Operating in the Dark Space

Operating in the Dark Space

Feb 18, 2020    |    Dr. John Ross MD FRCPC

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I have a really weird job. My PRAXES colleagues and I work in the shadows, the ‘Dark Space’ that people prefer not to routinely think about. We are experts in the ‘s*@# happens’ business, and when people want our help, they want it NOW! We operate in the dark space.

We provide medical advice and support to people who work or adventure in remote places around the world. Places where there are no formal, or informal, healthcare services. We are a bond of refined technology and emergency medicine expertise available 24/7 in French and English.

When planning for work or an adventure in a remote place, virtually all the time and expertise is directed at technical aspects of the journey. Experts plan for the expected tasks, the right equipment, communications, provisioning, financing and insurance – all those elements define the project and will determine its success or failure. While there are often a lot of details, it is an engineering exercise that is predicable. What is not well understood, and too often overlooked, is preparing for the unexpected vagaries of human biology – body or mind malfunction, sickness and injury. There are tools aboard ships to repair broken equipment, but there may not be the personnel or equipment aboard to assess and treat broken people.

We assist companies in planning for these emergency scenarios, by providing the right medications, supplies, equipment and medical training for the project, location and expected risks.   We help to ensure that employees or adventurers are in the best possible health to manage the demands on them, both of the work, but also the environment.  We understand that everyone operating in a remote setting must stay productive and that illness or injury is a burden on everyone, including family members at home.

We discretely provide our access to Emergency Physicians, usually within 2-3 minutes of first picking up a phone anywhere in the world, through secure phone, messaging, images, and video. All calls are audio recorded and written records stored for quality review, learning and training. Detailed monthly reports are sent to clients.

Why do we operate in the Dark Space? When a worker or adventurer is sick or injured, and we assist on-site personnel assessing, diagnosing, and treating people, it is generally not something companies or tour groups want to advertise or celebrate. It is awkward for us to share our success in helping a company manage an injury or acute illness on site, without diversion or medevac. That is because the illness or injury may be due to a failure in safety procedures or highlight the inherent risks of an activity that might scare off employees or potential clients.

Most people tell us, “I didn’t know you existed!” We’ll take that as a sign of success. Every month, usually in the absence of healthcare professionals (HCP) on-site, and sometimes with different types of HCP there, we help diagnose and manage a wide spectrum of minor to multi-trauma, minor to major infections, procedure advice such as assessing and suturing or stapling wounds, setting fractures, inserting catheters, managing psychosis or depression, etc.

We are specialists in reacting to medical problems and operating in the dark space. But we emphasize being proactive through rigorous personnel health and fitness screening, having a well-stocked medical kit, basic training, good telecommunications, and regular practice. So while we are comfortable working in the Dark Space, we prefer working with companies and adventurers before they push off, in the light of day.

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For more information on the remote health services PRAXES offers or any other questions you may have, please contact us: