Medicine in remote areas (MIRA)

Authors: Ruth McCabe 

Publication date:  05 Aug 2006

Who's it for?

Anyone with an interest in pre-hospital care or who works in remote or hostile environments. It would also be ideal for anyone planning a trip to the outback, jungle, or Arctic—remote just means a situation where there is no immediate access to adequate medical facilities, either by direct communication or access in terms of distance or time, which fits many holidays.

When did you do it?

May 2006 at ex+med in Hereford, near the end of an extended SHO (senior house officer) career. The course is certificated by the Faculty of Pre-Hospital Care, Royal College of Surgeons in Edinburgh ( [Link] ).

Why did you do it?

In preparation for working as a singlehanded cruise ship doctor in the western Caribbean and Central and South America.

How much effort did it entail?

The course is held over five days and includes an overnight exercise and a night under the stars. There is a mixture of lectures, practical stations, and moulages. These cover varying mechanisms of injury (for example, road traffic collisions, ballistic and violent assault, head injuries), airway management, life threatening chest injuries, shock and haemorrhage control, medical emergencies, fractures, dislocations and burns, environmental illnesses (including heat and cold injuries), and remote and prolonged patient care. The instruction is to a high standard and as all instructors still work in remote environments they are able to provide relevant and interesting case histories.

Is there an exam?

Yes. One multiple choice paper, one projected material paper, and a moulage. The pass mark in the written papers is 70% and most people pass.

Did you go on a course (and if so, what's the fee?)

The course costs £800 plus VAT. Food is provided during the overnight exercise. There are several bed and breakfasts close to the course venue for accommodation.

Top tip

Enjoy the course—it's great fun. What other course do you know of where you become aware of the life threatening haemorrhage by the fact that your trousers are being soaked in a pulsatile manner, or where you can cut a car apart while extracting a casualty? The night exercise isn't bootcamp, and tents and camp beds are provided. A comprehensive kit list is available before the course and few people should have to purchase anything special.

Was it worth it?

Absolutely. This course is completely up to date, for example, using hypotensive resuscitation and training in automatic input and output injectors for adults, and is kept under constant review. It's invaluable for learning how to adapt practice to the pre-hospital environment and I feel much better prepared for working on board a ship or simply stumbling across a road traffic incident. The varied backgrounds of the course members (medical, ambulance service, offshore medic, search and rescue, security industry) really adds to the learning environment.

Further information

ex+med UK, Fields Yard, Plough Lane, Hereford HR4 0EL. +44 (0)1432 355964; [Link] . â– 


Ruth McCabe senior house officer in emergency medicine Poole General Hospital

Cite this as BMJ Careers ; doi: