Medicalizar los equipos de rescate en montaña: justificación socio-económica en base a la evolución de la mortalidad en el Pirineo Central / Medicalization of mountain rescue teams: social and economic approach based on mortality evolution in Central Pyrenees

Introducción: El montañismo mejora la salud física y mental de las personas que los practican contribuyendo a lograr un menor gasto socio-sanitario. Todos los deportes tienen efectos colaterales no deseados: accidentes y lesiones. Las operaciones de rescate en montaña implican dificultades logísticas y ambientales que exponen a numerosos e importantes riesgos, pero se han incorporado sanitarios en estas operaciones de rescate ya que acortar los tiempos de intervención médica y el tratamiento apropiado in situ disminuyen la morbi-mortalidad de los accidentados. En España hay muchas Comunidades Autónomas (CCAA) sin rescate en montaña medicalizado. La realidad de los accidentes de montaña: En España hay 5,4 muertos por cada 100 rescatados en montaña. En Aragón, se contabilizan 3,5 muertos/100 accidentados rescatados. El 11,3% de los rescatados en Aragón entre 1999 y 2008 presentaba un índice Glasgow entre 13 y 9 y el 12,9% tenían un Glasgow < 9 (grave). Un 6,3% de los pacientes rescatados sufrieron politraumatismos. Un 63,7% de los rescatados presentaban un índice de gravedad NACA≥III que hace referencia a pacientes que requieren asistencia médica en el lugar del accidente. En Aragón se medicaliza el rescate en montaña desde 1998. También están medicalizados estos rescates en Asturias, Cantabria y Castilla-León. Los efectos de la medicalización del rescate en montaña: Existen claras diferencias entre las prestaciones que establecen unas CCAA y otras. La "medicalización del rescate" supone un médico o enfermera específicamente formado en Medicina de Urgencias en Montaña integrado en los equipos de rescate. Esto mejora la eficacia del primer tratamiento en el lugar del accidente, por difícil que sea el acceso, mejorando la supervivencia y disminuyendo la morbilidad. En Aragón, la tasa de mortalidad media ha pasado del 9,32% antes de la medicalización del rescate al 3,45% en los 15 años de rescate medicalizado con médicos y enfermeras CUEMUM, lo que supone una disminución del 62%. Mientras que la tasa de mortalidad media en España en el mismo periodo ha pasado del 8,8% al 6,8%; lo que supone una disminución del 12,5%. La relación coste-beneficio: Calculamos a la baja que los accidentes de montaña en España cuestan más de 375 millones Euros al año. En Aragón estimamos que superan los 50 millones Euros al año. La disminución de la tasa de mortalidad en un 62% ha supuesto un ahorro de más de 175 millones Euros. Conclusiones: La medicalización del rescate es un derecho y un deber con claros beneficios socio-sanitarios. La asistencia médica in situ disminuye la morbi-mortalidad y el gasto público. España debe mejorar la prevención, además de garantizar la medicalización de los rescates en todo el territorio con sanitarios formados en Medicina de Urgencias en Montaña

Introduction: Mountaineering improve the physical and mental health of people who practices it. All sports have a collateral not wished effects: accidents and sport injuries. Although mountain rescue operations involve logistic and environmental difficulties that expose everybody to important risks, alpine countries have joined sanitary people in these rescue operations because they know shorten times of medical intervention and an appropriate treatment in place diminish mortality and sequels, and consequently, social and sanitary expenses. Many mountain regions in Spain have not medical services in mountain rescue teams. The facts of mountain casualties: There were 5,4 fatalities for every 100 rescued people in mountains in Spain. There were 3,5 fatalities for every 100 rescued people in Aragon. 6,3% of rescued patients suffered polytraumatisms. 63,7% of rescued people in mountains in Aragon presented a NACA index ≥ III (that means they need medical assistance in the place of the accident). 11,3% of people rescued in Aragon between 1999 and 2008 had a Glasgow Index among 13 and 9 and 12,9% had a Glasgow Index < 9. Mountain rescue operations are medicalized in Aragon since 1998. Also, mountain rescues are medicalized in Asturias, Cantabria y Castilla-León. Effects of medicalized mountain rescue operations: There are important differences between some regions in Spain about medical services in mountain rescues. Medicalization means to have a doctor or nurse specifically trained in Mountain Emergency Medicine integrated in rescue teams. This improves the efficiency of first treatments on the field, despite the difficulties of access, improving survival and diminishing morbidity. In Aragon, the rate of average mortality has changed from 9,32% before the medicalization of mountain rescue to 3,45% during medicalization with CUEMUM physicians and nurses, which supposes a decrease of 62% in 15 years. Whereas the rate of mortality in Spain was changed to 8,8% to 6,8% in the same period what supposes a decrease of 12,5%. Cost-benefit analysis: We calculate downwards that mountain casualties in Spain costs more than 375 million Eurosper year. They overcome 50 million Euros per year in Aragon. This region has save of more than 175 million Euros with this decrease of mortality of 62%. Conclusions: Medicalization of mountain casualties is a human right and a duty with clear social and sanitary benefits. The medical assistance on the field diminishes morbidity and mortality and the public expenditure. Spain must to improve the prevention and to guarantee the medicalization of mountain rescues in the whole Spanish regions with nurses and physicians trained in Mountain Emergency Medicine

Acute mountain sickness and retinal evaluation by optical coherence tomography.

PURPOSE: Acute mountain sickness (AMS), the commonest form of altitude illness, might represent early-stage high altitude cerebral edema (HACE). Optical coherence tomography (OCT) was used to evaluate optic nerve head (ONH) consequences following a sojourn to extreme altitude. METHODS: This prospective study included 4 high-altitude expeditions in Himalayas. Twenty-four eyes of 12 healthy male climbers underwent baseline and postexpedition complete ophthalmic evaluation, including OCT to measure the peripapillary retinal nerve fiber layer (RNFL) thickness, ONH parameters, and macular thickness and volume. Lake Louise Scoring (LLS) self-report questionnaire was used to estimate AMS severity. RESULTS: All mountaineers experienced symptoms of AMS (LLS: 5.1±1.1, range 4.0-7.0). Average peripapillary RNFL thickness showed a significant increase in postexpedition examination (94±23 µm, 47-115), compared with baseline values (89±19 µm, range 45-114) (p=0.034). Superior (p=0.036) and temporal (p=0.010) quadrants also showed an increased RNFL thickness following exposure to high altitude. Vertical integrated rim area (VIRA) was significantly higher in postexpedition examination (0.71±0.43 mm(3), 0.14-1.50) than in baseline examination (0.51±0.26 mm(3), 0.11-1.00) (p=0.002). Horizontal integrated rim width was significantly higher in postexpedition examination (1.90±0.32 mm(2), range 1.37-2.34) than in baseline examination (1.77±0.27 mm(2), 1.27-2.08) (p=0.004). There was no correlation between LLS and OCT parameters (p>0.05). CONCLUSIONS: In climbers with AMS, OCT was able to detect subtle increases in the peripapillary RNFL thickness and in some ONH measurements, even in absence of HACE and papilledema. These changes might be a sensitive parameter in physiologic acclimatization and in the pathogenesis of AMS.