Page 83 - JSOM Winter 2018

SUPPLEMENT 1
Evaluation of a Concept for a Military Expedition Performance Environment

Rate of Perceived Exertion • Scenario-based evaluation checkpoint is implemented
during the team-building week in Andermatt, Switzer-
The rate of perceived exertion (RPE) is a subjective method land. In this scenario, the whole medical evacuation
of quantifying the day’s intensity experienced by the climber. plan is stressed from the point of injury to a pretended
The load is calculated by multiplying the day’s intensity by the base camp and, on paper, from base camp to hospital.
duration of the activity of that day (in minutes) to provide an The concept of telemedicine was also successfully tested.
expression of the load in arbitrary units (Foster, Daines, et al. • Classes on high-altitude physiology and pathology, and
1996). The intensity is described as a number (0–10) on the practical field care during team-building week in De-
CR-10 Rating of Perceived Exertion scale proposed by Borg cember 2015 in Andermatt, Switzerland.
(Borg 1982; Borg and Kaijser 2006).

Environmental Limitations on
Profile of Mood States
Patient Access and Evacuation
Profile of Mood States (POMS) is a standard validated psy- The preferred way of a medical evacuation in case of a major
chological test formulated by McNair et al. (1971). The test incident was by rotary wing. This service was facilitated by
requires the climbers to subjectively indicate for each word multiple helicopter companies located in Kathmandu, which
or statement how they have been feeling in the past day, using were visited before the expedition. The following limitations
the 5-point Likert scale, and represents six dimensions of the were identified: (1) the maximum flying altitude at which a
mood construct: tension, anger, confusion, vigor, fatigue, and rescue could be performed was between 6,000 and 7,000m,
depression. depending on the helicopter type. At these maximum altitudes,
person capability was limited to one or two, excluding the heli-
Training Program for All Team Members copter personnel; (2) by default, not capable of medical evacu-
The program contained the following components: ation by air, casualty evacuation only with medical equipment
on request; (3) estimated prolonged evacuation timelines to a
• Self-study: A selection of chapters from the Dutch Spe- Kathmandu hospital with ideal conditions: 2.5 to 4 hours with
cial Forces Medic handbook for trauma care based on no execution after 16:00 and before sunrise.
the respected Tactical Combat Casualty Care military
guidelines (Montgomery, Butler et al. 2017) Textbox: One Sherpa presented with clinical high-altitude ce-
• Individual medical first responder training, including rebral edema while fixing ropes near camp 4 (7,000m) and
teaching basic life-saving skills to self-execute or to sup- descended to camp 2 (6,300m). In camp 3, treatment was
port other healthcare providers started and evacuation to lower altitude was executed by an
• Live-tissue exercise for teaching five essential life-saving established RNLMC mountain rescue team.
skills: coniotomy, needle thoracentesis, applying a chest
drain, intravenous infusion, and intraosseous infusion.

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