By Dr. Marc Gosselin, Medical Director of SIRIUSMEDx
Four stories that could have gone wrong
Mining camp, Northern Quebec, Week 3.
For the past two days, Eric has been experiencing a dull pain in his jaw. He attributes it to an old filling that sometimes causes him pain. Tonight, his cheek is swollen. He has a fever. He is having trouble opening his mouth. The camp nurse, alerted at 10 p.m., immediately recognizes a periodontal cellulitis affecting the deep tissues of the face and jaw—an infection that can, within a few hours, compromise the airways. The camp is about a three-hour flight away, but the weather won’t allow it tonight, nor tomorrow morning according to the forecast.
Geology Expedition, Northwest Territories, Day 8.
Marie has had a small cut on her calf for the past four days. She cleaned it and put a band-aid on it. She didn’t mention it because “it’s no big deal.” This morning, the area is warm and red, and the redness has spread. The guide took out a marker and circled the edges: in two hours, the border had spread by a centimeter. It’s no longer a small cut. It’s a spreading cellulitis, in an area accessible only by helicopter, and the weather, once again, isn’t cooperating.
Forestry work camp, British Columbia.
Since last night, Patrick has had a sore throat. This morning, even swallowing his own saliva is a struggle. He refuses to drink. His temperature is 39.2°C. When we look at the back of his throat, we see his tonsils covered in pus and painful lymph nodes in his neck. Patrick mentions that this is his third such episode in less than a year, and that each time, strep throat was the cause. It’s likely a recurrence. Without treatment, within 24 to 48 hours, Patrick will be unable to eat or drink.
Research vessel, Gulf of St. Lawrence, Day 5.
For the past three days, Sophie has felt a burning sensation when she urinates. She has been drinking more water in the hope that it would go away. This morning, she has pain in her left side that radiates downward. This morning, she is suddenly seized by a severe chill, an uncontrollable shivering that shakes her from head to toe for several minutes—a sign that the infection has now become systemic. It is no longer a simple lower urinary tract infection. The infection has spread to her kidneys. On a boat 80 kilometers from shore, every hour counts.
These four stories are not hypothetical scenarios invented for this occasion. They are real situations encountered by the SIRIUSMEDx teams over the years. A toothache, a scratch, a sore throat, a burning sensation when urinating: situations that seemed trivial at first, but which nearly led—or actually did lead—to an emergency evacuation.
The lesson isn't that remote areas are dangerous, but rather that a minor infection and a serious one can look alike at first, and that it is in the gap between the two that the role of those on the ground comes into play.
What are the most common infections encountered in the field?
One might think that serious infections occur in hospitals, and that in the field, we’re only dealing with minor ailments. The reality is quite different. Living conditions on expeditions or in work camps create a breeding ground for infections: close quarters, inconsistent hygiene, shared equipment, and immune systems sometimes weakened by fatigue or the cold.
Skin infections are the most common. Burst blisters, work-related cuts, scrapes, and scratched insect bites: each of these minor injuries serves as an entry point for bacteria. Cellulitis, an infection of the skin and underlying tissues, is one of the most common complications. It presents as a warm, painful redness that spreads, sometimes accompanied by a pink streak extending toward the groin or armpit (lymphangitis), a sign that the infection is spreading through the lymphatic system. The golden rule in the field: mark the edges of the redness with a permanent marker, and reassess every four to six hours. If the edge advances or a fever sets in, the infection is not under control.
ENT infections (ear, nose, and throat) are exacerbated by the crowded conditions in camps. A simple cold can spread through a group of 20 people within 48 hours. Bacterial pharyngitis should be distinguished from viral infections: severe sore throat, pus on the tonsils, fever, and swollen lymph nodes. These symptoms point to strep throat and justify the use of antibiotics. Ear infections—external otitis in kayakers and swimmers, and otitis media in those who have traveled by plane—are common and generally manageable on-site if recognized early.
