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van Veelen MJ, Likar R, Tannheimer M, Bloch KE, Ulrich S, Philadelphy M, Teuchner B, Hochholzer T, Pichler Hefti J, Hefti U, Paal P, Burtscher M. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol 2025; 26:70-86. [PMID: 39073038 DOI: 10.1089/ham.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
van Veelen, Michiel J., Rudolf Likar, Markus Tannheimer, Konrad E. Bloch, Silvia Ulrich, Michael Philadelphy, Barbara Teuchner, Thomas Hochholzer, Jacqueline Pichler Hefti, Urs Hefti, Peter Paal, and Martin Burtsche. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol. 26:70-86, 2025. Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders. The aim of this review is to give insights on providing the best possible care for victims of emergencies at high altitude. Methods: Authors provide clinical recommendations based on their real-world experience, complemented by appropriate recent studies and internationally reputable guidelines. Results and Discussion: This review covers most of the emergencies/health issues that can occur when trekking or during high altitude climbing, that is, high altitude illnesses and hypothermia, freezing cold injuries, accidents, for example, with severe injuries due to falling, cardiovascular and respiratory illnesses, abdominal, musculoskeletal, eye, dental, and skin issues. We give a summary of current recommendations for emergency care and pain relief in case of these various incidents.
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Affiliation(s)
- Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, SFU Vienna, Klagenfurt, Austria
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, Ulm, Germany
- Department of General and Visceral Surgery, ADK-Klinik Blaubeuren, Ulm, Germany
| | - Konrad E Bloch
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | | | - Barbara Teuchner
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Urs Hefti
- Swiss Sportclinic, Bern, Switzerland
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Peter Paal
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St John of God Hospital, Paracelsus Medical University, Salzburg, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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Dorji T, Giri S, Tshering U, LeVine S, Tshering U, Chhetri S, Dhakal N, Gaikwad SN, Flaherty GT, Lucero-Prisno DE, McIntosh S. Challenges in the management of high-altitude illnesses and emergencies in Bhutan and Nepal. Travel Med Infect Dis 2023; 56:102660. [PMID: 37926372 DOI: 10.1016/j.tmaid.2023.102660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Many popular tourist attractions and trekking routes in Bhutan and Nepal are situated between 3000 and 6000 m in elevation. High-altitude emergencies are becoming more common and medical providers must be aware of the practical and medical issues in managing these disorders. We reflect on the challenges in providing high-altitude emergency medical services in Bhutan and Nepal.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan.
| | - Sweta Giri
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Bhutan Emergency Aeromedical Retrieval, Ministry of Health, Thimphu, Bhutan.
| | - Ugyen Tshering
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; Bhutan Emergency Aeromedical Retrieval, Ministry of Health, Thimphu, Bhutan.
| | - Shankar LeVine
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Department of Emergency Medicine at Dartmouth, Geisel School of Medicine at Dartmouth, NH, USA.
| | - Ugyen Tshering
- Department of Health Services, Ministry of Health, Thimphu, Bhutan.
| | - Sunit Chhetri
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Narayan Dhakal
- Department of Internal Medicine, Shree Birendra Hospital, Kathmandu, Nepal.
| | | | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Scott McIntosh
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA.
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Yang J, Tan H, Sun M, Chen R, Zhang J, Liu C, Yang Y, Ding X, Yu S, Gu W, Ke J, Shen Y, Zhang C, Gao X, Li C, Huang L. Prediction of High-Altitude Cardiorespiratory Fitness Impairment Using a Combination of Physiological Parameters During Exercise at Sea Level and Genetic Information in an Integrated Risk Model. Front Cardiovasc Med 2022; 8:719776. [PMID: 35071338 PMCID: PMC8782201 DOI: 10.3389/fcvm.2021.719776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022] Open
Abstract
Insufficient cardiorespiratory compensation is closely associated with acute hypoxic symptoms and high-altitude (HA) cardiovascular events. To avoid such adverse events, predicting HA cardiorespiratory fitness impairment (HA-CRFi) is clinically important. However, to date, there is insufficient information regarding the prediction of HA-CRFi. In this study, we aimed to formulate a protocol to predict individuals at risk of HA-CRFi. We recruited 246 volunteers who were transported to Lhasa (HA, 3,700 m) from Chengdu (the sea level [SL], <500 m) through an airplane. Physiological parameters at rest and during post-submaximal exercise, as well as cardiorespiratory fitness at HA and SL, were measured. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to predict HA-CRFi. We analyzed 66 pulmonary vascular function and hypoxia-inducible factor- (HIF-) related polymorphisms associated with HA-CRFi. To increase the prediction accuracy, we used a combination model including physiological parameters and genetic information to predict HA-CRFi. The oxygen saturation (SpO2) of post-submaximal exercise at SL and EPAS1 rs13419896-A and EGLN1 rs508618-G variants were associated with HA-CRFi (SpO2, area under the curve (AUC) = 0.736, cutoff = 95.5%, p < 0.001; EPAS1 A and EGLN1 G, odds ratio [OR] = 12.02, 95% CI = 4.84–29.85, p < 0.001). A combination model including the two risk factors—post-submaximal exercise SpO2 at SL of <95.5% and the presence of EPAS1 rs13419896-A and EGLN1 rs508618-G variants—was significantly more effective and accurate in predicting HA-CRFi (OR = 19.62, 95% CI = 6.42–59.94, p < 0.001). Our study employed a combination of genetic information and the physiological parameters of post-submaximal exercise at SL to predict HA-CRFi. Based on the optimized prediction model, our findings could identify individuals at a high risk of HA-CRFi in an early stage and reduce cardiovascular events.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hu Tan
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mengjia Sun
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Renzheng Chen
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jihang Zhang
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuanqi Yang
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaohan Ding
- Department of Health Care and Geriatrics, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China
| | - Shiyong Yu
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wenzhu Gu
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Shen
