Persia Bowater/ FY2 Doctor/ Glasgow
Jenny Bradshaw/ FY2 Doctor/ Newcastle
Founded in 2021, Endeavour Medical is a new provider of global health and expedition medical training. Their large faculty can boast of decades of experience in multiple extreme environments, including mountain, jungle, polar, and desert, and countless teaching and academic accolades. Endeavour Medical delivers an array of courses, including global health, sports medicine, wilderness, expedition, and leadership. The Altitude Medicine in Practice course, designed by Lucy Obolensky and Anna Shekhdar, runs once a year in March, and is based in St Jean d’Aulps in the French Alps. This year it was led by Dr Nathan Hudson-Peacock, an ED doctor with experience leading multiple high-altitude expeditions, and supported by Dr Francis Screech, a previous endeavour fellow and now an expedition medic.
Duration: Seven days in total: one to two days of resort-based skiing, three to four days spent ski touring to and from a high mountain hut (conditions dependent). Arrival and departure days either side. Teaching interspersed throughout.
Dates: Next course March 2024 (check website for dates)
Location: Base: an apartment in St Jean d’Aulps. High mountain huts: best available given the conditions.
Cost: Early Bird Price £1895 (before 1st December 2023) then £1995. Price includes course tuition, a ski guide, ski pass, all ski and safety equipment, accommodation in Morzine, accommodation and meals in mountain refuge.
Qualification/Accreditation: Course attendance certificate, worth 40 CPD points, and the opportunity to complete Supervised Learning Events (including case-based discussions and clinical evaluation exercises).
Delegates: Five Delegates (medics and non-medics welcome).
Prerequisites: A moderate level of fitness. Enthusiasm to learn about expedition medicine and global health. Beginner and intermediate courses available dependent on previous level of skiing/touring experience.
St Jean d’Aulps is easily accessible from the UK, with regular flights to Geneva followed by a less than two hour transfer to the town. The rest of the Portes du Soleil ski area, including the resorts of Avoriaz and Morzine, are all close by, and there are a multitude ski touring routes and mountain huts to stay in. Your guide for the week decides the best route and itinerary based on the mountain conditions at the time. Each day one of us was allocated as ‘medic of the day’ to get an idea of how it felt to be the expedition medic.
Example Course Contents
- Altitude sickness, HAPE, HACE
- Avalanche safety
- Hypothermia and cold injuries
- Expedition preparation and mental health
- Medical Kits
- Expedition Sustainability
- Ski touring skills and ski technique optimisation
- Trauma and Primary surveys
- Packaging casualties
- Avalanche rescue
- Rope skills and crevasse rescue
- Use of crampons and ice axe
Delegates arrived on the Sunday and settled into the apartment, with dinner made for us by the Endeavour faculty. We were met on the Monday morning by our guide for the week, Guillaume, who is president of the high mountain guides of Portes du Soleil and is accredited by the International Federation of Mountain Guides Associations (IFMGA). After picking up our ski touring gear we headed off for a day on the slopes of Avoriaz. This not only allowed us to get our ski legs back, but also to become accustomed to the touring gear for those not familiar, with and get personalised tips on how to improve our skiing technique from Guillaume. A highlight of the day was Guillaume talking us through the seven different types of snow, and which ones carry the highest avalanche risk. We enjoyed a picnic lunch in the sunshine, chatting about what to include in the daily medic brief expected during expeditions. In the evening, informative and hands-on teaching sessions were led by Nathan and Francis, covering airway management, major trauma, and splinting limbs. We learnt how to expertly package a casualty in a “burrito” to ensure they are kept warm and dry, before perfecting this technique on each other.
Ski Tour to Le Refuge des Prés
Tuesday saw us setting out for the start of our ski touring expedition. Unfortunately, the weather conditions are not controllable, and the plan for a hut to hut trip had to be adjusted owing to forecasted snow and rain storms leading to a dangerously high avalanche risk. This was no trouble for our faculty who took it in their stride and found an excellent hut that would remain safe, Le Refuge des Prés. We set off from the valley and, after touring somewhat unconventionally over, at times, a mixture of ice and mud, made it to the hut in time for a beer and cake as the forecasted snow started to fall. We had a practical session on the use of avalanche safety equipment before our evening finished with more lectures about altitude medicine over a delicious, hut-cooked dinner.
On Wednesday morning we awoke to snowy scenes. Guillaume led us out on a morning ski tour to a nearby col, from which we skied through powder back to the hut for lunch. In the afternoon we headed out for an afternoon tour. On our return we were surprised with a scenario. Francis had been caught in an imagined avalanche and we needed to find him using our transceivers, assess him with an ABCDE framework, and carry him back to the hut to avoid him becoming more hypothermic. This was a great way to put into practice the skills we had learned so far, and the teaching continued with a debrief and discussion. Due to Friday’s forecast being suboptimal, we made plans to leave the hut a day early, and tucked into well-earned cheese fondue to celebrate our final night in the hut.
On Thursday the sun was unexpectedly shining, but we could see evidence of avalanches that had happened overnight. This experience helped to put into perspective the importance of all that we had learned so far. We headed out for a tour with low avalanche risk which would take us back to the bottom of the valley, stopping on route for an excellent practical session on rope skills and crevasse rescue, led by Guillaume. As we were approaching the van, another surprise scenario saw us assessing and treating Francis for high altitude cerebral oedema (HACE). We had dinner out at a local pizzeria in St Jean d’Aulps, and reminisced over our incredible experience in the mountains.
On our final day, we were glad to be off the mountain as we woke up to a thunderstorm. Luckily this cleared quickly, and we discovered that at the slightly higher altitude in Avoriaz, the rain had fallen as snow. We were treated to a resort powder day. Guillaume showed us all the best places to go ‘off-piste’, and we practiced our deep powder technique. This was, of course, interspersed with a final scenario: we discovered a trauma casualty (Nathan) who had sustained a crampon inflicted arterial injury and a femoral fracture. We worked together as a team to assess and manage this scenario and felt much more confident after the previous scenarios and debriefs. We finished the week with a final dinner in Morzine, before setting off in different directions of onward travel. We all felt exhausted but inspired, and glad to have met a group of such intrepid, like-minded people.
We would highly recommend this course to all those interested in altitude medicine, who enjoy ski touring or have a strong desire to learn. The course material was interesting and focused, and the ability to apply it immersively, in a practical setting, was fantastic for consolidating our learning. The faculty were all incredibly knowledgeable. We felt safe in their hands at all times whilst they ensured that we all had an excellent time in what were challenging weather and snow conditions.
- Having an intermediate level of ski ability and a moderate level of physical fitness prior to the course will enable you to get the most out of the skiing side of the trip.
- Watch the pre-course lectures online prior to attending, as this means that you can have more in-depth discussions surrounding the topics during the course.
- Pack light. Ski touring is heavy work.
- Remember to log the teaching and CPD points in your portfolio.
To find out more about Endeavour’s winter Altitude in Practice course in Morzine, see Endeavour’s website
Photos courtesy of Dr Persia Bowater