Dental infections are among the most overlooked aspects of expedition preparation. A dental abscess can, within a few days, develop into facial cellulitis that compresses the airways. In the field, local relief (Orajel, a tea bag applied to the gum) can buy some time, but antibiotics are still necessary, and evacuation to a dentist is often required as well.
Urinary tract infections These conditions mainly affect women, exacerbated by changes in hydration habits, hard-to-reach restrooms, and cold weather. A lower urinary tract infection (burning sensation, frequent urination, pain in the lower abdomen, no fever) responds well to three to five days of antibiotics. However, if a fever develops, if the pain radiates to the flanks, or if percussion of the lower back is painful, the infection has likely spread to the kidneys (pyelonephritis), and management becomes more complex. Severe flank pain, especially in someone with a history of kidney stones, may indicate an obstruction: this is an indication for urgent drainage.
Traveler's diarrhea is a common occurrence in international expeditions, as well as in certain Nordic or surface-water settings. The vast majority of cases can be resolved with thorough rehydration. Blood in the stool, fever, inability to rehydrate, and more than six loose stools per day: these are the signs that point to a serious bacterial infection requiring antibiotics and close monitoring.
Antibiotics in the Field: Choosing and Using Them Wisely
It is impossible to discuss infections in remote areas without mentioning antibiotics.
The choice of antibiotics for a medical mission depends on several factors: the geographic destination, the duration of the project, the number of participants, the level of medical care available, and any known allergies among the group.
A good selection of antibiotics for a medium-length expedition in North America typically includes:
- Amoxicillin-clavulanate (Clavulin): the ultimate broad-spectrum antibiotic, effective for ENT, skin, urinary tract, and even abdominal infections as a last resort. Its only real drawback: it is heat-sensitive and must be protected from both extreme heat and freezing temperatures.
- Cefadroxil or cephalexin: highly effective for skin and urinary tract infections. Cefadroxil has the practical advantage of being taken twice a day rather than four times.
- Clindamycine: the drug of choice for patients with penicillin allergies suffering from skin, ENT, and dental infections. It also inhibits the production of bacterial toxins, making it useful for severe soft tissue infections. Be aware of the rare but real risk of Clostridium difficile colitis.
- TMP-SMX (Septra) : Excellent for MRSA skin infections and urinary tract infections. Use with caution in people with fair skin, as it causes significant photosensitivity.
- Ciprofloxacin : essential for traveler's diarrhea and complicated urinary tract infections, but should be used with caution. It is not very effective against lung infections and is associated with a risk of tendonitis, particularly during intense physical activity.
- Metronidazole (Flagyl): essential for treating abdominal infections caused by anaerobic bacteria, Giardia, and other intestinal parasites. It has the advantage of being heat-stable.
- Azithromycine : the first-line treatment for traveler's diarrhea in certain regions of Asia where resistance to ciprofloxacin is more common, and useful in cases of penicillin allergy for ENT and respiratory infections.
Prescribing a 14-day supply means providing two treatments
A common rule of thumb: if you’re going away for several weeks, ask for prescriptions for at least 14 days’ worth of medication rather than 7. This gives you some flexibility in case the situation drags on or if another team member gets sick.
The issue of clinical judgment
It would be tempting to think that in remote areas, the rule is simple: at the slightest sign of infection, antibiotics are prescribed. That would be a mistake.
Antibiotics carry real risks: allergic reactions that may themselves require medical evacuation, severe diarrhea, bacterial resistance, and drug interactions.
The threshold for initiating antibiotic treatment may be slightly lowered in situations of prolonged isolation, given the inability to obtain an advanced diagnosis and the cost of evacuation. But this does not mean a free pass. Treatment should be administered only when clearly indicated, following an assessment, and ideally after consulting a physician.
Telemedicine
For any situation that goes beyond the scope of practice of the person on the ground, telemedicine is no longer a luxury—it’s the standard. Starlink and other satellite systems have transformed access to remote care. A consultation with a doctor by phone or video can prevent a wrong decision in either direction: treating unnecessarily or delaying necessary treatment.
Get ready before you leave
The best infection is the one you don't catch. And prevention starts long before you leave.
