Intended for Physicians, First Responders, Mountaineers (original) (raw)
High altitude medicine & biology, 2018
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131-140, 2018. Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed...
Background: This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. Methods: The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. Results: The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care. Conclusions: Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
Wilderness & Environmental Medicine, 2014
To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness
Wilderness & Environmental Medicine, 2019
To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations.
Wilderness & Environmental Medicine, 2018
Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
High Altitude Medicine & Biology, 2011
Tomazin, Iztok, John Ellerton, Oliver Reisten, Inigo Soteras, and Miha Avbelj. Medical standards for mountain rescue operations using helicopters: Official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt. Med. Biol. 12:335-341.-The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally < 20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.
Impact of Study Design on Reported Incidences of Acute Mountain Sickness: A Systematic Review
High Altitude Medicine & Biology, 2015
Impact of study design on reported incidences of acute mountain sickness: A systematic review. High Alt Med Biol. 16:000-000, 2015-Aims: Published incidences of acute mountain sickness (AMS) vary widely. Reasons for this variation, and predictive factors of AMS, are not well understood. We aimed to identify predictive factors that are associated with the occurrence of AMS, and to test the hypothesis that study design is an independent predictive factor of AMS incidence. We did a systematic search (Medline, bibliographies) for relevant articles in English or French, up to April 28, 2013. Studies of any design reporting on AMS incidence in humans without prophylaxis were selected. Data on incidence and potential predictive factors were extracted by two reviewers and crosschecked by four reviewers. Associations between predictive factors and AMS incidence were sought through bivariate and multivariate analyses for different study designs separately. Association between AMS incidence and study design was assessed using multiple linear regression. Results: We extracted data from 53,603 subjects from 34 randomized controlled trials, 44 cohort studies, and 33 cross-sectional studies. In randomized trials, the median of AMS incidences without prophylaxis was 60% (range, 16%-100%); mode of ascent and population were significantly associated with AMS incidence. In cohort studies, the median of AMS incidences was 51% (0%-100%); geographical location was significantly associated with AMS incidence. In cross-sectional studies, the median of AMS incidences was 32% (0%-68%); mode of ascent and maximum altitude were significantly associated with AMS incidence. In a multivariate analysis, study design (p = 0.012), mode of ascent (p = 0.003), maximum altitude (p < 0.001), population (p = 0.002), and geographical location (p < 0.001) were significantly associated with AMS incidence. Age, sex, speed of ascent, duration of exposure, or history of AMS were inconsistently reported and therefore not further analyzed. Conclusions: Reported incidences and identifiable predictive factors of AMS depend on study design.
Limits to human performance: elevated risks on high mountains
Journal of Experimental Biology, 2001
SUMMARY In 1950, Maurice Herzog and Louis Lachenal became the first climbers to reach the summit of an 8000m peak (Annapurna, 8091m). In the half century since that pioneering climb, mountaineers have increasingly sought to climb the fourteen ‘8K peaks’ of the Himalayas and Karakoram, with remarkable success; they have made 5085 ascents of those peaks up to the year 2000. While seeking adventure on those great peaks, mountaineers are inevitably exposed to hypoxia, cold and dehydration as well as to the physical hazards of climbing. Those few mountaineers who successfully summit an 8K peak are likely to be at or near their physiological limits and probably confront an elevated probability of dying during their descent. We will briefly review some of the physiological challenges climbers face at extreme elevation and then compare success rates and death rates on mountains of different heights (Rainer, Foraker, Denali, K2, Everest). Success rates decline with summit height, but overall...
WILDERNESS ENVIRONMENTAL MEDICINE, 2010
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.
Ambulatory Physiological Status Monitoring during a Mountaineering Expedition
Military Medicine, 2000
Objective: To evaluate an ambulatory physiological monitoring system during a mountaineering expedition. We hypothesized that the Environmental Symptoms Questionnaire, combined with frequent measurement of oxygen saturation and core temperature, would accurately identify cases of environmental illness. Methods: Twelve military mountaineers took a daily Environmental Symptoms Questionnaire, monitored fingertip oxygen saturations, and recorded core temperatures while climbing a 4,949-m peak. Illnesses identified by the system were compared with those identified by spontaneous reports. Results: The system correctly identified one case of highaltitude pulmonary edema and two illnesses that were not reported to the physician (one case of acute mountain sickness and one of self-limited symptomatic desaturation). However, it did not identify two illnesses that were severe enough to preclude further climbing (one case of sinus headache and one of generalized fatigue). Conclusions: Our monitoring system may complement, but cannot replace, on-site medical personnel during mountaineering expeditions.
