Adventures — 10 September 2014 at 1:16 pm

Vintage Cars meet Medicine: from Peking to Paris

Dr Andrew Buckley / CT2 Acute Medicine, Bath

The Peking to Paris vintage car race is EnduroRally‘s crazy resurrection of the original 13,000km challenge laid down in the early 1900’s by the Italian exploring enthusiast, Prince Borghese. Dr Andrew Buckley is an army acute medic in Bath, who spent time last May/June as part of the team providing medical cover for this epic rally. You may have seen some of his spectacular photos here on Adventure Medic last month, and here he follows up by taking us through the journey from Beijing to Paris, via rural Mongolia, the greens of Siberia and quaint swathes of Eastern Europe amongst others.

 

“What are you doing next May?”

The casual line that started the whole thing off. I’m a military physician and the setting was the slightly awkward silence just prior to the arrival of a trauma casualty in the British Military hospital in Camp Bastion.  The opportunity was serendipitous and fantastic. 100 vehicles ranging from 1913 to 1970s, with a small but experienced support team, were re-creating the madcap challenge of Prince Borghese, the Italian who originally established the contest in 1907. A staunch evangelist for the relatively new motor car, Borghese threw down the gauntlet of a race from Peking, now Beijing, to Paris.  Just 5 cars responded to the call.  In context, at the time the London to Brighton race was still seen as a fairly extraordinary thing, and saw the original cars struggling with reliability.  Suggesting a route through the complete wilderness of the Gobi desert was insanity.  With characteristic flamboyance, the Prince painted his Italian Fiat red – a racing colour the Italians, and particularly Ferrari, hold dear to this day in honour of his victory.  Ford’s Model T was released the following year, and it was fitting that the oldest car competing in our race was an original edition from 1913; quite an event for its 100th birthday!

The Route

Peking to Paris Route

The route would leave China via Mongolia and enter Russia through Siberia. The organisation opted to skirt north of the ‘Stans, feeling that keeping the border crossings to as few as possible would ease the flow of such a large group on a tight schedule. Examining the route revealed it to be just shy of 13000km. The first 11 days would be spent traversing a short section of China before entering the relative wilds of Mongolia. Whilst this was a seemingly insignificant distance compared to the total, it would be 2600km with few formal roads in one of the truly sparsely populated land masses on the planet. With fewer than 3 million people in an area greater than 6 times that of the UK, its density is lower than even Western Sahara, bested only by Greenland and Svalbard. All of this becomes relevant when considering the implications of providing medical cover.

The Adventure

“Ollie, have you seen the IV fluids?”. Rummaging through the vehicle after what had been meticulous months of preparation for this fairly epic trip. We had 48 hours in the benign environs of a western hotel in the centre of Beijing, and were still identifying gaps. Cue some clumsy taxi rides and an awkwardly confused conversation with a Chinese doctor in a local state hospital, who kindly agreed to sell me some saline.  A truly extraordinary dinner at the China Club and we were set for the off, with an impressive farewell.

The first couple of days meandered startlingly from the megalopolis that is Beijing with its 8 (!) M25-sized ring roads, ostentatious wealth and irrepressible capitalism. A harsh juxtaposition with truly poverty-stricken countryside. From traditional villages to “Brave New World” visions: entirely uninhabited new cities with a potential capacity of millions, innumerable densely packed skyscrapers rising earnestly from the surrounding paddy fields. Our caravan of more than 100 vehicles drew welcome attention and tremendous hospitality from local enthusiasts wherever we stopped. A few short days later we passed under the famed Rainbow arch into Mongolia and an immediate popular vacuum. Not a soul, car or road for the first day: meandering tracks or no tracks at all and limitless expanses of grasslands, punctuated intermittently by the occasional yurt – or lost classic car!

We camped throughout Mongolia, with the exception of the genuinely buzzing Ulaan Baataar, where we had an extra rest day. More than 50% of the population live here, which still makes it a small city. With the recent symbolic opening of McDonalds, the country’s first, there is a true sense of energy and positivity. Mongolia’s vistas were breathtaking, and no roads meant no traffic laws. Races were long – up to 80km – fast and furious. Several vehicle rollovers fortunately resulted in no major casualties; the more remarkable given the age of the vehicles. The traditional way of life seems entirely unchanged for the most part: nomadic farming over the vast grasslands, with mixed herding of cows, sheep, goats and camels which takes place predominantly on horseback. After 10 days we reached the end of the Mongolian adventure and entered the bustling metropolis of eastern Siberia. The move to tarmac roads yielded an eerie silence which seemed as alien as the camel herding had been just a few days before. Lifelong – and admittedly ill-informed – preconceptions of Siberia as a snowy wasteland utterly failed to prepare me for a spectacularly green wilderness, with evergreen forests, endless valleys, and ribbons of blue water meandering for hundreds of kilometres alongside the roads.

The Russia we had expected emerged after about a thousand kilometres of spectacular Siberian beauty, and we tracked the route of the Trans-Siberian express back towards Ukraine. Of note for would-be travellers to Russia, the unexpected sophistication and Euro-chic nature of the towns bordering the vast Volga River, particularly Samara and Saratov, really were fantastic. The river widens until it becomes a sea; beaches of white sand snake through the town centres and cool cocktail bars and restaurants form a backdrop to the evening activities of running, rollerblading and busking.

