Mountaineers As Comrade Rescuers – Küpper T, Morrison A
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Review Küpper T 1,2, Morrison A2,3 ACCEPTED: October 2020 PUBLISHED ONLINE: November 2020 Mountaineers as Comrade Rescuers – Küpper T, Morrison A. Mountaineers as comrade rescuers – deficiencies in First Aid knowledge, minimum physical fitness and Deficiencies in First Aid Knowledge and technical requirements, and environmental exposures. Dtsch Z Sportmed. 2020; 71: Minimum Technical Requirements 280-285. doi:10.5960/dzsm.2020.468 Bergsteiger als Kameradenretter – mangelnde Erste Hilfe-Kenntnisse und minimale technische Anforderungen Summary Zusammenfassung 1. RWTH AACHEN TECHNICAL UNIVERSITY, Institute of Occupational & Social Medicine, Aachen, Germany › Self-reliance in the mountains requires the ability to cope › Rettungsmaßnahmen, Erste Hilfe und Verletztenversorgung 2. MEDICAL COMMISSION OF THE UNION with most eventualities that may arise. This includes First Aid eines Bergkameraden sind extrem komplexe Situationen und INTERNATIONALE DES ASSOCIATIONS (FA) care and rescue of a fellow mountaineer in an emergency Handlungsabläufe, die sowohl taktische als auch operationelle D’ALPINISME (UIAA, INTERNATIONAL situation that can require complex but trainable skills. This FA Fähigkeiten, medizinische Kenntnisse, körperliche Fitness, psy- CLIMBING AND MOUNTAINEERING training should reflect the environmental conditions encounte- chische Belastbarkeit und Aufmerksamkeit gegenüber äußeren FEDERATION), Bern, Switzerland red, as these vary and add complications. Risiken erfordern. Dabei sind Daten über Stressmanagement und 3. ROYAL FREE LONDON NHS FOUNDATION › The minimum fitnessrequired by the group of rescuer has been mögliches posttraumatisches Stresssyndrom praktisch inexis- TRUST, London, U.K. estimated to be 3 to 3.5 W/kg body weight. Different deficiencies tent und erfordern weitere Forschung. in FA knowledge were identified according to the climbing sty- › Im Folgenden wird ein Überblick über diese Anforderungen le, and the subjects were generally unable to judge their level of gegeben, damit es denjenigen, die in eine solche Situation gera- knowledge. Rescue services data on the victim’s injuries inform ten, möglich wird, die in Not geratene Person so gut wie es die and vary FA content according to the mountaineering activity. Umstände erlauben, zu versorgen bzw. präventiv Erste Hilfe-Kur- Data on the rescuer’s mental health (e.g. acute stress manage- se zu organisieren, die auf die Spezifika der Zielgruppe eingehen. ment or post-traumatic stress disorder) are sparse and require › Die minimal notwendige Leistungsfähigkeit wurde ab- further research. hängig von der Gruppengröße auf 3,0 -3,5 W/kg Körpergewicht › This review summarises the known requirements and other geschätzt. Es werden auch die Faktoren berücksichtigt, die eine considerations to perform preventive specialist mountain FA Gefahr für das Leben der Helfer darstellen können. courses to enable mountaineers to provide health and safety for the victim and for themselves. These skills should be periodically refreshed. KEY WORDS: SCHLÜSSELWÖRTER: Accidents, Emergency Medicine, Injury Care, Unfälle, Notfallmedizin, Verletztenversorgung, Emergency Situation Notfallsituation Article incorporates the Creative Commons Attribution – Non Commercial License. https://creativecommons.org/licenses/by-nc-sa/4.0/ Scan QR Code and read Introduction article online. CORRESPONDING ADDRESS: Over 50 years ago, the former Chief Physician of he made this statement, but accurately descri- Prof. Thomas Küpper, MD, PhD the Bavarian Mountain Rescue wrote, “The cha- bed the environmental exposures of mountain Institute of Occupational & Social Medicine racteristics of an emergency in the mountains rescuers. He also never mentioned the rescuer’s RWTH Technical University are that it always happens at altitude, it is either psychological stress when caring for a comrade in Pauwelsstr. 30 too hot or too cold, often windy, rainy, misty or an emergency situation, or indeed after (e.g. post 52074 Aachen, Germany : [email protected] snowing, the options are limited, it is never at a traumatic stress disorder). The rescue may have horizontal place, and sometimes the helicopter short or long-lasting psychological effects and is is unable to come.” (42, 43). He had no data when explored later. 