Vaccinations. In addition to routine vaccinations (tetanus, hepatitis B, and meningococcal vaccine, depending on the situation), international travel may require specific vaccinations: hepatitis A, typhoid fever, rabies, yellow fever, and Japanese encephalitis. It is recommended that you visit a travel medicine clinic at least four to six weeks before departure.
A visit to the dentist is also a must. A loose molar, a filling that’s coming loose, a partially erupted wisdom tooth: all these minor issues in an urban setting can turn into emergencies when you’re 200 kilometers down the road. A comprehensive dental exam should be routine before any expedition lasting more than a week in a remote area.
Feet. Often overlooked, always hard at work. Untreated blisters, improperly cared-for ingrown toenails, and neglected fungal infections: these are all potential entry points for skin infections. Trimming your nails straight across, moisturizing your feet, and choosing the right socks are practical preventive measures.
The health record. Record known allergies, regular medications, blood type, and vaccinations. This document must be readily accessible to all expedition leaders.
During the expedition: staying vigilant every day
Minor injuries. On an expedition, the pressure to perform often leads people to ignore minor injuries. That’s a mistake. A blister that has burst, a scratch, an insect bite scratched until it bleeds: each one deserves immediate attention. Clean under pressure (using a water bottle, a syringe with a catheter, or even a water bottle with a small hole in the cap), apply antiseptic to the skin around the wound—never directly on it—and ensure protection and daily monitoring.
Topical antibiotics. For superficial wounds, an antibiotic cream (mupirocin, or Polysporin if mupirocin is not available) applied daily significantly reduces the risk of secondary infection.
Reassess regularly. Infections can progress rapidly. A wound that seemed to be healing well can change in appearance within a few hours. Mark the edges of any redness, take the temperature daily, and document the progress: these simple habits allow for early detection of deterioration.
Infection Transmission and Control in Camps
In a work camp or on an expedition, an infection rarely affects just one person. Shared meals, communal facilities, and constant close contact create conditions that are conducive to the spread of infection.
Infections are primarily transmitted through four routes: direct contact (handshakes, providing care without gloves), droplets (coughing, sneezing), the fecal-oral route (poor hand hygiene, contaminated water or food), and vectors (mosquitoes, ticks). This knowledge has direct practical implications: preventive measures vary depending on the route of transmission.
Hand hygiene remains the simplest, most effective, and most often overlooked practice. Hand sanitizer should always be readily available, especially before meals, after providing care, and after using the restroom.
The person in charge of meals is a potential critical source of infection in a camp with a communal kitchen. Someone with gastroenteritis or a hand infection can contaminate a meal and trigger an outbreak. If someone has gastrointestinal symptoms, they should not prepare meals for the group.
Isolating the sick person, even if only partially (separate room, mask in common areas), can make a significant difference for droplet-transmitted infections such as the flu or strep throat.
Water and waste management. In the wilderness, always treat surface water before drinking it. Bury human waste at least 60 meters from waterways.
Recognizing red flags
Some infections require hospital care. Seek medical attention immediately if you notice:
- - fever with confusion and mottled or bluish skin (possible sepsis)
- - Pain rated 8 to 10 out of 10, disproportionate to the visible infection (necrotizing fasciitis)
- - stiff neck accompanied by severe headache and fever (meningitis)
- - trismus or marked difficulty swallowing (deep pharyngeal abscess)
- - uncontrollable, chills (possibility that the infection is in the bloodstream)
- - absence or near absence of urine (a sign of shock or severe kidney damage)
- - an infection that progresses rapidly despite antibiotic treatment
When in doubt, evacuate. A false alarm is embarrassing and costly. A delayed evacuation can cost lives.
In conclusion
Infections are the most common medical issue in remote areas. Not all of them are serious—far from it. But they can all become serious if they are ignored, if action is delayed, or if one is unprepared.
Prepare before departure. Stay alert in the field. Act quickly. Know how to identify situations that can’t wait. Maintain contact with a doctor. And don’t underestimate the value of a physical exam and close monitoring.
