Though this is a slight deviation from the normal ‘Skids Up’, we at HLTH have received a bunch of questions about working with TV productions… So here we go!
For clarity, I am going to write this in two parts.The first part of this blog will focus on being a medic supporting a production. My involvement is obviously limited to extreme remote jungle locations, whether in Central America or deep ‘behind enemy lines’ in Colombia (FARC Territory), with Netflix, National Geographic and Disney World. The second part will include some of the challenges of involving helicopters, medical and corona virus precautions.
Getting into the ‘Hollywood’ business (It sounds cool!) is usually is by word of mouth. My first production was by someone who remembered me from a networking event. I had helped him out with something trivial, as a matter of fact, and that was the repayment.
Production planning starts MONTHS in advance; a zillion emails, conference calls, messages and then ultimately once the production team has what they need, they release what is called the ‘call sheet’. This immensely useful document covers literally EVERYTHING: everyone involved, personal details, hotels, logistics, medevac plan, insurance details, and even the exact list of what camera gear they will carry. It also includes travel details and the planned filming schedule, but usually by the time it is released, you have been involved so much that the program is just a useful reminder of what day it is. Usually, the production insurance company will mandate certain items to be carried. For example: lightweight (collapsible) stretcher, AED, and, in my case, both types of anti-venom (coral and viper). The fact of the matter is that in your medical professional opinion, you do not actually need nor would ever use it (depending on the location), you have to carry it. Period. Production crews do not travel light! You will need to help! You don’t want to carry kit because you’re the medic? Do not expect to work again, quite simply.
Medical kit wise, what do you take? I never personally carry O2, because it’s too heavy (will touch on that in a moment), and how long does a cylinder last on 15 liters a minute? I used to have the EmOx system that relies on chemical components to create oxygen, and this allowed each member of the team to carry two small containers of chemicals… but alas, I don’t have that capability anymore.
Depending on the location, sometimes I carry a large ACLS type bag, but I cross reference with the ‘call sheet’ and see what the mandatory trauma/medical bag is that the production company is fetching. I normally carry a basic set of manual vital signs/Obs kit, and then the one thing that you CANNOT REPLICATE: drugs!
I have a machete, paracord and gaffa tape – I can make anything I need from the jungle. But I cannot replicate drugs. Though, with a machete, you can do ANYTHING!
A basic load-out would include epinephrine for anaphylaxis, a ton of different pain/analgesics from ketamine, tramadol, morphine and acetaminophen – all based on the projected tasks. Pelvic binders are carried due to the biggest killer in the jungle (Deadfall) as well as hypertonic solution for increased ICP. This does not included OTC’s and broad spectrum antibiotics for routine GI disturbances… Oh, and the anti-venom.
I roll my eyes with anti-venom, because, believe it or not, it is not a magic cure. Only in extenuating circumstances would I ever consider administering it in the field, because I do not have available all of the patient monitoring and advanced drugs necessary to manage a patient correctly post-administration. The main reason it is carried (and it is Gen 3, so it does not need a fridge) is that part of the medevac plan you develop as the medic allows you, if necessary, to hand it to a local doc. They then have the facilities and equipment to manage it in addition to the insurance company saying I have to.
In my experience, the main “drug”, for want of a better word, is the use of Vicks Vapo Rub. (That’s right – the pot of strong-smelling Vaseline that parents may or may not have rubbed on your chest if you have a cold.) I carry big tubs of the stuff. Remember our sole purpose is to put the presenter in front of the camera. If they’re covered in insect bites, put Vicks all over the bites. They go numb, so they cannot feel or scratch them, and the eucalyptus fragrance keeps the majority of other insects away since it’s alcohol based. Especially in a hot and humid jungle environment, this temporarily cleans/disinfects the bite.
Probably nothing about any of that is covered in formal medical training, but it functions. Keeping the presenter in front of the camera, as part of the production crew, is our ONLY AIM.
Routinely, I only carry a drug pack with syringes, tourniquets, gauze, elastic bandages (since machetes are in use all of the time), and then a simple, small, but well-stocked first aid kit. That is IT. I still have to carry my own water, shelter, 1x set of dry clothes (to follow the ‘wet/dry routine’) and food. I literally do not have the space on my back to carry more without becoming a casualty myself.