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Zhang
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xubin Gao
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chun Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lan Huang
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- *Correspondence: Lan Huang
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Posch M, Schranz A, Lener M, Burtscher M, Ruedl G. Incidences of Fatalities on Austrian Ski Slopes: A 10-Year Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082916. [PMID: 32340228 PMCID: PMC7215823 DOI: 10.3390/ijerph17082916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
The study evaluated incidences and potential differences of traumatic and nontraumatic fatalities among recreational skiers and snowboarders on Austrian ski slopes within a 10-year analysis. Within this retrospective study, data were collected by the Federal Ministry of the Interior. Data comprised all traumatic and nontraumatic deaths on Austrian ski slopes which occurred between the 2008/09 and 2017/18 winter seasons. Age, sex, nationality, gear used, altitude, slope difficulty, accident cause, primary cause of death and helmet use were collected at the death scene. Incidence of fatalities was calculated based on number of skier days. In total, 369 fatalities, with an average of 36.9 ± 7.9 fatalities per year, were registered. The yearly incidence of traumatic and nontraumatic deaths decreased by 25.8% and 40.1% during the 10-year time period, leading to an evaluated mean incidence of 0.70 deaths per million skier days, with an incidence of 0.36 traumatic deaths and 0.34 nontraumatic deaths per million skier days. Incidences of both traumatic and nontraumatic deaths decreased during the 10-year analysis, representing death as a rare event on Austrian ski slopes. However, adequate prevention measures to reduce potential risk factors to further reduce the mortality risk on ski slopes are needed.
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Affiliation(s)
- Markus Posch
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-507-45855
| | | | | | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
| | - Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
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Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203920. [PMID: 31618960 PMCID: PMC6843304 DOI: 10.3390/ijerph16203920] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 01/21/2023]
Abstract
Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.
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Burtscher M, Ruedl G. Favourable changes of the risk-benefit ratio in alpine skiing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6092-7. [PMID: 26035659 PMCID: PMC4483689 DOI: 10.3390/ijerph120606092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/18/2022]
Abstract
During the past five decades recreational alpine skiing has become increasingly safer. The numerous annual media reports on ski injuries have to be interpreted on the basis of the tremendous numbers of skiers. These favourable changes seem primarily be due to the introduction of short carving skis, more rigid and comfortable ski boots, the use of protective gear like helmets, and the optimized preparation of ski slopes. The associated health benefits from skiing, especially arising from its association with a healthier life style, and possibly also from effects related to hypoxia preconditioning and increasing subjective vitality by natural elements clearly outweigh the health hazards. Technical improvements will likely help further reducing the injury risk. At least hypothetically, each individual skier could help to prevent injuries by the development of an appropriate physical fitness and responsible behaviour on ski slopes thereby optimizing the risk-benefit ratio of alpine skiing.
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Affiliation(s)
- Martin Burtscher
- Department of Sport Science, Medical Section, University of Innsbruck, Fürstenweg 185, A-6020 Innsbruck, Austria.
| | - Gerhard Ruedl
- Department of Sport Science, Medical Section, University of Innsbruck, Fürstenweg 185, A-6020 Innsbruck, Austria.
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Burtscher M, Gatterer H, Kleinsasser A. Cardiorespiratory Fitness of High Altitude Mountaineers: The Underestimated Prerequisite. High Alt Med Biol 2015; 16:169-70. [PMID: 25946474 DOI: 10.1089/ham.2015.0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Martin Burtscher
- 1 Department of Sport Science, Medical Section, University of Innsbruck , Austria
| | - Hannes Gatterer
- 1 Department of Sport Science, Medical Section, University of Innsbruck , Austria
| | - Axel Kleinsasser
- 2 Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck , Austria
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Abstract
Mountains all over the world are attracting a steadily growing number of visitors due to the increasing number of cheap flights; the construction of new roads, railways, and cable cars; and commercial offers of trekking tours and expeditions to attempt even the world's highest peaks. However, one must not forget that mountains are typically inhospitable areas characterised by cold and hypoxic environments and rapidly changing weather and track conditions associated with a relatively high risk of accidents and emergencies. Beside the objective hazards, subjective hazards, for example physical fitness and health status, mountaineering skills, and equipment, contribute substantially to the risk. Whereas in some regions, for example the Alps, rescue operations and medical emergency interventions can be performed rapidly and effectively, this is absolutely not the case in most of the very remote areas and on very high mountains. Therefore, the understanding of the risk associated with the various modes of mountaineering as well as knowledge about how to optimise prevention is of the utmost importance. Ultimately, it is the informed mountaineer who has to decide whether the risks are acceptable or not. Continuing joint efforts of scientists, medical and alpine institutions, expedition organisers, and mountaineers will help to make high-altitude mountaineering safer.
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Affiliation(s)
- Günther Sumann
- Department of Anesthesiology and Critical Care Medicine, District hospital, Voecklabruck, Austria
- Austrian Society for High Altitude and Alpine Medicine, Innsbruck, Austria
| | - Thomas Hochholzer
- Austrian Society for High Altitude and Alpine Medicine, Innsbruck, Austria
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
- Privat Hospital Hochrum, Innsbruck, Austria
| | - Martin Faulhaber
- Austrian Society for High Altitude and Alpine Medicine, Innsbruck, Austria
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Austrian Society for High Altitude and Alpine Medicine, Innsbruck, Austria
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
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