Search

Hillebrandt, David, Anil Gurtoo, Thomas Kupper, Paul Richards, Volker Schöffl, Pankaj Shah, Rianne van der Spek, Nikki Wallis, and Jim Milledge. UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol. 24: 110–126.—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. [ABSTRACT FROM AUTHOR]

To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic. [ABSTRACT FROM AUTHOR]

Summary Background The SteriPEN ® is a handheld device for disinfecting water with ultraviolet (UV) radiation. The manufacturer claims a reduction of at least 99.9% of bacteria, viruses, and protozoa. The present study intends to verify the general effectiveness of the device. Furthermore, the influence of bottle geometry and water movement is examined and the issue of user safety with regard to UV-C radiation is addressed. Methods The device was applied on water containing a known number of microorganisms ( Escherichia coli , Staphylococcus aureus , and the spore of Geobacillus stearothermophilus ) and the survival rate was examined. Three different types of bottles commonly used among travelers served as test containers. All tests were conducted with and without agitating the water during irradiation. Furthermore, a spectral analysis was performed on the light of the device. Results The SteriPEN ® reached a mean reduction of more than 99.99% of bacteria and 99.57% of the spores when applied correctly. However, the results of the trials without agitating the water only yielded a 94.98% germ reduction. The device's maximal radiation intensity lies at 254 nm which is the wavelength most efficient in inactivating bacteria. The UV-C fraction is filtered out completely by common bottle materials. However, when applied in larger containers a portion of the UV-C rays exits the water surface . Conclusions If applied according to the instructions the device manages a satisfactory inactivation of bacteria. However, it bears the danger of user errors relevant to health. Therefore, education on the risks of incorrect application should be included in the travel medical consultation. Also there are still aspects that need to be subject to further independent research. [ABSTRACT FROM AUTHOR]

The evolution in communication and digital technologies is revolutionising the practice of medicine. A physician is now able to oversee provision of healthcare at a distance. In this paper, we argue that practice of telemedicine is an essential and evolving aspect of high altitude and expedition medicine. We acknowledge the lack of international consensus, limited legislation as well as possible reservations towards telemedical practice. Given some unique social and medical aspects of participation in remote, high altitude expeditions we propose a number of guiding principles for those involved in provision of telemedical services for such endeavours. [ABSTRACT FROM AUTHOR]

The number of persons visiting high altitude regions for various purposes (recreation, business etc.), and the age of people who do so, increases. Therefore there are more and more patients who need specific and individual advice to prevent emergency situations at altitude and to deal with emergencies if the safety strategy should fail. Since literature concerning cardiocirculatory diseases at altitude is scarce and studies with a controlled setting and high evidence level are missing, UIAA MedCom has checked all available literature for specific information to enable physicians who are active in travel or high altitude medicine to advise the patients at the highest possible level of evidence. It must be pointed out that there are several other medical fields where such information is mandatory, e.g. in occupational medicine, when employees depart to high altitude destinations for business purposes. The recommendations are based on a detailed literature research (databases, handbooks and the respective references). For easier use the paper has been structured as follows: general information, cardiocirculatory system and ECG at altitude, several cardiocirculatory diseases and their specific recommendations. The commission concludes, that a general "don't go!" is no state-of-the-art advice for the patients. With the information presented here a safe trip to altitude should be possible for many patients. [ABSTRACT FROM AUTHOR]

AbstractRichards, Paul, and David Hillebrandt. Clinicians Corner: The practical aspects of insulin at high altitude. High Alt Med Biol14:197–204, 2013.—With the increasing prevalence of diabetes and current social philosophy of enablement, many more diabetics are travelling to high altitude where the rate of AMS in Type 1 diabetic mountaineers is no different than nondiabetics. Numerous effects of exercise, both degree and duration, dietary change, illness, stress, mountain sickness, counter-regulatory hormones, and altitude increased sympathetic output, and catecholamines have led to conflicting accounts of insulin requirement increasing or decreasing at altitude. Overall, it would appear that the effects of diet and exercise outweigh those of altitude. Good control requires continual insulin dose adjustment with frequent feedback from blood sugar testing, but glucometers can over- or under-read at altitude. Additionally, heat or cold exposure can degrade insulin efficacy; strategies for storing insulin are described. [ABSTRACT FROM AUTHOR]

The article presents information on the recommendation of the Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MEDCOM). The commission says that an environment with oxygen concentration of 14.0% or more or an altitude of 3,000 meters (m) or less is safe for non-acclimatized person provided he does not have severe cardiopulmonary disease or severe anaemia and he should be exposed for a limited hours only, that is, single work shift.

Venturing into the mountains, doctors have accompanied expeditions to provide routine care to the teams, undertake research and occasionally take on a rescue role. The role of doctors practicing mountain medicine is evolving. Public health issues involving concepts of health and safety have become necessary with the coming of commercial and youth expeditions. Increasingly individuals with a disability or a medical diagnosis choose to ascend to high altitudes. Doctors become involved in assessment of risk and providing advice for such individuals. The field of mountain medicine is perhaps unique in that acceptance of risk is part of the ethos of climbing and adventure. The pursuit of mountaineering goals may represent the ultimate conquest of a disability. Knowledge of mountain environment is essential in facilitating mountain ascents for those who choose to undertake them, in spite of a disability or medical condition. [ABSTRACT FROM AUTHOR]

With the current media coverage of the spread of Zika virus from Africa and Asia to Central and South America and its possible relationship with fetal abnormalities, UIAA Medcom has produced an advice sheet for mountaineers visiting risk areas. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Medical and sporting ethics of high altitude mountaineering: the use of drugs and supplemental oxygen" by D. R. Wagner in the previous issue.