Page 79 - JSOM Winter 2018

(1) thinking power, (2) personal effectiveness, (3) interpersonal The group was divided into summiteers and nonsummiteers
effectiveness, (4) working approach, and (5) management. Sec- retrospectively. Besides hemoglobin (9.1 [0.4] versus 9.6 [0.2];
ond, soft skills were judged on experiences gained during visits p < .05) and hematocrit (42.6 [1.4] versus 45.1 [0.9]; p < .01)
or prior experience in extreme team projects. Third, technical values of summiteers and nonsummiteers, respectively, there
skills were assessed during a project performed a year earlier, were no differences between the groups in physical competen-
the Alps project 2015. Fourth, the physical fitness of the se- cies (Table 3). One climber consulted the expedition doctor
lected members was judged during the Alps project 2015 and with symptoms related to his medical history (an episode of
also objectified by an incremental cycling test. recurrent migraine; Figure 2).

Because of the limited access to healthcare on the mountain, FIGURE 2 AMS, acute mountain sickness.
all team members were preliminarily screened by following a
thoroughly designed screening protocol (Table 2) as a precau-
tionary measure against possible preventable medical issues.
This revealed relevant issues in the medical history of two
climbers but did not lead to their exclusion after multidisci-
plinary consultations (both climbers were summiteers). None
of the team members was excluded after the preliminary phys-
ical screening.
TABLE 2 Pre-expedition Screening Tests
Screening Test
Anamnestic • Pre-existing medical complaints and/or
consultation chronic diseases
• Medical history
• Medication use
• Allergies Medical Planning and Support
• Previous high-altitude experience
• Previous altitude-related problems Stock appropriate medications
Physical • Musculoskeletal problems Medication and equipment for advanced remote trauma care
examination • Incremental cycling test and resuscitation therapy were stocked at base camp. The re-
• Resting 12-lead electrocardiogram quired climate conditioning of medication was achieved with
• Lung function test during rest and directly a portable heating and cooling system and guaranteed by reg-
after finishing the incremental cycling test
Vaccinations • Hepatitis A and B ular temperature controls.
check • Diphtheria, tetanus, polio
• Measles Provide appropriate medication and equipment
• Typhoid fever (Salmonella typhi) A first aid trauma kit was provided to all climbing teams,
• Rabies including medication for altitude sickness (namely,. ibupro-
• Japanese encephalitis. fen, acetazolamide, nifedipine ,and dexamethasone, following
Blood analyses • Hemoglobin the treatment protocols of the Wilderness Medical Society).
6
Anthropometrics • Height (cm) In anticipation of the most common illnesses and injuries, a
• Body weight (kg) selection of medication was made on the basis of their possi-
ble multipurpose functionality, weight, usability, durability in
Finally, the five teams were formed around a team leader in a extreme climates, and ease of use. Extra oxygen canisters for
way that was highly flexible, coherent, and complementary. treatment, in addition to the canisters reserved (from point
All scenarios were rehearsed in brainstorm sessions and the of injury to hospital) for the planned supportive oxygen at
definitive teams were presented a year before the expedition; higher than 7,000m, were stocked at each camp with a mobile
however, changes could be and were made until base camp stretcher. Because of the identified technical route from camp
and even before and during the expedition if personal gain 1 up to camp 2, a portable hyperbaric chamber was stocked
extended above the team goal or altitude-related disabilities at camp 2 (Figure 3) in case of the need for prolonged field
occurred. care. 7

TABLE 3 Average Overall Characteristics (Medical Competencies) of the Team Members
HR at
a
Vo 2max , Rest, HR max , FEV , PEF, Hb,
1
W/kg mL/min per min per min VC max , L FVC, L L/sec L/min mmol/L Hct, %
b
W max
357.8 4.52 53.4 56.8 185.2
Summiteer 7.1 (0.4) 7.1 (0.4) 5.6 (0.6) 11.8 (2.3) 9.1 (0.4) 42.6 (1.4)
(39.3) (0.25) (52.6–55.6) (12.0) (7.3)
387.1 4.64 54.4 183.5
Nonsummiteer 61.2 (5.2) 6.5 (0.7) 6.3 (0.6) 4.9 (0.5) 10.4 (1.0) 9.6 (0.2) 45.1 (0.9)
(24.0) (0.32) (49.1–55.8) (6.6)
Team members were divided into two group, summiteers and nonsummiteers, before the expedition. Data are presented as mean (standard
deviation) or median (interquartile range).
FEV , forced expiratory volume in the first second of expiration; FVC, forced vital capacity; Hb, hemoglobin; Hct, hematocrit; HR, heart rate;
1
PEF, peak expiratory flow; VC max , maximum vital capacity; Vo 2max , maximum oxygen uptake; W, weight; W max , maximum weight.
a p < .05.
b p < .01.
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