Page 81 - JSOM Winter 2018

TABLE 4 Mood State Changes During the Expedition
Mood States Arrival in Kathmandu Arrival at BC Return From Camp 1 Return to Kathmandu p Value a
Tension 0.52 (1.12) 0.80 (1.28) 0.54 (1.13) 0.66 (1.30) .05
Anger 0.27 (0.93) 0.37 (0.97 0.32 (0.95) 0.20 (0.74) .252
Confusion 0.54 (1.17) 0.46 (1.06) 0.39 (1.00) 0.44 (1.09) .295
Vigor 2.36 (1.54) b 2.56 (1.19) 2.37 (1.30) bc 2.42 (1.42) c .003
Fatigue 0.08 (0.43) 0.17 (0.46) 0.16 (0.37) 0.31 (0.70) .110
Depression 0.08 (0.48) 0.09 (0.61) 0.03 (0.16) 0.01 (0.21) .011
Data are given as mean (standard deviation), although the assumption of normality was markedly violated.
BC, base camp.
a Related-samples Friedman’s two-way analysis of variance by ranks.
b Arrival in Kathmandu versus return from Camp 1, p = .018.
c Return from Camp 1 versus return to Kathmandu, p = .017.

camp. During the acclimatization climb into base camp (8 altitude as good, and did so, as well, after return to base camp,
days), there was no difference detectable in the perceived load indicating a solid command and control structure. The Sher-
between the future summiteers and nonsummiteers. The load pas’ local knowledge was also assessed as vital in each phase
correlated moderately (r = 0.40; p < .01) with the increase in of the expedition by the expedition team. The expedition doc-
altitude during the days of the acclimatization climb. On all tor (a military medical officer) was responsible for coordinat-
the measurement points, the graph showed a typical “iceberg ing the remote expedition’s healthcare, including management
profile,” reflecting adequate mental health. An overview of the of medical queries by telemedicine or physical consultation.
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different mood states is shown in Table 4. Tension increased on The expedition leader, advised by the expedition doctor, was
arrival in base camp and decreased when the members returned responsible for the decision to evacuate a patient.
from camp 1, but this was not significant over time. Anger,
confusion, and fatigue followed the same pattern. Depression Discussion
was scored as maximum at arrival at base camp and the scores
differed significantly over time (p = .011), but depression was The MEPE setup is a novel approach in the preparation and
mainly scored as 0 after arrival at base camp. The most inter- execution of an expedition. In the case of this Manaslu ex-
esting changes occurs with vigor. The changes in vigor over pedition, it resulted in achieving the predefined goal of the
time were statistically significantly different at the different expedition.
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time points of the expedition (χ (d.f. 3) = 13.906; p = .003).
The process of selecting the individual members for this expe-
The social cohesion questionnaires were scored on a scale from dition was an intensive, time-consuming process performed by
1 (totally disagree) to 10 (totally agree). The social cohesion the expedition leader and staff members. Information known
questionnaire returned mean scores by measurement location beforehand influenced selection of the individual team mem-
(i.e., arrival in base camp, after returning to camp 1, and on bers and could have biased the selection criteria. The phys-
return in Kathmandu) of, respectively, 8.4 (1.6), 8.6 (1.5), and ical competence expressed in maximum oxygen uptake was
8.5 (1.5). The mean scores of the individual questions were excellent in most of the expedition members (>50 mL/kg/min);
not different in time (measurement moments [MM]) as were there were no differences between the two groups. Selection on
the overall scores. The response rate for this questionnaire this physical parameter is not justified; successful participant
differed from 85.0%, 40.0% to 65.0% during the different selection and team composition must be based on all variables
MMs. The self-perception and performance scores also were within the MEPE model. GI problems were most prevalent (in-
high. The mean scores were 8.9 (1.1), 8.8 (1.1), and 8.9 (1.2) cidence of approximately 35%). Almost all GI consultations
during the different MMs, with a same response rate as for the were during the trek to base camp and back to Kathmandu.
social cohesion questionnaire. The mean scores of the individ- In contrast to the base camp meals, which were prepared by
ual questions were not different in time, as were the overall the Nepalese support team, the meals during the treks were
scores. The buddy-perception and performance questionnaire prepared by local Nepalese cooks in small diners along the
scores were very high for the different MMs (9.3 [1.0], 9.1 trek. In future expeditions, rations should be considered as
[1.0], and 8.9 [1.3]), these scores did not differ statistically an effective solution in preventing GI problems during the
from each other. The mean scores of the individual questions complete expedition. Symptoms like nausea and vomiting can
also did not differ by time. also be manifestations of AMS and are often seen in moun-
taineers along with anorexia also caused by altitude, including
Chain of Command (Accountability) GI problems. 9,10 The decrease in expedition members’ body
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Administrative rules were established and distributed. This weight could be a reflection of this problem. The significant
mission command military expedition was based on hierarchy decrease in weight of expedition members correlated with the
within the concept of operations. The command and control duration at altitude (r = −0.508; p < .01).
given to the expedition leader gave full potential clearance
within the boundaries of the expedition plan and provided The detection of transient, distinct mood states was done using
“checkpoints” for clearance from the Ministry of Defense the POMS test and showed the classic iceberg profile for vigor,
(commander of the RNLMC). The mission command structure representing the desirable emotional health status. Only the
was identical for the team, and the team leader of the summit maximum score was lower than normally found in athletes.
climbing team perceived the role of the expedition leader as This profile of the mental health is associated with high per-
functional in these type of extreme expeditions. The summit formance levels. The change in vigor during the course of the
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team leader assessed his judgement and communication on expedition might be explained by the fact that altitude causes
Preparation for and Performance During High-Altitude Expeditions | 79