Acute Mountain Sickness: Pathophysiology, Prevention, and Treatment
Progress in Cardiovascular Diseases, 2010
Barometric pressure falls with increasing altitude and consequently there is a reduction in the partial pressure of oxygen resulting in a hypoxic challenge to any individual ascending to altitude. A spectrum of high altitude illnesses can occur when the hypoxic stress outstrips the subject's ability to acclimatize. Acute altitude-related problems consist of the common syndrome of acute mountain sickness, which is relatively benign and usually self-limiting, and the rarer, more serious syndromes of high-altitude cerebral edema and high-altitude pulmonary edema. A common feature of acute altitude illness is rapid ascent by otherwise fit individuals to altitudes above 3000 m without sufficient time to acclimatize. The susceptibility of an individual to highaltitude syndromes is variable but generally reproducible. Prevention of altitude-related illness by slow ascent is the best approach, but this is not always practical. The immediate management of serious illness requires oxygen (if available) and descent of more than 300 m as soon as possible. In this article, we describe the setting and clinical features of acute mountain sickness and highaltitude cerebral edema, including an overview of the known pathophysiology, and explain contemporary practices for both prevention and treatment exploring the comprehensive evidence base for the various interventions. (Prog Cardiovasc Dis 2010;52:467-484) An additional clinical assessment scoring is sometimes used. GI indicates gastrointestinal.
Journal of travel medicine, 2017
Objective: To provide medical kit recommendations for short mountain wilderness recreation trips (hiking, trekking, backpacking, mountaineering etc.) based on the epidemiology of injury and illness sustained and best treatment guidelines. Additionally, to compare these recommendations to the medical kit contents of mountain climbers in Colorado. Methods: A primary literature review concerning the epidemiology of injury and illness in mountain wilderness settings was performed. This information and literature on the efficacy of given treatments were used to derive recommendations for an evidence-based medical kit. The contents of 158 medical kits and the most likely demographics to carry them were compiled from surveys obtained from mountain climbers on 11 of Colorado's 14 000-foot peaks. Results: Musculoskeletal trauma, strains, sprains and skin wounds were the most common medical issues reported in the 11 studies, which met inclusion criteria. Adhesive bandages (Band-Aids) were the most common item and non-steroidal anti-inflammatory drugs were the most common medication carried in medical kits in Colorado. More than 100 distinct items were reported overall. Conclusion: Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.
Effect of Ascent Protocol on Acute Mountain Sickness and Success at Muztagh Ata, 7546 m
High Altitude Medicine & Biology, 2009
Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt. Med. Biol. 10:25-32, 2009.-Data on acclimatization during expedition-style climbing to Ͼ5000 m are scant. We evaluated the hypothesis that minor differences in ascent protocol influence acute mountain sickness (AMS) symptoms and mountaineering success in climbers to Muztagh Ata (7546 m), Western China.
The purpose of this study was to examine the long-term and short-term effects of high altitude climbing (above 3000 meters) on the human body, and the positive and negative effects that the usage of drugs as climbing aids can have on climbers. Literature from thirty-four professional medical journals and eleven professional websites was reviewed. The resulting information was organized into categories as described in the purpose of this study. Each year, 35 million people climb above 3,000 m, and 4,000 people have summited Everest since 1953 (WHO, 2012; Jenkins, 2014). Many climbers experience acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE) (Medscape, 2012). Without properly acclimatizing, there is a 77.7% increased risk of developing HAPE (Deshwal, 2012). Studies by the Center for Disease Control have shown that 1 out 10,000 skiers in Colorado and 1 out of 100 climbers above 4,300 m experience HAPE (CDC, 2013. The effects of high altitude climbing were evaluated to determine the short term physiological changes in the human body. Temporary increases in perimacular retinal thickness and mean optic nerve sheath diameter were shown due to the altitude (Fischer, 2012; Keyes, 2013). Genes such as ANGPTL4 became upregulated (Goodin, 2013). The heart's right ventricular performance was altered (Pagé, 2013). Environmental and psychological factors also increased susceptibility to AMS (Alizadeh, 2012; Dong, 2013). The long term physiological effects of high altitude climbing were also evaluated. Increased inflammatory responses and mitral valve prolapse (MVP) was evidenced in people who lived at moderately high altitudes for short (< 1 year) periods of time (Carrera-Quinatanar, 2012; Güvenç, 2012). Gender and age were iii shown to play an important role in increasing the risk of AMS (MacInnis, 2013). Genetic polymorphisms were found in high altitude populations and were associated with incidence of AMS (Yang, 2013; Xing, 2013; Ge, 2012). Cognitive ability was not negatively impacted by high altitude residence (Richardson, 2011; Yan, 2011). Lastly, the physiological effects of drugs used as climbing aids were also assessed. Quercetin, acetazolamide, nifedipine, fenofibrate, and dexamethasone helped reduce AMS and hypoxic edemas (Patir, 2012; Apostolo, 2014; Wang, 2012; Sarada, 2012; Deshwal, 2012; Goodin, 2013; Lei, 2014). NSAIDS such as ibuprofen also helped prevent the severity of AMS (Lipman, 2012; Gertsch, 2010). Several Nepalese herbal remedies did not help reduce the risk of AMS, although CoQ 10 and melatonin supplements effectively reduced inflammation (MacInnis, 2013; Diaz-Castro, 2012; Ochoa, 2011). Overall, traveling to high altitudes poses numerous potentially life-threatening risks, yet genetic mutations and commonly used AMS prophylactics have allowed some people groups to live at high altitudes and are beneficial in aiding climbers to reach their summits (Medscape, 2012).
