more about how he juggles this along with a rota onboard. Here’s what he told us… I’m originally from Stoke-on-Trent in the UK and trained as a HCPC registered Paramedic. I’ve spent almost 5 years working at sea now, with almost continuous employment on three different vessels, after leaving the ambulance service in 2019. My first role was as a Paramedic/Deck hand on Superyachts, and I now work as a Medical Officer on a maritime vessel. Even before I applied to become a Paramedic, I intended to complete my studies to help find employment in a remote or offshore environment. I had always been attracted to the idea of being able to travel the world while earning a salary. Working at sea has meant that I have travelled extensively, earnt a higher salary, and have a better work/rest balance than would be possible in a role on land. Note: At the time of writing, a qualified Paramedic’s starting pay in the UK was £28,407 and Simon’s old rota was 2 days, 2 nights (all 12 hours) and 4 days off with very inflexible annual leave. This year I decided to carry out some continual professional development (CPD) at a hospital in Mexico, to keep my skills up to date. I was interested in travelling to find out more about how healthcare services are provided outside the UK and Europe. The CPD activity in Mexico allowed me to do exactly that, while caring for and treating a wide variety of patients who had either self-presented in the emergency department, or been conveyed to hospital by ambulance.

Inequalities in CPR on Women

by Rachel Smith • 25 September 2024
Welcome to our September blog, and as we all start (in the UK at least!) to think about adding a few layers for warmth, we’d like to talk about getting naked! Well, to be more specific, getting bra’s off. Fact: Women are dying because bystanders are less likely to carry out CPR on women than men. Research shows that women are 27% less likely to receive CPR than men and if a defibrillator is used, their chance of survival is affected by bra’s being left on. Most of us have never had the chance to train using a female manikin. The #BraOffDefibOn campaign aims to address the inequality in CPR for women and we’re supporting it.

Mark Hannaford - Founder and CEO of World Extreme Medicine

by Rachel Smith • 5 August 2024
Last year, the Red Square Medical team descended on the World Extreme Medicine (WEM) conference for the very first time. We’d been aware of this unique organisation for many years, but just not had the chance to get involved. Liz was involved in a panel discussion and spoke at the conference, and we came away literally buzzing with enthusiasm - our first impressions were that WEM is a place with no ego’s, where everyone wants to learn, and is willing to share. We met some of the most fascinating people ever and can’t wait to go back this year. But what about the person who started it all… We spoke to Mark Hannaford, founder of World Extreme Medicine and its far reaching impact. Here’s what he had to say. I’ve been involved in expeditions, working in low resource environments and extreme medicine for the past three decades! My family was made up of generations of seafarers from Cornwall although I was brought up variously in Devon, Antigua in the Caribbean and the Middle East; reflecting my father’s job as a Master Mariner. My father was at one time the youngest captain aboard the UK’s largest registered vessel, and my grandfather was Harbour Master for Malta and the first in that role in Plymouth at the start of Queen Elizabeth’s reign. I wear a number of hats but primarily I am the founder and CEO of World Extreme Medicine, and the annual WEM Conference. I also founded the MSc in Extreme Medicine at the University of Exeter and Graduate Certificate program at Bouvré College of Health Sciences, Northeastern University, Boston.

Women's Health

by Rachel Smith • 3 July 2024
Women’s health is a huge topic, while it’s true that in the maritime sector women make up just 2% of seafarers at sea, up to 34% of the shore based staff are female. Looking at the bigger picture, women’s health directly affects just under half of our population globally, and indirectly (whether you like it or not!) the other half, we thought it was worth a blog about some of the issues, and the taboo’s, that could be affecting our maritime workforce and the women in our lives. It's common knowledge that women experience huge hormonal changes at puberty and menopause, both of which can have significant physical and mental health impacts. In the UK, there is a growing discussion and openness about peri-menopause (the years before periods stop altogether) and how for some women, this has devastating effects across all aspects of their lives, including work. Of course men experience changes at puberty, but their later life changes are less significant and generally don’t affect their ability to work. In December 2023 the World Health Organisation (WHO) issued a statement to advise that every year, at least 40 million women are likely to experience a long term health problem caused by childbirth. So there’s a good chance that we all know one or more women affected, or if you are female… this could be you. As part of a special series on maternal health, the study showed a high burden of postnatal conditions that persist in the months and years after giving birth. These issues include more than a third of women experiencing pain during intercourse, urinary incontinence (8-31%), anal incontinence (19%), anxiety (9-24%), depression (11-17%), perineal pain (11%), a fear of childbirth (6-15%) and secondary infertility (11%). All in all it doesn’t paint a great picture of life after childbirth for some women. If any of your workers experience these issues, either on or off shore, it could have a significant impact on areas of their working life and it’s something they may be reluctant to open up about. Even before childbirth, we may take it for granted that contraception is available, certainly in the developed world. But in developing countries where sexual violence is not uncommon, contraception is considered lifesaving due to the high level of unsafe abortions carried out. Around 13 million women (and girls) under 20 give birth annually and complications in the pregnancy and birth is a leading cause of death. Consequently abortion is an option, but this carries its own huge risks.