Big kit stays at the base camp. No base camp = no big kit.
PLUS, as part of the production team, you are a general ‘helper’, and at some stage will end up carrying Pelicases cameras (which are worth more than you have ever earned in your lifetime).
So, you are finally away on the production… The filming we did in 2019 is now released, so I will allude to that for insight. We filmed on the Guatemalan/Mexican border. It took the presenter and director two hours from arrival at Guatemala City to arrive on location by helicopter. The rest of us took five days, by commercial airline, 4×4 trucks and canoes; digging 4×4’s out of mud, winching, chainsaws, digging out canoes with outboard motors the size of a small car, you name it. It is 100 percent team effort to get to any of the locations.
As a medic, we are not actually that important (until it goes wrong obviously). As soon as we arrived at the location, kit is opened, cameras and sound prepared. What do WE do? Set up the camp, organize (or dig/build) a bathroom, and EVERYTHING else we can physically do to help our team.
Everything you do is always like a super-secret Special Forces Ninja Operation. By that I mean ZERO NOISE – EVER!! The sound guys literally pick up everything, so some basic rules for filming are:
- NEVER EVER get into the camera shot or ‘frame’
- SHUT UP AT ALL TIMES
- SIT and WAIT (for most of the day)
That is what it takes. Typically, filming starts at sunrise and finishes at sunset. Expect to sit still for all of that time, without making any noise.
The presenter, camera, etc. are usually 100 meters ahead of the ‘porters/support group’. So, take one of those really small camping-type stools to sit on, a headnet or ‘group fly sheet’, and sit under that for many hours. I personally carry a double-bed size anti-mosquito net, anyway, in case I need to do patient care. I sit inside that, and people may look at you funny, but I do not get as many bites as them, so I am happy! But we still have to monitor the film crew. It is why we are there, obviously. The cameraman is generally the one to watch out for dehydration, etc. as they are so focused on ‘getting the shot’ that the rest of the world is in oblivious to them..
The Advantages
The paycheck is usually above average, which helps everyone, obviously, but for me, more importantly, you get to visit places that normal people only ever see on the television. For example: The first Westerners EVER to visit a site that’s 5000 years old, rappelling INSIDE a Mayan temple, and you become lifelong friends with some very cool and famous people.
Occasionally, when it happens, you need to be on your A-game. Non-routine skills such as digital blocks with Lidocaine, suturing and SC injections of Lidocaine into large bites are common. This goes all the way up to a full-blown acute GI attack that requires a Medevac for four hours by canoe. But will that affect the production timeline by you leaving? It is all part of the challenges of supporting remote productions!
The Disadvantages
The downsides (if they can be called that) are a lot of planning/preparation, and then a lot of self-reliance. You may have a Medical Director, but productions usually occur where there is ZERO signal. Many promote the use of telemedicine for remote medics, and I fully support its use. But when even a GPS cannot get a signal, who are you going to call? You simply cannot – YOU ARE IT. I am a big believer in POCUS (Point of Care Ultrasound), but in some of the places I have been to, what difference does it ACTUALLY MAKE? For diagnosis, FAST scan, or measurement of ocular nerves for ICP… Plus, actually all of the super modern medical Gucci gear on the planet is no good as you cannot charge it! If the base camp has a generator, its sole purpose is to recharge camera batteries and allow the ‘back up’ of film data. Not our gear. The PRODUCTION is first and foremost. Expensive kit does not make any real difference as YOU ARE IN THE MIDDLE OF NOWHERE. Basic skills such as patient assessment, vital signs, SAMPLE, and trending are what we have to work on. A good understanding of the ‘Priorities of Survival’ and survival training are also a fundamental part of the game. If you get stuck, EVERYONE will look at YOU for advice.
In Part 2 of this blog, I will include the helicopter and Coronavirus precautions into the mix.
TV productions are uniquely challenging, an absolutely AWESOME experience, and NOT for the faint-hearted. Get prior advice and training from instructors that DO – not instructors that SAY THEY DO.