High Altitude Medicine & Biology
UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol 00:000-000, 2018.-The object of this advice article is not only to give the diabetic mountaineer general guidance but also to inform his or her medical team of practical aspects of care that may not be standard for nonmountaineers. The guidelines are produced in seven sections. The first is an introduction to the guidelines, and the second is an introduction to this medical problem and is designed to be read and understood by diabetic patients and their companions. The third section is for use in an emergency in mountains. The fourth is for rock, ice, and competition climbers operating in a less remote environment. These initial sections are deliberately written in simple language. The fifth and sixth sections are written for clinicians and those with skills to read more technical information, and the seventh looks at modern technology and its pros and cons in diabetes management in a remote area. Sections One and Two could be laminated and carried when in the mountains, giving practical advice.
Risk and protective factors for acute mountain sickness: a meta-analysis
2021
BackgroundCurrently, many people reach 3000-meter summits or greater. Some of these climbers suffer from acute mountain sickness (AMS), while others remain symptom-free. Some risk factors for AMS are well defined, such as lack of pre-acclimatization, rapid ascent, maximum altitude, and resilience at low altitude. However, there are other poorly described associated factors, such as sex, age, smoking, body mass index, medication use, and awareness or history of AMS. The objective of this meta-analysis was to establish the risk and protective factors associated with AMS. MethodsPubMed, UNIKA, and Scopus databases were searched in July 2020 for articles to include in the analysis. AMS was separately evaluated by the Lake Louise Score (LLS) and Hackett’s Score (HS). After screening and application of eligibility criteria, 14 articles were included in the meta-analysis (LLS = 12 and HS = 2). ResultsA total of 18,938 participants were included in the study with 17,450 in the LLS group and...
South African Medical Journal, 2017
Mr X-a fit and healthy 30-year-old man-joins a group climbing Mount Kilimanjaro, hoping to reach Uhuru Peak (5 895 m above mean sea level). His 6-day, 5-night expedition is following the Rongai route, approaching from the northern side of Kilimanjaro. After flying in from his home at sea level in South Africa (SA), they begin their trek near the Kenyan border at 1 900 m. Despite no previous experience at altitude, he shows no signs of struggling with the ascent, and easily copes during the deliberately slow hikes of the first 3 days to reach Kikelewa Caves (3 675 m). However, on arrival at Mawenzi Tarn camp (4 300 m) at the end of the hot 4th day, Mr X complains of a headache, dizziness and nausea. The local lead guide offers Mr X 800 mg oral ibuprofen to ease the headache and encourages him to rest. Having no appetite, Mr X skips dinner that night, but does take care to remain well hydrated. In the morning his headache has resolved, but he complains of having had fitful sleep. Routine screening by the guides shows elevated resting breathing and heart rates (respiratory rate 28/min.; heart rate 120/ min.). A portable fingertip pulse oximeter shows that his peripheral arterial oxygen saturation (SpO 2) has dropped to 64%. The guides are nevertheless anxious to push on, and Mr X continues with the group to Kibo Huts (4 714 m). During the day, his headache returns, and he feels lethargic and breathless. Nonetheless, with his bucket-list goal in sight, he participates in the final summit preparations. The group leaves camp for the summit at midnight. During the relentless climb to the crater rim (5 680 m), Mr X feels increasingly cold, and develops ataxia and tunnel vision. Amid the tired party in the predawn light, his deterioration remains unnoticed. At Gilman's Point on the summit ridge, the group stops for a brief rest. Mr X is disorientated, has lost fine motor control, and speaks incoherently before he collapses. By this point, the guides have discovered that you are a doctor, and turn to you for help. What is your assessment and action plan? Thinking back, if you were the expedition's doctor, would you have intervened earlier? This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 2015
High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.
Fatalities Among Iranian High-altitude Outdoor Enthusiasts: Causes and Mechanisms
Asian journal of sports medicine, 2012
This study was performed to determine the possible causes and mechanisms of fatalities among Iranian mountaineers during climbing. By contacting several sources, deceased mountaineers were identified. Data about the causes and mechanism of death was retrospectively obtained using a standard questionnaire for each case. A total of 29 deaths were identified from March 2006 to June 2010. Deceased subjects had a mean age of 39 years (SD: 12.8, Range: 20-67). Falling was the most common accident leading to death of outdoor enthusiasts (n = 14, 48%). Asphyxia (n = 6, 24%) was the most common cause of death among the subjects, followed by heart attack, internal bleeding, cerebral hemorrhage and hypothermia (17%, 17%, 17% and 10%, respectively). Our findings suggest that education of medical service providers of the climbing groups on facing victims in high altitude areas, where they have limited resources, can be particularly helpful. In addition, a national program to educate mountaineers...