Occupational Aspects of Alpine Helicopter Rescue Operations: Recommendation of the Medical Commission of the Union Internationale des Associations d'Alpinisme.

Helicopter rescue operations in the mountains or at high altitude are well-known as strenuous tasks often associated with some risk. However, there is no standardized procedure for preventive checkups of rescue personnel by occupational care professionals. Therefore, the Medical Commission of the International Climbing and Mountaineering Federation (UIAA MedCom) suggests the procedure presented in this study. This comprehensive recommendation is based on more than 2 decades of research of MedCom members and extensive literature search. A total of 248 references were selected by the committee as relevant for the topic. To keep the recommendation handy, the complete list is available as supplemental material (see online Supplemental Material). This article recommends standardized procedures for occupational screening and better health of search and rescue personnel.

Companion Rescue and Risk Management of Trekkers on the Everest Trek, Solo Khumbu Region, Nepal.

BACKGROUND: Trekking to high-altitude locations presents inherent health-related hazards, many of which can managed with specific first aid (FA) training. This study evaluates the trip preparation, FA knowledge, and FA self-assessment of trekkers (organized by tour operators vs. individually planned tours). Data obtained shall be used for specific FA trip preparation and management of emergencies en route for this population. METHODS: A total of 366 trekkers on the Everest Base Camp Trek, Nepal, were interviewed using a questionnaire specifically designed to evaluate their FA knowledge and management of emergencies. Data evaluation was performed using descriptive statistics. RESULTS: A total of 40.5% of trekkers experienced at least one medical incident during their trip, of which almost 50% were due to acute mountain sickness (AMS). There was more AMS in commercially organized groups than in individually planned ones (55% vs. 40%). For more than 50%, no medical care was available during their trip. A total of 80% could answer only 3/21 FA questions completely correctly. Only 1% showed adequate knowledge concerning FA strategies. A total of 70% were willing to enroll in an FA class specialized towards the needs of trekkers. CONCLUSIONS: The importance of high-altitude FA knowledge and trip preparation is widely underestimated. There is an unmet demand amongst trekkers for specific wilderness FA classes.

Cardiovascular Risk Profiles and Pre-Existing Health Conditions of Trekkers in the Solu-Khumbu Region, Nepal.

BACKGROUND: High-altitude tourist trekking continues to grow in popularity on the Everest Trek in Nepal. We examined which pre-existing cardiovascular and health conditions these global trekkers had and what health issues they encountered during the trek, be it exacerbations of pre-existing conditions, or new acute ones. METHOD: Trekkers (n = 350) were recruited from guesthouses along the Everest Trek, mostly at Tengboche (3860 m). After completing a questionnaire on their health and travel preparation, they underwent a basic physical examination with an interview. RESULTS: Almost half (45%) had pre-existing conditions, mostly orthopaedic and cardiovascular diseases. The average age was 42.7 years (range 18-76). The average BMI was 23.4 kg/m2, but 21% were overweight. A third were smokers (30%), and 86% had at least one major cardiovascular risk factor. A quarter (25%) were suffering from manifest acute mountain sickness (AMS), and 72% had at least one symptom of AMS. Adequate pre-travel examination, consultation, and sufficient personal preparation were rarely found. In some cases, a distinct cardiovascular risk profile was assessed. Hypertensive patients showed moderately elevated blood pressure, and cholesterol levels were favourable in most cases. No cardiovascular emergencies were found, which was fortunate as timely, sufficient care was not available during the trek. CONCLUSION: The results of earlier studies in the Annapurna region should be revalidated. Every trekker to the Himalayas should consult a physician prior to departure, ideally a travel medicine specialist. Preventative measures and education on AMS warrant special attention. Travellers with heart disease or with a pronounced cardiovascular risk profile should be presented to an internal medicine professional. Travel plans must be adjusted individually, especially with respect to adequate acclimatisation time and no physical overloading. With these and other precautions, trekking at high altitudes is generally safe and possible, even with significant pre-existing health conditions. Trekking can lead to invaluable personal experiences. Since organized groups are limited in their flexibility to change their itinerary, individual trekking or guided tours in small groups should be preferred.

Variables Influencing the Pressure and Volume of the Pulmonary Circulation as Risk Factors for Developing High Altitude Pulmonary Edema (HAPE).

