This October I travelled to Reykjavík for Rescue 26, the international search and rescue conference hosted by Slysavarnafélagið Landsbjörg (ICE-SAR), Iceland's volunteer rescue association. The hall was packed with rescuers in red jackets from across Iceland and beyond, and over the weekend I heard from some of the most experienced people in remote and extreme medicine anywhere in the world.
I go to events like this because the problems we deal with in Somerset are the same ones rescuers face everywhere: getting the right clinician to a patient, keeping them alive when help is a long way off, and working safely as a team when things don't go to plan. These are the sessions that stuck with me.
“Take a medic (or two)”: Dr Sarah Spelsberg
Dr Sarah Spelsberg MD is an emergency medicine consultant at the Mayo Clinic and Director of US Field Operations for World Extreme Medicine. She talked about what a medic actually brings to an expedition. In her words, a medic can “enhance the chances of success and survival by mitigating risks, managing emergencies, and promoting the well-being of expedition members.”
She used real cases to make the point:
- A shark bite in the South Pacific. Nobody on the free-diving trip was medically trained, the island's only medic was getting ready to leave, and definitive care in Guam was 11 hours away. A tourniquet went on, and each attempt to let it down caused too much bleeding. The patient spent two days in hospital.
- Heat stroke in the UAE desert. Spotting neurological compromise early, starting active cooling and keeping it going, and coordinating a multi-stage evacuation through difficult terrain, all with a confused patient who couldn't cooperate.
- A collapse on a remote beach. The man had a pulse but wasn't breathing. Basic airway support with an OPA kept him alive until he could be medevaced. He came back the next day to say thank you.
The beach case is the one I keep thinking about. There was no advanced kit and no heroics, just someone trained standing in the right place and getting the basics right.
Sarah also went through tourniquet conversion, which matters for anyone facing a prolonged evacuation. That covers when it's appropriate, when it isn't (shock, being unable to monitor for rebleeding, amputation, or a tourniquet that has been on for more than six hours), and the golden rule: if conversion doesn't control the bleeding, go straight back to the tourniquet. She closed with altitude illness, infection, heat and cold injury, and dive emergencies, and the same approach for all of them: prevent, mitigate, treat.
Her take-home messages were simple: be prepared for the unexpected, teamwork makes the impossible possible, the reward is worth the effort, and above all, take a medic (or two).
A night in the river: Dr Jorian Kippax
Dr Jorian Kippax is a HEMS retrievalist with Ambulance Tasmania, an adjunct professor at the University of Tasmania, a trauma and emergency specialist, a reserve Lieutenant Colonel in the Australian Defence Force, and the 2026 Tasmanian Australian of the Year. He talked us through a rescue in a remote Tasmanian river gorge. A rafter's leg had become trapped between boulders in fast-flowing white water.
He told the story through timestamped photos, starting in the late afternoon and running through to the early hours, as helicopter crews, swiftwater rescuers and clinicians worked in the dark. They tried everything: sit harnesses, 6:1 pulley systems, pneumatic air bags, hydraulic jacks and spreaders. Throughout, the patient got continuous analgesia, warm drinks and constant encouragement. The slide timed at 03:40 simply read “Consent”. It was a stark reminder of how hard the decisions in prolonged entrapment can be.
His lessons on scene leadership apply to every incident we attend:
- Take command.
- Add value, and don't lose time or opportunity.
- Balance technical tasks with situational awareness.
- Protect your cognitive bandwidth so you can anticipate the next problem.
- Keep everyone safe, including yourself.
The SAR Games: learning through competition
It was a real highlight to see Eoin and Sverre take the stage to talk about the SAR Games. Eoin is a big supporter of Apex, so it was especially good to watch the two of them share their experience with such a knowledgeable international audience.
Their message was that competition is a powerful way to learn. Put rescuers into realistic, high-pressure scenarios against other teams and the lessons stick in a way that classroom sessions rarely manage. Teams have to communicate clearly, make decisions under time pressure, and find their weak spots before a real job finds them. Afterwards, comparing approaches with other teams spreads good practice far faster than any manual.
That's very close to how we think about training at Apex. People learn best by doing, under realistic pressure, and by reflecting honestly afterwards. The conversations after their session went on long after it ended.
What it means for Apex
We don't work on glaciers or in Tasmanian gorges. But on a motocross track, at a riverside event, on the water with our rescue boat, or on Exmoor, the principles are exactly the same. Plan for the unexpected. Put trained clinicians in the right place before something goes wrong. Make sure your team can hold on for as long as it takes to get the patient to definitive care.
I'm bringing these lessons home to our crews and into our training courses, particularly around prolonged casualty care, haemorrhage control, scene leadership and more scenario-based, competitive training.
A huge thank you to Slysavarnafélagið Landsbjörg for hosting such an outstanding conference, and to every speaker who shared their experience so openly. Takk fyrir!
If you're planning an event and want to talk about the right level of medical cover, or you'd like to book onto one of our first aid and pre-hospital care courses, get in touch with the Apex team.
John Witt, Apex Medical & Rescue
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