Arctic Emergency Medicine: Navigating the Intersection of Climate and Health in Rural Alaska

“We might be able to charter a plane from Big, he might be willing to land and pick her up.”

You wouldn’t expect to hear this in the back room of an emergency department (ED). After spending some time in Kotzebue, however, something like this wouldn’t seem out of place at all. Kotzebue is located on Alaska’s western coast, about 33 miles north of the arctic circle. The population of a few thousand Inupiat is served by a small hospital with a 6-bed emergency department. When I first arrived, I couldn’t help but wonder — can you really practice “wilderness” medicine in a place that people call home?

The short answer is yes. I believe that working in Kotzebue’s ED highlights the scope of wilderness medicine. I had to rethink my (recently minted) way of practicing emergency medicine: no in-house specialty support, no MRI, no ICU, a 90-minute flight time to the closest tertiary center. There is no shortage of bread-and-butter cases such as necrotizing marine zoonotic infections, hypothermia, or frostbite. Some days, it feels like a cultural immersion: an elder may describe his symptoms with a peppering of Inupiaq words. These words soon become wonderfully familiar, you chat about muktuk (whale blubber) and seal oil, and you wonder “am I really still in America?”

I move to my next patient, a middle-aged woman living at camp, her lifestyle defined by subsistence hunting and fishing. With a grimace, she describes how she now needs to be careful snowmachining into town, because although it’s the middle of January, there are still holes in the river ice. I recently read an article shared by Harvard Kennedy School’s Arctic Initiative, which supports “the proposition that Arctic warming has been proceeding at almost 4X the global rate, rather than the often quoted 2-3X.” The daily impact of a warming environment is much more tangible at these latitudes.

I doubt residency training prepares you for the work that goes on in the “radio room.” Imagine running medical control for several villages scattered across an area the size of Indiana. The population of these villages varies from a handful to a few hundred people. Their clinics are staffed by a community health aide, a trained community member who functions as your eyes, ears, and hands. Through a patchwork of Zoom, phone calls, and written notes, I became a telemedicine “regular” in between ED patients. When planning a village transfer, since there are no roads connecting any of these villages, I begin the following mental gymnastics: is this patient stable for the commercial flight tomorrow? If not, do I save the local crew for a potential future critical patient, and send the Anchorage crew instead?

When we only have 90 minutes of daylight and a village with an emergency has broken runway lights, we get creative (see line 1). Often, we see communities come together in amazing ways for patients: an entire village rallying on a dark morning to line dozens of ATVs and snowmachines along the length of the runway, lighting the way for the plane to land. Kotzebue is an example of how wilderness medicine is so much more. It is within the walls of this ED that the idea of wilderness medicine blurs with rural medicine, global health, EMS, and climate health.