BACKGROUND: At altitudes above 2500 m, the risk of developing high altitude pulmonary edema (HAPE) grows with the increases in pulmonary arterial pressure. HAPE is characterized by severe pulmonary hypertension, though the incidence and relevance of individual risk factors are not yet predictable. However, the systolic pulmonary pressure (SPAP) and peak in tricuspid regurgitation velocity (TVR) are crucial factors when diagnosing pulmonary hypertension by echocardiography. METHODS: The SPAP and TVR of 27 trekkers aged 20-65 years en route to the Solu Khumbu region of Nepal were assessed. Echocardiograph measurements were performed at Lukla (2860 m), Gorak Shep (5170 m), and the summit of Kala Patthar (5675 m). The altitude profile and the participants' characteristics were also compiled for correlation with the measured data. RESULTS: The results showed a highly significant increase in SPAP and TVR after ascending Kala Patthar. The study revealed a lower increase of SPAP and TVR in the group of older participants, although the respective initial measurements at Gorak Shep were significantly higher for this group. A similar finding occurred in those using Diamox® as prophylaxis. There was an inverse relationship between TVR and SPAP, the peripheral capillary oxygen saturation, and heart rate. CONCLUSIONS: The echocardiograph results indicated that older people are an at-risk group for developing HAPE. A conservative interpretation of the basic tactical rules for altitudes should be followed for older trekkers or trekkers with known problems of altitude acclimatization ("slow acclimatizer") as SPAP elevates with age. The prophylactic use of Acetazolamide (Diamox®) should be avoided where not necessary for acute medical reasons. Acetazolamide leads to an increase of SPAP, and this may potentially enhance the risk of developing HAPE. Arterial oxygen saturation measurements can provide an indicator for the self-assessment for the risk of developing HAPE and a rule of thumb for the altitude profile, but does not replace a HAPE diagnosis. Backpack weight, sex, workload (actual ascent speed), and pre-existing diseases were not statistically significant factors related to SPAP and TVR (p ≤ 0.05).

Analysis of local drinking water for fecal contamination in Solu-Khumbu / Mt. Everest region, Nepal.

BACKGROUND: To evaluate the drinking water quality in the popular trekking area of Solu-Khumbu Mt. Everest region as a possible source for the high incidence of diarrhea. MATERIAL AND METHODS: Drinking water samples (n = 80) were collected from whatever primary source the locals/tourists used at altitudes 2,608 to 5,180m; and where possible, also from inside households. Samples were analyzed for fecal contamination using the DelAgua Dual Incubator at 37 °C and 44 °C to detect the total and thermotolerant coliform bacteria. The pH, temperature, turbidity, smell, and taste were also registered. RESULTS: No thermotolerant bacteria were found but a significant number of specimens contained many colony forming units (CFU) of total coliform bacteria. Household specimens were more often contaminated compared to the water from the primary source. CONCLUSION: Data indicate a significant secondary contamination when water was handled and stored in unhygienic containers. Health education programs on water hygiene, sanitation, and the safe handling and storage of water needs improvement. It is strongly recommended that drinking water is disinfected using filter systems, UV-light dispensers or halogens (e.g. chlorine), or a combination of two methods. Although cooking is a common disinfection method here, fuel is scarce. Water was generally safer when collected directly from the primary source in a clean container than from a lodge.

Inpatient treatment of trekkers and Nepalese workers in the high-altitude environment of Mt. Everest Region 1996-2011: A retrospective analysis.

BACKGROUND: The study investigates the diagnoses of inpatients (tourists and Nepali workers) of Kunde Hospital (Mt.Everest region) over 15 years. METHODS: Records from January 1996 to September 2011 were analyzed concerning date, gender, age group, nationality, purpose of visit, diagnosis, length of treatment, and condition at discharge. Diagnoses were coded according to ICD-10-WHO 2010. Data were analyzed using descriptive statistics and non-parametric tests. P < 0.05 was defined as significant. RESULTS: 479 inpatients were included: 363 (75.8%) males (202 trekkers (42.2%), 277 Nepalese workers (57.8%)). Most suffered from altitude sickness (45.5%), acute gastroenteritis (10.4%) or acute respiratory infection (8.4%). Severe cases of altitude sickness amongst trekkers decreased but increased amongst workers. Severe cases of acute gastroenteritis amongst trekkers increased. Mean length of inpatient treatment was 4.6 days ±2.7 days. 573/2030 days of treatment were caused by altitude sickness. 70 patients were evacuated, 9 died. CONCLUSION: Altitude illness caused the majority of inpatient treatment and acute gastroenteritis may be an underestimated risk for both groups. Other severe problems were mostly illnesses, not trauma. Improved prevention strategies are needed for both groups. For tourists who often show pre-existing diseases this includes an individual pre-travel expert advice. Nepali workers should be instructed concerning acclimatization.

A sport-specific upper-body ergometer test for evaluating submaximal and maximal parameters in elite rock climbers.