And so to a more familiar, but no less sensational, final few days en route to France. Crossing Ukraine, Slovakia, Austria, Switzerland and France to our final conclusion in Paris. With the exception of a short trek on the Haute Route a few years ago, my experience of the Alps has been entirely winter sport based. There are few roads more special than the high traverse from Austria into Switzerland, by turns awe-inspiring, quaint and downright terrifying!

The Medical Laydown

There was a driver and co-driver for each competitor’s vehicle, and 96 made it to the start line. In addition to this were 7 support vehicles and a number of host-vehicles from each of the countries through which we passed. Total numbers therefore were between 200 and 250. On a typical day, the cars set off at 1 minute intervals, leading to a vehicle spread of about two hours at the start of the day (frequently far longer by the end). The remit was pre-hospital and primary care; all vehicles were obliged to carry a basic first aid kit and be familiar with its contents. They had also been strongly advised to attend a course in basic life support to allow them to initiate resuscitation in anticipation of our arrival.

The role, and the potential requirement for medical input, varied tremendously throughout the trip. It was largely dependent on host nation health facilities and road quality, and the remoteness of the route from medical facilities and evacuation. Interesting to see the physical toll that 35 days of straight travel in a 1920s vehicle with broken suspension can have on weary bodies.

Trauma care was the greatest concern for us in Mongolia. With its low level of development and sparse population, the chances of other emergency services reaching any incident before us would be vanishingly low. Resuscitation efforts would require prolonged field care capability, evacuation would be extremely difficult, and the vehicle spread would be greatest where the roads (or absence of them) were most challenging.

Moving into mainland Europe, emergency services with fully-equipped ambulances were rarely more than a few minutes away, and with a vehicle spread of over 2 hours were more than likely to arrive before us. Accordingly, as we entered the more developed and populous areas west of Siberia, the emphasis for us switched to primary care. Roads hardened, traffic laws became enforced and consequently race sections shifted to closed roads and racetracks.  Our role became much more predictable: gone were the extensive spread between the leaders and laggards of the field, enter formal medical stations and regular evening clinics.

 

The trauma equipment, packed in our medical Hilux:

We had a standard Blackhawk trauma bag to take to difficult to reach incidents, divided into fairly standard ATLS pouches as follows:

  • C – Gauze, Celox (haemostatic dressing), pressure dressings, pelvic binder
  • A – Guedel/Nasopharyngeal airways, iGel LMA, ET tubes, surgical airways, forceps, handheld suction device
  • B – Bag-valve mask, D-type oxygen cylinder, reservoir bag masks, portable pulse oximeter
  • C – 4x bags of Hartmann’s solution, assorted IV cannulas, EZ-IO intraossesous access device, three-way taps, connectors, syringes
  • D/E – 3x Sam splints, rescue blankets, kendrick traction device, c-spine immobilisation collars, spinal board, assorted bandages, digital thermometer, clinical gloves
  • Drugs – adrenaline, chlorpheniramine, hydrocortisone, morphine, ondansetron, salbutamol, basic oral analgesia


An additional trauma kit stayed in the truck:

  • Electromedical – 12-lead ECG, BP/oximetry capacity
  • Traction devices
  • Spinal board
  • Box splints
  • Replacement fluids
  • 4x D-type oxygen cylinders
  • Further extensive selection of medication

Conclusions

As with all remote pre-hospital care, the challenge is rarely medical ability, but unpredictability and expectation management in the face of truly remote environments. Our skills were fortunately rarely challenged, but the event was marred by tragedy when one of the competitors was sadly involved in a fatal car accident on the notorious Russian roads. This served as a stark reminder of the risks inherent to such an event, with our medical assets located elsewhere at the area of highest perceived risk, and far removed from the random accident on a routine stretch of road.

Experiencing pre-hospital emergency care (PHEC) can be one of the most challenging and rewarding experiences in medicine. From forming part of a team, to contingency planning, hardware procurement, understanding the population at risk and their needs, liaising with the event team, clients and customs to hammer out issues and risks, and accepting compromises between deficiencies and dreams. All contribute to the formation of a better doctor in day to day work.

I have been lucky enough to experience PHEC at a relatively early stage in my career. This has been possible thanks to military training which, through a combination of both anachronism and design, endows its junior doctors with tremendous responsibility from both medical and man management perspectives. Attending health committees early in one’s career and knowing that your opinions will be valued is extraordinarily empowering and encourages a greater trust in one’s own convictions, along with a balanced approach to risk.

The lessons learned from epic adventures like this should stand me in good stead for future challenges. Adventures in Burma/Myanmar beckon in the New Year; I can’t wait!

More information

What level of experience was required? Ideally those who hold CCTs in General Practice or other, but they will consider others who have extensive pre-hospital trauma experience.

Who covers the medical indemnity? MPS covered Andrew for the Rally on the basis that he had extensive, validated pre-hospital experience, that there was another doctor on the Rally and that he was “remotely supervised” by a consultant from the UK via sat phone as required.

How much does it cost? Expenses were covered by the company, so zero! All accommodation, food and flights were covered.

How do you get involved? Andrew is involved in coordinating the medical teams for the next adventure, and is happy to be contacted via email (ambuckley@live.co.uk).