Jim Moonie / Emergency Medicine Registrar
In April 2014, BS 8848, the Specification for the Provision of Visits, Fieldwork, Expeditions and Adventurous Activity was introduced. BS 8848 is an important document and those working as expedition or event medics need to become familiar with it. However, it is also 48 pages long and costs £100 (plus VAT). Fortunately for us, Jim Moonie bought it (and read it!) so he can tell us what it is all about.
What are British Standards?
Here is some background for the curious few. British Standards are ‘an agreed way of doing things’, a necessarily vague description given their breadth of coverage.
They vary from a standardised ‘recipe’ for manufacturing processes, to a distillation of expertise, or as a suggested ‘best way’ to guide others in their search for best practice. Examples range from, the ‘Specification of… Steel Boiler Tubes for Locomotive Boilers’to the standard for ‘Preparation of a Liquor of Tea for Use in Sensory Tests’. For practical examples, think of specifications for plugs and phone sockets.
They are not laws, but can used as reference points so that in some cases they come to represent the opinion of the law. They may be expanded from British Standards (BS), to become European (EN) or even global standards (ISO). The dimensions of identity cards are, for example, standardised under ISO/IEC 7810 such that credit cards, passports and SIM cards abide by the same physical characteristics worldwide. Similarly, toys are governed by BS EN 71, and newly manufactured toys must be compliant to be sold in the European Union. These toys bear the CE logo that you will no doubt remember from that cuddly Care Bear you had as a child.
BS8848: Some context
In 1993, four school children drowned during a supervised kayaking trip in Lyme Bay. Prosecutions followed, with the activity centre and its owner being found guilty of corporate manslaughter.
Two years later, after much discussion in government, the Activity Centres Act was passed and the Adventure Activities Licensing Authority (AALA) was formed. The AALA applies only to those charging for adventurous activities for under 18 year-olds and, therefore, is not entirely inclusive. School groups led solely by teachers are not covered. Still, it is generally thought that it could be used as the standard in court irrespective of this. It only applies to activities taking place within the UK.
BS 8848, the specification for the provision of visits, fieldwork, expeditions and adventurous activities outside the United Kingdom, takes its title from the height of Everest in metres and is a good practice guideline for those organising overseas trips. It differs in many respects from the AALA, particularly as overseas trips are governed by the laws of the country being visited. BS 8848 then can only be a recommendation and is not legally binding. Equally though, simply being compliant does not make a trip immune to legal action.
The original 2007 BS8848 standard, like the AALA, emerged from tragedy. It was instigated by Peter Eisenegger, after his daughter Claire died of heat stroke on a gap year project in 1999. Developed with input from the Royal Geographical Society, it offered a set of guidelines that aimed to minimise risk of illness or injury for those undertaking educational or adventurous activities overseas. It also gave the activity organisers a means of demonstrating their compliance with agreed guidelines. The standard went on to be revised in 2014.
The 2014 update
Here are some definitions and examples. The examples are not exhaustive lists, but do give you an idea.
Venture providers / Any UK organisation including schools, universities and charities.
Ventures / Expeditions, fieldwork, gap year schemes and educational trips.
Participants / Students, adults, vulnerable adults, children.
Environment / Mountain, desert, sea.
The venture provider is accountable for all aspects of the trip. This includes any third parties, such as those providing food, transport and accommodation.
It is their responsibility to ensure that the leaders (or leadership team) are competent to fulfill their roles. In this way, the leaders should be right for the participants (e.g. mixed gender leaders for mixed gender groups, fully screened if accompanying children) and for the environment (e.g. suitably-qualified climbers for certain mountain activities).
Participants should be adequately informed about the nature of the risks (e.g. altitude sickness or infectious diseases) that they are undertaking. This should enable them to make an informed decision as to whether it is suitable for them and allow them to plan accordingly with vaccinations, fitness training, financial planning etc.
Much of the above is reliant on proper planning. This should include the safety implications of all aspects of the trip, itinerary, budgeting, screening and local medical considerations. As well as informing participants, it allows the venture providers to risk assess them and ensure that they are emotionally, psychologically, physically and medically suitable for the venture. There should be contingency planning in the event of an emergency. This could range from an individual medical crisis including death, to political instability or a natural disaster. All leaders should know what to do in an emergency and who to contact.
It remains the responsibility of the participants to uphold reasonable behaviour – for example, deciding not to wear a seat belt against the advice of the leader would be unreasonable.
The Small Print for Expedition Medics
There are eight subheadings in the medical section of the document: General, Medical Planning, Pre-existing Medical Conditions, Prevention of Ill Health, Environment-Related Illness, Medical Expertise and First Aid. Most of these have been touched upon already, but it is worth drawing your attention to a few points:
1. The venture provider should have access to medical support, but there does not necessarily have to be a doctor on the team.
2. A thorough medical risk assessment and screening process should be undertaken. This should be approved by a medical professional with expertise relevant to the venture.
3. If screening reveals any pre-existing conditions that may be exacerbated by the venture the participant’s doctor needs to provide a letter confirming fitness to participate. It is the responsibility of the venture provider to give the doctor enough information such that they can make an informed decision.
4. Participants should be advised regarding vaccinations and any recommended prophylaxis and directed to a suitable health care provider (GP, travel clinic etc).
5. The venture provider must inform the leaders and participants of any significant risks and how to prevent and manage them. Those highlighted are dehydration, altitude sickness, heat illness and malaria.
6. Medical services must be provided by a medical practitioner with expertise relevant to the venture. The team on the ground must have access to this expertise at all times. If the venture is particularly remote then a medical professional should accompany the team. It does not stipulate that this professional need have expertise relevant to the venture, though it would seem wise.
7. First aid, and someone suitably qualified to administer it, should be available during the venture. This should have been planned with the specific venture in mind by a medical professional with expertise relevant to the venture.
8. Medical protocols relevant to the venture should be carried and understood by the leadership team.
BS 8848 is a set of recommendations and not a law. However, that does not mean that it cannot be used by the law.
Some points are open to interpretation, but most are fairly clear cut. ‘Expertise relevant to the venture’is important – indeed, as expedition medicine develops as a specialty, ever greater levels of expertise and training are likely to become expected.
At first glance, prescriptive devices such as ‘Standards’ can seem rather at odds with the nature of adventure. However, we would advise you to think again. BS8848 is not a standard for elite mountaineers, but for lay people stepping out of their comfort zones and into the care of perceived ‘experts’. It is right that they should know what they are getting themselves into and with whom.
BS8848 may seem tedious, but it is here now. It may not yet have the reputation that it deserves, but this will change, so, know that it exists and use it – and choose companies that use it too. And don’t let it stop you. As the foxes say to the wolf at the end of Wes Anderson’s Fantastic Mr Fox – ‘Good luck… Good Luck out there’.
If this article has piqued your interest, then you can pick up your own copy of BS 8848 here.