A Scottish Perspective of Pre-hospital Care and Emergency Medicine in Norway - Part 5

I am a ST5 Emergency Medicine trainee in Edinburgh, Scotland.  After receiving the Robin Mitchell Travel Fellowship, I have been given a fantastic opportunity to explore the Pre-hospital and Emergency care services in Oslo, Norway.  The Robin Mitchell Travel Fellowship was set up to commemorate Dr Robin Gordon Mitchell, an Emergency Medicine Consultant in Edinburgh and is open by application to all Scottish Emergency Medicine trainees to pursue a 4-6 week placement away from their base hospital, within the setting of Emergency Medicine or another associated clinical specialty to enhance their clinical experience and expertise.

As my travel fellowship draws to a close I have taken some time out to travel up the west coast of Norway visiting some of the more rural parts of Norway, and in addition look at the pre-hospital and emergency medicine facilities in Norway's most northerly island, Svalbard.   Observing the scenic west coast of Norway travelling on the Hurtigruten, kayaking in the wilderness around the Lofoten islands, and seeing the Northern Lights were some of my highlights en route to Svalbard. 

Svalbard, approximately 1,318km from the North Pole has a population of approximately 2,600 inhabitants, 2,800 snowmobiles and 3,000  polar bears (although sadly I didn't see one).  Svalbard has only two small towns, Longyearbyen which is the main small town, and also Barentsburg, which is a Russian settlement inhabited entirely by Russian miners and their families.  As the only roads which exist on the island are in Longyearbyen and Barentsburg, people have to travel by helicopter, boat, snow mobile or dog sleds to get from one area to another.  Due to the threat of polar bears, and also to maintain Svalbard's national heritage it is illegal to travel outwith the main towns either without a permit (and gun licence) or be accompanied by a Svalbard guide.  In addition to being a tourist driving dog sleds and travelling on the boat to visit glaciers and explore the scenery of Svalbard, I took some time to explore the pre-hospital and hospital services in one of the most remote areas in Norway. 

Svalbard has 2 Super Puma rescue helicopters based at Longyearbyen airport, with 2 crews being on call at a time.  Each helicopter crew consists of 2 pilots, a winchman, assistant winchman and a "rescueman" (HEMS crewman).  As you may recall from my earlier blogs, the resuemen have probably the coolest jobs in the world!  They are highly skilled critical care paramedics, who also have to have additional climbing and diving qualifications and be able to fly the helicopter.  In Svalbard, the majority of missions are rescue missions, and due to the limited possible landing areas the rescuemen have to be winched down to the patient.  I was lucky to meet the one and only female rescueman (or rescuelady) in Norway, who works in the harshest of all Norwegian environments, in Svalbard  - she is one hardcore lady!  

The rescuemen live on the base working for 2 weeks, with 4 weeks off.  There are approximately 70-80 primary missions/year, and the helicopter has only been used for 1 secondary mission to Tromsø (the most Northerly University Hospital) this year.  Most missions are around the island, but the helicopters have been used frequently to provide medical support to ships, and once even to Greenland.  Most missions are for medical causes (for example cardiac arrest, myocardial infarctions and collapses) however the helicopter is also used to retrieve trauma patients including those falling from height on the mountains, mining accidents and also polar bear attacks.  As no medical staff work at the helicopter base, if the  mission is likely to require physician assistance, the rescueman can request the addition of a physician/nurse from the hospital.

If someone was to call 113 (the medical emergency number), the call would go directly to the hospital receptionist or nurse in charge.  The nurse in charge would contact the rescue helicopter, and in addition dispatch a doctor and/or nurse to the airport (if required).  However, before the helicopter can fly on a rescue mission, they have to contact the Sysselmannen ( the Governor of Svalbard) for permission.  After the patient is rescued, the helicopter returns to base at the airport, and is met by the one (and only) ambulance on Svalbard (driven by a volunteer fireman), and taken to the hospital in Longyearbyen. 

The hospital in Longyearbyen is the only medical facility on Svalbard (excluding the Russian hospital at Barentsburg which only provides medical care for the inhabitants of the Russian settlement).  The hospital has a GP service, 5 hospital beds ( 2 two bedded areas and one single "isolation" room), an Emergency Room, X-ray (but no CT), light therapy box (to treat dermatitis) and 1 operating theatre, in addition to a dentist, physiotherapist, occupational health nurse, midwife and district nurse.  There are 3 doctors living on the island (2 GPs and 1 surgeon) and 3 nurses and 2 anaesthetic nurses.  Typically there is one doctor and one nurse and one anaesthetic nurse working per shift, however the other medical staff can be called upon in a major incident or if medical staff are required to go on a rescue mission. 

The Emergency Room, is set up like a resuscitation room, and also has telemetry to Tromsø University Hospital on the mainland, allowing them to speak directly to the specialist.  In addition X-rays (taken by the nursing staff) are formally reported by a radiologist in Tromsø.  The operating room is used occasionally when the surgeon is on the island to perform minor operations (e.g. varicous vein surgery, hand surgery).  As there are no anaesthetists, anaesthetic nurses provide the anaesthetic during the operation.  The hospital admits typically well, ambulatory patients, eg for iv antibiotics, fractures and occasionally some end of life care however the majority of patients are transferred to Tromsø University Hospital.

Secondary transport is provided by the Norwegian Air Ambulance fixed wing planes.  There are no planes in Svalbard, so planes have to fly (approximately 1.5-2hrs) from Tromsø to pick up patients.  However, due to the harsh climate in Svalbard, sometimes this creates difficulties if the plane cannot fly.

Because of the limited medical facilities available on the island, all pregnant females have to leave the island (by law), at least 2 weeks before their estimated due date.  Previously, the law in Svalbard used to state that only people who had jobs on the island (and their children) could live there.  If people retired, they were required by law to leave the island.  However this has recently changed, but the island does not provide care packages to the elderly or facilities to disabled people.

Spending time in Svalbard has given me an amazing insight into how the Pre-hospital and Emergency Medicine services work within one of the remotest areas of Norway, and the challenges faced by both those working within these services, and people living on the island.  

Whilst I travel back to Oslo to complete the last few days of my fellowship, I leave you with a couple more of my photos from Svalbard.   

Until next time!