Guest Blog - Wendy Sullivan

by Rachel Smith • 25 June 2024
We just love speaking to and finding out more about the people who inspire us and we guarantee that this month’s blog will not disappoint! We first got in touch with Wendy Sullivan via LinkedIn and thought she seemed like a pretty awesome human. Wendy and her company, Maritime Medical Solutions in Australia, certainly share the same outlook as Red Square Medical. Fast forward a couple of years and we’re now collaborating on a project in Australia and the Pacific Islands. What we’ve learnt along the way is simply fascinating and Wendy has kindly agreed to share her story with us… Here is Wendy’s Guest Blog: I was born in Canada, grew up in Africa and now call Australia my home. I feel lucky to live in paradise where the weather allows us to be on the water year-round. I had to work hard to gain my Australian citizenship and I credit my work in the marine industry with giving me a pathway to stay in Australia permanently. It took years of hard work and uncertainty to gain my residency and is still one of the achievements I am most proud of. I started sailing in Canada and since emigrating to Australia gained my professional and commercial qualifications as a vessel master, marine engine driver, trainer and assessor. I also have a Diploma of Paramedical Science, ship masters medical qualifications, business administration and development and there is still so much more to come.

Safety of Lives at Sea

by Rachel Smith • 17 June 2024
Working at sea can be one of the most rewarding and fulfilling careers. But you can’t gloss over the fact that it can be dangerous. Whether you’re working on a tanker, ploughing up and down the oceans, a Superyacht enjoying a busy season of charters, or any vessel in between; our love/hate relationship buddy Neptune takes no prisoners! The Safety of Lives at Sea (SOLAS) Convention in its successive forms is generally regarded as the most important of all international treaties concerning the safety of merchant and other vessels. The first version was adopted in 1914, in response to the Titanic disaster, and went through several iterations up to 1974. The Convention in force today is generally referred to as SOLAS 1974, as amended. SOLAS regulations cover all areas of safety at sea, including construction, fire prevention and detection, life saving equipment, cargo carriage, navigation, communications and a host of other areas. Regulation 33 of the SOLAS Convention applies to all ships, and places an obligation on Masters to respond to distress calls at sea and proceed ‘with all speed’ to their assistance. Anyone working in the maritime sector, hopes that they are never on the receiving end of this regulation, but we’ve experienced two quite different instances, where the ships we work with have responded and our Medical teams have played an important part in rendering aid.

Telemedicine - access to a healthcare professional

by Rachel Smith • 29 May 2024
This week’s blog is an introduction to telemedicine as although it’s probably been around for longer than you think, you might not be familiar with what’s available to help you. So whether you’re a leisure sailor taking on the ARC; work in commercial shipping, spend your time on a Superyacht, or anything in between, read on for more information… According to the UKs National Institute for Clinical Excellence, (NICE: https://www.nice.org.uk/), ships being on the water for months at a time mean that health can be a life-threatening challenge for sailors and seafarers. Access to healthcare providers has always been one of the most critical issues for offshore crews and it’s worth remembering that the International Labour Organization (ILO), dictates that access to medical treatments and health services should be guaranteed to seafarers in the same way as for people working ashore. Nowadays, telemedicine technology has emerged to improve healthcare delivery in many remote areas where there is no direct access to healthcare services using telecommunication services. Among them, maritime Telemedical Assistance Services (TMAS) have become more readily available and are now considered an integral part of a shipowner's emergency response operations. The advent and uptake of Starlink in both the commercial and leisure sectors can only be a positive from a medical perspective. So, what is Telemedicine? What does it do and how does it work? Telemedicine is a term that’s becoming more and more common in the maritime world. Quite simply, it is the provision of remote clinical services, via real-time two-way communication between the onboard medic (trained crew or healthcare professionals) and/or the patient themselves, and a shore-based healthcare professional, using electronic audio and visual means. The modern history of Telemedicine can be traced back as far as 1905, when a Dutch physician used long distance transfer of ECGs (electrocardiograms) to be read remotely. But as early as the 1920s onwards, radio communications were being used to pass medical information to patients at sea on ships and on remote islands. More recently, the COVID-19 pandemic has brought Telemedicine to the forefront of healthcare. Though we may not easily recognise what it actually is, the majority of GPs (certainly in the UK) and other allied healthcare professionals in the non-acute world, such as Physiotherapists and Mental Health support, have relied heavily on telephone and video consultations since March 2020. A survey conducted by Nautilus International and Martek Marine (2017) showed that a staggering 98% of seafarers believed that greater access to Telemedicine support would save lives at sea. Of those questioned, 68% had been on a vessel that was forced to divert due to a medical emergency and 70% had been on a vessel where there had been a medical evacuation. Emergencies experienced at sea ranged from severed limbs and broken bones, to gunshot wounds, tropical diseases, allergic reactions and sudden cardiac arrest. Whether you’re a commercial seafarer or leisure sailor, it would improve confidence in making a decision on whether an injury, or illness was severe enough to warrant a diversion, or evacuation, if there was a trained medic on the end of the phone or radio. Ever improving communications also means that we can now go far beyond voice calls. Photos of injuries, files of test results and even live streaming is all possible and helps to provide a much more indepth service. Our own team member, Rachel, received Telemedicine support via SatPhone and email, on a 7 metre Ocean Rowing Boat (yes, you did read that right!) in the middle of the Atlantic, when her rowing partner developed a painful injury. Remote intervention from a Doctor onshore helped to maximise use of the medical kit contents for the short and long term, rule out immediate worries of infection, and develop a pain management plan for the rest of the rowing race. One in five commercial ships a year are forced to divert for a medical emergency, with unknown numbers of other, non-commercial vessels on top. So there is also consideration for the cost and time involved, plus the stress to both the patient, and their medic who is managing a situation onboard, possibly alone!

Guest blog: Jordan Lin

by Rachel Smith • 8 May 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!

That Lightbulb Moment!

by Rachel Smith • 24 April 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.
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