UNLABELLED: Traditional treadmill or bicycle ergometry neglects the upper-body musculature that predominantly limits or terminates rock-climbing performance (ie, the inability to continually pull up one's body mass or "hang on"). PURPOSE: To develop an incremental maximal upper-body ergometer test (UBT) to evaluate climbers' aerobic fitness and sport-specific work capacity and to compare these results with a traditional treadmill protocol. METHODS: Eleven elite sport climbers (best redpoint grade Fr.8b) performed a UBT on a vertically mounted rowing ergometer and, on a separate occasion, performed a maximal incremental treadmill test (TMT). Cardiorespiratory parameters were measured continuously. Lactate (La) samples were collected. RESULTS: Peak oxygen consumption (VO2peak) and heart rate in UBT and TMT were 34.1 ± 4.1 vs 58.3 ± 2.6 mL · min-1 · kg-1 and 185 ± 8 vs 197 ± 8 beats/min, respectively, and both variables were of significantly lower magnitude during UBT (P < .001). End-of-test La levels for UBT (11.9 ± 1.7 mmol/L) and TMT (12.3 ± 2.5 mmol/L) were similar (P = .554). Treadmill VO2peak was not correlated with either upper-body (UB) VO2peak (P = .854) or redpoint and on-sight climbing grade ability (P > .05). UB VO2peak and peak power output per kg body mass were both strongly correlated (P < .05) with climbing grade ability. The highest correlation coefficient was calculated between current on-sight grade and UB VO2peak (r = .85, P = .001). CONCLUSION: UBT aerobic- and work-capacity results were strongly correlated to climbing-performance variables and reflected sport-specific fatigue, and TMT results were not. UBT is preferred to TMT to test and monitor dedicated and elite rock climbers' training status.

The epidemiology of injury in mountaineering, rock and ice climbing.

Climbing and mountaineering sports are gaining more and more public interest. This chapter reviews scientific studies on injuries and accidents in climbing and mountaineering sports to evaluate the danger of these sports and their specific injuries and preventive measures. An initial PubMed query was performed using the key words 'rock climbing', 'sport climbing', 'mountaineering', 'alpine injuries' and 'climbing injuries'. More than 500 extracted papers were analyzed which gave information on injury, mortality/fatality, prevention and risk factors. Cross-references were also scanned according to the above given criteria. Also the data sources of the UIAA and IFSC Medical Commissions were analyzed. Overall, alpine (traditional) climbing has a higher injury risk than sport climbing, especially indoor climbing. Alpine and ice climbing have more objective dangers which can affect climber safety. Overall injury rates are low, nevertheless fatalities do occur in all climbing disciplines. Altitude-related illnesses/injuries also occur in mountaineering. Most injuries in sport climbing are overstrain injuries of the upper extremity. In alpine climbing, injuries mostly occur through falls which affect the lower extremity. Objective reporting of the injury site and severity varied in most studies according to the injury definition and methodology used. This creates differences in the injury and fatality results and conclusions, which in turn makes inter-study comparisons difficult. In future studies, the UIAA MedCom score for mountain injuries should be used to guarantee inter-study comparability. Evidence in preventive measures is low and further studies must be performed in this field.

The UIAA Medical Commission injury classification for mountaineering and climbing sports.

OBJECTIVE: Variations in definitions, scores, and methodologies have created differences in the results and conclusions obtained from studies on mountaineering and climbing sports injuries and illnesses; this has made interstudy comparisons difficult or impossible. To develop a common, simple, and sport-specific scoring system to classify injuries and illnesses in mountaineering and climbing studies; such retrospective scoring would facilitate the analysis and surveillance of their frequencies, severity and fatalities, and outcomes of any treatment. METHODS: The UIAA (The International Mountaineering and Climbing Federation) makes recommendations, sets policy, and advocates on behalf of the climbing and mountaineering community internationally through its various commissions. Using a nominal group consensus model approach, a working group was formed during the UIAA Medical Commission's meeting in Adrspach - Zdonov, in the Czech Republic, 2008. This group critically examined climbing and other relevant literature for various methodological approaches in measuring injury incident rates and severity, including data sources, and produced a working document that was later edited and ratified by all members of the UIAA Medical Commission. RESULTS: Definitions of injury location, injury classification, and fatality risk are proposed. Case fatality, time-related injury risk, and a standardized metric climbing difficulty scale are also defined. CONCLUSIONS: The medical commission of the UIAA recommends the use of the described criteria and scores for future research in mountaineering and climbing sports in order to enable robust and comprehensive interstudy comparisons and epidemiological analysis.

Evaluation of injury and fatality risk in rock and ice climbing.

Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

Physiological responses to rock climbing in young climbers.

Key questions regarding the training and physiological qualities required to produce an elite rock climber remain inadequately defined. Little research has been done on young climbers. The aim of this paper was to review literature on climbing alongside relevant literature characterising physiological adaptations in young athletes. Evidence-based recommendations were sought to inform the training of young climbers. Of 200 studies on climbing, 50 were selected as being appropriate to this review, and were interpreted alongside physiological studies highlighting specific common development growth variables in young climbers. Based on injury data, climbers younger than 16 years should not participate in international bouldering competitions and intensive finger strength training is not recommended. The majority of climbing foot injuries result from wearing too small or unnaturally shaped climbing shoes. Isometric and explosive strength improvements are strongly associated with the latter stages of sexual maturation and specific ontogenetic development, while improvement in motor abilities declines. Somatotyping that might identify common physical attributes in elite climbers of any age is incomplete. Accomplished adolescent climbers can now climb identical grades and compete against elite adult climbers aged up to and >40 years. High-intensity sports training requiring leanness in a youngster can result in altered and delayed pubertal and skeletal development, metabolic and neuroendocrine aberrations and trigger eating disorders. This should be sensitively and regularly monitored. Training should reflect efficacious exercises for a given sex and biological age.