Page 78 - JSOM Winter 2018

Military Expedition Performance Environment 4. Chain of command (accountability): The setup of the expe-
The MEPE is versatile and the performance depends on the dition team was based on a military mission command struc-
following four interacting factors that go beyond traditional ture. The organization has a number of overlapping work units
psychosocial and physical domains: in a hierarchy under the expedition leader. The team leaders
make decisions on their own; however, all decisions regarding
1. Selecting individual members: The selection of individual the team’s composition, concept of operations, risks, and res-
members is the backbone of the MEPE and is based on two cues must be approved by the expedition leader. The Sherpas’
criteria. The first selection criterion is made by the expedition knowledge was used in the decision process. The expedition
leader in conjunction with the project team, on the basis of leader keeps the responsibility during the whole expedition,
two questions: (1) How do you assess the skills, besides the unlike during commercially organized expeditions.
physical competencies, of the team members required for the
team’s task or goal? (2) How do you assess the skills necessary Statistical Analysis
for effective collaboration and interaction among the team Statistical software (SPSS, version 25; IBM Corp., www.ibm
members? The second selection criterion includes the physical .com) and GraphPad Prism (version 7.00 for Mac; GraphPad
competencies (i.e., prebiometry measurements, maximum ex- Software, https://www.graphpad.com/) were used for data
ercise stress test, and spirometry). analysis. A t test was used to determine differences between
the summiteers and nonsummiteers when values were nor-
2. Medical Planning and Support: Medical support for re- mally distributed; if the distribution was skewed, we used the
mote extended expeditions is complex and requires in-depth Mann-Whitney U test to analyze continuous values. Mean
planning. The medical planning was done according to the (standard deviation) values are reported if data were normally
guidelines presented by Iserson et al. The optimization of the distributed; median (quartiles 1–3) is reported if the data were
3
workers’ fitness is presented in selecting individual members, skewed. The Spearman product-moment correlation was used
but the other key elements about medical planning are as- to determine the strength and direction of continuous variables.
signed to this factor. 3 The Kruskal-Wallis H test was used to determine differences
in urine osmolality, heart rate, and pulse oximetry readings of
3. Competencies in the field: Competencies in the field are oxygen saturation on different days during the acclimatization
described as team work and human factors. We defined hu- trek into base camp. Pairwise comparisons were performed
man factors as anticipatable, treatable problems and changes using Dunn’s (1964) procedure with a Bonferroni correction
during the course of the expedition. Three self-developed ques- for multiple comparisons. The Friedman test, a nonparametric
tionnaires were used to test social cohesion, self-performance, alternative to the one-way repeated measures analysis of vari-
and buddy performance (Table 1). ance, was used to determine whether there were statistically
Human factors were determined before and during the ex- significant differences between the measurement points of the
pedition. Participants were screened for pre-existing and recent different mood states and teamwork questionnaires. A p value
physical problems and basic clinical measurements related to ≤ .05 was considered statistically significant.
altitude (Lake Louise Self-Report Score) and acclimatization.
The Lake Louise Self-Report Score was used to diagnose acute Results
mountain sickness (AMS) and a score ≥3 was considered as hav-
ing AMS. Psychological factors were assessed with the rate of The 20 MLs/HBFs were all men. Their median age was 32
perceived exertion (RPE) and the profile of mood states (POMS) (29–40) years, mean height was 181.2 (3.0) cm, and mean
tests (Supplement 1). The daily tasks of the individual climbing weight was 82.5 (3.3) kg. The respective median ages (38 [32–
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members were expressed by the RPE. The climbers were asked 40] versus 32 [28–38] years; p = .503), heights (181.4 [9.4] cm
to fill out the RPE score every active day and the score was versus 181.1 [3.4] cm; p = .922), and weights (78.6 [5.0] kg
presumed to be 0 on rest days. The POMS test was performed versus 84.0 [4.2] kg; p = .123) of the summiteers (n = 7) and
four times during the course of the expedition: (1) at arrival in nonsummiteers (n = 13) did not differ significantly.
Kathmandu, (2) at arrival in base camp, (3) after returning from
camp 1 the first time, and (4) on return to Kathmandu. The Selecting Individual Members
Injury and Illness Severity Classification Union Internationale Four assessment criteria were used to classify the potential team
des Associations d’Alpinisme Medical Commission score was members. First, the military competence dictionary was used to
used by the expedition physician to grade the severity of the judge the 76 potential team members of the RNLMC ML com-
complaints members experienced during the expedition. 5 munity according to the following five competence clusters:

TABLE 1 Three Questionnaires to Test Social Cohesion, Self-Performance, and Buddy Performance
Social Cohesion Self-Performance Buddy Performance
I consider my team members to be friends. I am reliable. My buddy is trustworthy.
I feel connected to my team. I am motivated. My buddy is motivated.
I can get along well with my team. I mix well with other people. My buddy is able to mix with other people.
I like my team. I show a great commitment. My buddy shows a great commitment.
I perform well. My buddy performs well.
I am well able to deal with medical My buddy is well able to deal with medical problems.
problems. My buddy is well able to deal with personal
I am able to deal with personal problems. problems.
I think my buddy is sympathetic. My buddy thinks I am sympathetic.

76 | JSOM Volume 18, Edition 4 / Winter 2018