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Objectives: The Commission gives recommendations on how to provide health and safety for employees in different kinds of low oxygen atmospheres. So far, no recommendations exist that take into account the several factors we have outlined in this report. Methods: The health and safety recommendations of several countries were analysed for their strength and deficiencies. The scientific literature was checked (Medline, etc.) and evaluated for relevance of the topic. Typical situations of work in hypoxia were defined and their specific risks described. Specific recommendations are provided for any of these situations. Results: We defined four main groups with some subgroups (main risk in brackets): short exposure (pressure change), limited exposure (acute altitude disease), expatriates (chronic altitude disease), and high-altitude populations (re-entry pulmonary oedema). For healthy unacclimatized persons, an acute but limited exposure down to 13% O2 does not cause a health risk. Employees should be advised to leave hypoxic areas for any break, if possible. Detailed advice is given for any other situation and pre-existing diseases. Conclusions: If the specific risk of the respective type of hypoxia is taken into account, a pragmatic approach to provide health and safety for employees is possible. In contrast to other occupational exposures, a repeated exposure as often as possible is of benefit as it causes partial acclimatization. The consensus statement was approved by written consent in lieu of a meeting in July 2009

Background: The number of young volunteers in international social projects has increased significantly with governmental and non-governmental project support. This paper investigates the hypothesis that the preventative medical advice currently given prior to departure is inadequate because the risk profile of young persons (<30 years) differs from that of the general population. Methods: A retrospective cross-sectional study was performed with participants of international social projects. A specific questionnaire was developed; inclusion criteria were age between 18 and 30 years at departure and a duration with the project of at least 6 months. Results: One hundred and fifty-three data sets could be evaluated. Fifty-three percent were females; the destinations were as follows: 65.4% to Asia, 14.4% to Africa, and 10.5% to Latin America. The mean age was 20 years. Ninety percent of the participants received some kind of advice in travel medicine prior to departure. The vaccination rate was quite good, but pertussis (13.7%), yellow fever (80%), typhoid fever (54%), and rabies (49.7%) should be improved when travelling to high-risk regions. Food is a very important potential source of problems as 66% receive catering by the project, 56.2% from street stalls, and 44% were regularly invited to dine with locals. In Africa, only two-thirds of the participants of projects had regular access to safe water and the sanitary facilities were also poor; 51.7% of respondents reported new sexual contacts (one to more than six new partners). In most cases, condoms were used, but there were two unintended pregnancies. Conclusions: We conclude that young people need to be targeted with specialized advice for health and safety while abroad. This should highlight age-specific risks compared to advice for a more general population. Vaccination status should be improved for some regions and diseases

Objective: There is a lack of data to establish minimal requirements for technical alpine climbing skills needed by rescue teams involved in alpine helicopter rescue operations to perform such operations safely. Methods: A year of rescue operations (N = 2731) were investigated for the technical difficulties of the terrain. The difficulties were graded according to the Union Internationale des Associations d'Alpinisme (UIAA) scale for rocky terrain and steepness for ice slopes. Results: For 99.7% of the operations, the terrain could be accurately evaluated. In at least 30.7% of all rescue operations, personal advanced alpine climbing skills were required for the rescue personnel, and in 6.0%, the difficulties of the rocky terrain correspond to UIAA scale grade III with another 2.4% to UIAA grade IV or above. About 1.5% of all operations took place in ice faces steeper than 50°. Conclusions: To be able to manage 90% of all operations safely, all crew members, except the pilot, must be competent at climbing rock terrain of UIAA scale grade IV and ice of 50° steepness using appropriate rescue, rope, and belaying techniques. These recommendations include a technical safety margin for adverse conditions, such as bad weather