Step 1 · Mission profile
| Population | ~110 passengers, mostly older, broadly healthy but not medically screened; ~50 crew and expedition staff (younger, working outdoors). |
|---|---|
| Duration | ~14-day polar itinerary, with daily shore landings by Zodiac. |
| Distance to care | Days from a hospital; frequently >48 h from definitive care. |
| Evacuation | Helicopter or diversion, both weather- and range-limited; sea state constrains any transfer. |
Step 2 · The demand model (a real case log)
What does this population actually present with? A de-identified series of 1,169 unique encounters from contemporaneous physician logs across eight polar expedition vessels gives a concrete demand model. This is the log of cases that actually occurred, not a guess.
Step 3 · The kit present (Quark Expeditions, North Pole 2008)
The ship carried a real, par-level-tracked formulary aboard the icebreaker 50 Years of Victory. It holds the everyday load in depth and keeps a lighter resuscitation core for the rare emergency. Here is a representative slice of the actual inventory, with item, dose and target par:
| Section | Actual line items (selected, with par targets) |
|---|---|
| Resus / ALS core | Adrenaline 1:10,000 prefilled (target 10) and 1:1,000; lidocaine PFS; atropine 0.5 mg/ml PFS; furosemide; methylprednisolone; dexamethasone; glucose 50%; haloperidol; activated charcoal. |
| Respiratory | Throat lozenges (52; target 18 boxes); pseudoephedrine (target 200); guaifenesin syrup; prednisone (target 100); albuterol MDI + aerochamber; salbutamol nebs (target 20); duo-nebs; diphenhydramine oral (target 50) and IV. |
| Gastrointestinal | Antacid (target 100); ranitidine (target 100); omeprazole; lomotil (target 100) / loperamide; bisacodyl; glycerin suppositories; enema; Anusol; haemoccult cards. |
| Analgesia / MSK | Aspirin 325 mg (target 200); ibuprofen 400 mg (target 300); paracetamol 500 mg (target 400); ketorolac injectable. |
| Antimicrobials | Amoxicillin (target 100); cephalexin (target 100); dicloxacillin; plus the broader oral set. |
Step 4 · What was actually used
The same logs show what was given. Three over-the-counter agents, promethazine, ibuprofen and paracetamol, account for over a third of all prescribing between them; wound care and splinting are the procedural workload. That confirms the demand model and tells you which sections of the kit must never run dry.
| Most-used medications | n | % |
|---|---|---|
| Promethazine (oral + IM) — antiemetic / motion | 165 | 13.4 |
| Ibuprofen | 155 | 12.6 |
| Paracetamol / acetaminophen | 141 | 11.4 |
| Throat lozenge | 73 | 5.9 |
| Cough preparation (guaifenesin/dextromethorphan) | 46 | 3.7 |
| Antidiarrhoeal (loperamide/diphenoxylate) | 43 | 3.5 |
| Wound dressing / gauze (procedure) | 58 | 4.7 |
| Splint / brace / sling (procedure) | 47 | 3.8 |
Step 5 · Run the smoke-test
Scenario, delivered VEMS-first with the laminated cards, then walked into the real ship's hospital: an older passenger develops chest discomfort and near-syncope after climbing back aboard from a Zodiac. Vitals card starts borderline and deteriorates if the team is slow. The case forces them to find the monitor and the resus drugs, decide on aspirin and a nitrate, attempt a reach-back consult, and make an evacuation call on a moving ship days from a hospital.
Step 6 · The gaps it exposed
Findings, sorted into the five dimensions and labelled by action. This is the exact set loaded by the “Load sample” button on the Gap Analysis Worksheet.
| Dimension | Finding | Action |
|---|---|---|
| Kit | No point-of-care labs (troponin, electrolytes, ionised calcium, lactate) to risk-stratify chest pain or guide resus. | Add |
| Kit | 12-lead ECG present but a single lead set, off the charge rotation. | Re-organise |
| Kit | Motion-sickness stock deep, but only sedating options for staff who must stay functional. | Add |
| Kit | Same antiemetic in three places and two strengths. | Consolidate |
| Kit | Resuscitation core (oxygen, adrenaline, amiodarone, atropine, aspirin, nitrate) correct. | Keep |
| Personnel | Only the physician can run a monitored resuscitation; no trained second responder. | Add |
| Personnel | Crew AED/CPR currency uneven and undocumented. | Re-organise |
| Footprint | No defined space to assess a collapsed passenger; corridor too narrow for a litter with the ship rolling. | Re-organise |
| Footprint | Oxygen and resus kit two decks from the likely collapse points (dining room, lecture theatre). | Re-organise |
| Training | Team unfamiliar with the drug-locker layout; time lost finding adrenaline. | Re-organise |
| Training | No shared handover script; reach-back consult was unstructured. | Add |
| Comms/Evac | Maritime radio-medical reach-back known only to the physician; number not posted. | Add |
| Comms/Evac | No written PACE comms plan for a medical evacuation request from the ship. | Add |
The lesson
The Quark kit already stocks the everyday load in depth, which the case log proves is where nearly all the work sits. The smoke-test set out to check the rarer half of the job: that the resuscitation core is complete, quick to find and possible to staff for a cardiac event, and it found the real gaps in point-of-care labs, in trained people, in the space and in the comms plan before a passenger ever arrives with chest pain. That is the whole return on an hour of simulation.