280 GERMAN JOURNAL OF SPORTS MEDICINE 71 11-12/2020 Bergsteiger als Kameradenretter Review Several physical and mental factors must be considered to Kühn (2016) found a different profile of injuries and FA enable mountaineers to provide health and safety for a victim, knowledge on vias ferratas (18). Here exhaustion was the most and safety for themselves. The most important are: important and potentially life-threatening diagnosis, followed - adequate alpine technical skills to move safely on the terrain by several minor injuries. Like others, Kühn also found that FA - knowledge of alpine dangers, the terrain, and the weather knowledge differed significantly from the profile of diagnoses - good First Aid (FA) skills specific to emergencies in the moun- encountered on the climb, was insufficient in general, and the tain subjects were unable to judge their level of knowledge (18, 32, 47). - ability to work efficiently as a team, to communicate and to set Amongst mountaineers climbing classic routes in the Cen- priorities, and to accept responsibility for all involved tral Alps, FA knowledge was also generally poor (32). The best - resilience, confidence, and peace of mind FA knowledge results were in relation to cardiac emergencies, - mindfulness, calmness and emotional intelligence to balance altitude sickness, and hypovolaemic shock. The worst results the expectations and limitations of the group concerned hypothermia, traumatic injuries, treatment of pain - adequate prevention of external risks (e.g. cold, radiation, re- and management of emergencies. Although traumatic injuries scue helicopter noise) represent about 50% of mountain accidents in the region, there - adequate physical fitness to assist a stranded person even was a general lack of basic knowledge on this subject. On the though there will be significant loss of stamina in the hypoxic other hand, cold and altitude diseases are common here (28), environment at high altitude (19). (38). It must be concluded that the deficits in the mountaineer’s FA knowledge regarding trauma do not fit with the demands in Adequate fitness in mountaineering or at altitude has been the mountains. discussed in several papers since more than 140 years (e.g. (5, 41, Amongst trekkers, altitude-related diagnoses were higher. 51)). Physiologists in the early 20’s were discussing whether Mt. Kühn (2019) analyzed the diagnoses of 479 inpatients (202 trek- Everest might be possible without artificial oxygen or not (15). kers, 277 Nepalese workers) at Khunde Hospital in Solo Khum- Recent research focused elderly people or those with pre-exis- bu, Nepal (17). Most suffered from altitude sickness (45.5%), ting diseases (e.g. (1, 7, 8, 16, 35, 36, 46), but none ever except acute gastroenteritis (10.4%) or acute respiratory infection one group (19, 21, 30) published data about the workload and (8.4%). Major injuries were rare. These results were in accor- therefore minimal fitness in rescue situations. dance with Gschwandtl’s (2019) obtained in Nepal’s Solo Khum- bu region where 40.5% of all trekkers experienced at least one Technical Alpine Skills medical incident during their trip, of which almost 50% were due to acute mountain sickness (14). Once again, FA knowledge Climbing teams should not rely wholly on the FA skills of the was generally poor and did not meet the demands. leader as the leader may also become the victim. It’s also pos- It is unrealistic to train mountaineers for all types of emer- sible to be the first responder on an accident scene and whose gencies in all styles of mountaineering, and the psychological informed FA actions may improve the victim’s chance of reco- barriers to engage them in such training are high (9, 13, 32, 34, very, or save their life. Either way, it is essential that at least one 44), with those at higher individual risk level being the most other team member has sufficient knowledge, skills and fitness reluctant (27, 34). To address mountaineers as directly as pos- to handle emergency situations. Rescuers must be able to move sible Kühn (2016) developed a modular FA training course with safely if the conditions should worsen and become more diffi- a basic core training module for all disciplines, and additional cult (e.g. wet or ice-covered rocks). The safety margin will de- modules specifically designed for the respective disciplines (18). pend on the individual tour. In Alpine rescue operation studies It’s pointless to train very rare diagnoses or differential diag- where a safety margin was included, the minimum climbing noses such as seizures (2, 3, 20, 37), or high altitude pulmonary requirement for rescuers to operate safely on the Alpine terrain edema versus pertussis (12). But for any mountaineer climbing of classic routes was that they should be able to climb 50°on ice, above 2500m, the diagnosis and differential diagnosis of alti- and solo UIAA grade 3 on rocky terrain (19, 23, 30, 31). tude diseases should be trained in detail because even medical professionals sometimes fail (12). Alpine First Aid Skills Podsiadło (2018) found that an e-learning platform was an effective tool to improve knowledge on hypothermia in moun- In contrast to trekking emergencies, the spectrum of problems taineers. However, when assessed a year