Feature Christmas 2024
How to transport a polar bear, and other idiosyncrasies in providing emergency medical services in the Arctic
Astrid K V Harring, Siri Idland, Mari Mowe Martinsen, et al
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2417 (Published 18 December 2024)Cite this as: BMJ 2024;387:q2417
Emergency helicopters in Norway’s northern Svalbard archipelago sometimes take unusual passengers, write Astrid K V Harring and colleagues
Six hundred miles north of mainland Norway, deep in the Arctic Circle, the Svalbard archipelago spans over 60 000 km2, with a population of just 2596. Longyearbyen, the “capital city,” has a small hospital to provide primary and emergency care. The hospital has 24 staff,1 including three doctors and at least one surgeon. Longyearbyen also has a fire department that has one ambulance with a stretcher.
With few roads and rugged terrain, Svalbard has two search and rescue helicopters that also provide helicopter emergency medical service (HEMS)—and unusual transfer missions.2 Each helicopter crew includes a medical rescue technician, and one has an anaesthetist. The helicopters carry the same equipment as mainland HEMS bases, including a handheld ultrasound machine and blood products.2 Annually the crews conduct over 80 missions, mostly search and rescue or as primary responders to medical emergencies. Authorities have recorded fewer than five cardiac arrests that occurred outside of hospital in the past 10 years.
Oxygen masks can crumble
Winds blowing across the vast Arctic landscape lead to low and unpredictable temperatures, from −30 °C one day to a relatively comfortable +5 °C the next. Here, battery life is short, oxygen masks can crumble, and endotracheal tubes must be secured with strips to prevent connectors from detaching.
Despite the frozen road conditions, there are no reports of injuries from road traffic incidents.3 Over half of Norway’s registered snowmobiles are found in Svalbard.4 Most snowmobile crashes involve inexperienced drivers and alcohol consumption.45 The population acts as an ambulatory blood bank.6
Roaming polar bears
Three thousand polar bears live in the wider Barents Sea region, and about 300 roam Svalbard’s islands.7 Polar bears have a better sense of smell than dogs, and have the strength to smash in cabin doors or windows in search of food. They also enjoy items with questionable nutritional value, such as snowmobile seats and clipboards (fig 1).8 In the past 50 years, polar bears have killed six people and injured several more.89 Outside Longyearbyen people must carry a rifle and flare gun (the doctor and helicopter medical rescue technician have Magnum 44 revolvers).10Every year, polar bears are shot during encounters with people.9 If an autopsy is needed, dead polar bears can be transported in a cargo net hanging beneath a helicopter (fig 2).
The changing climate in the Arctic results in less sea ice. This has changed the habits of polar bears, forcing them to the mainland.11 Thus polar bears sometimes stray into populated areas. To escort them back to the wild, they are herded using a helicopter. The polar bears are monitored using thermal imaging to ensure that they do not overheat while running (fig 3).
If herding fails, bears are sedated and then transported by helicopter. A veterinarian administers 5-10 mg/kg of tiletamine and zolazepam intramuscularly and might supplement this with medtomidine.12 Further sedation is often not needed after administration of the potent and long acting sedative drugs (figs 4 and 5).12 Tiletamine is more potent and has a longer duration of action than ketamine,13 and zolazepam is four times more potent than diazepam.14 The crew roll sedated bears (300-600 kg male or 150-350 kg female) onto stretchers and into helicopters with brute strength and teamwork (fig 6).15 Given the effects of the muscle relaxing drugs and the effects of atmospheric pressure with increasing altitude, the stretcher and the bottom half of the polar bear should be wrapped generously in plastic (fig 5).
