Mountain medicine education in Europe

Diabetes-Related Knowledge of Polish National Mountain Leaders

Nabrdalik, Katarzyna, Hanna Kwiendacz, Monika Gubała, Kinga Tyrała, Mariusz Seweryn, Andrzej Tomasik, Tomasz Sawczyn, Michał Kukla, Władysław Grzeszczak, and Janusz Gumprecht. Diabetes-related knowledge of Polish national mountain leaders. High Alt Med Biol. 19:237-243, 2018.-Mountain trekking is a popular activity for patients with diabetes. In Poland, mountain leaders often accompany organized groups to ensure their safety during treks; we aimed to evaluate their competency in caring for diabetic clients by assessing their diabetes-related knowledge. This was a cross-sectional study among Polish, certified, active mountain leaders carried out by means of an anonymous, standardized 41-item questionnaire adapted from a study by Wee et al. It was distributed through e-mail to 500 leaders. A total of 106 (21.2%) mountain leaders completed the questionnaire (males 60.4%) with a mean (standard deviation [SD]) age of 38.6 (13.5) years. Their mean (SD) length of experience acting as a mountain leader was 11.9 (10.2) years. The average score was 72.4% of the maximum possible (29.7 of 41 points). Results varied significantly depending on gender (p = 0.006). The percentage of correct answers among questions in each section varied between 23.6% and 100%. The main sources of diabetes-related knowledge identified by respondents were members of their family and their friends who suffer from diabetes (33%). First aid courses were indicated as sources of information by only 12.6% of the informants. Results of the questionnaire revealed that respondents did have a reasonable level of diabetes-related knowledge. There were topics in which the respondents achieved lower than an average score, demonstrating a need for further education.

The ski camp doctor’s role in the the prevention of winter sport accidents

A tavalyi év több halálos végű téli sportbaleseteinek száma, mely különösen a gyermekkorúak síelésével volt kapcsolatos, felvetette azt a gondolatot, hogy a síelő csoportokat olyan kiképzett orvosok kísérjék, akik alkalmasak arra, hogy a téli sportokkal kapcsolatos sürgősségi helyszíni ellátást elkezdjék, és ezáltal a balesetek és megbetegedések következményeit enyhítsék. Mivel hasonló kezdeményezésről még nem számol be a szakirodalom, a jelen közlemény megpróbálja összefoglalni a sítábororvosokkal szemben támasztott szakmai követelményeket, valamint felméri a tábororvosok feladatkörét. A sítábororvos, bármely diszciplína művelője is, jártas kell hogy legyen az utazási orvostan alapkérdéseiben és a sürgősségi betegellátás készségszintű művelésében. Prevenciós feladatai között szerepel az utazás előtti egészségfelmérés, a szokványos megbetegedések felismerése és kezelése a helyszínen, az orvosi elsősegély nyújtása a sípályán, valamint a beteg ellátásának és hazaszállításának megszervezése. Az elképzelés helyességét bizonyította az első sítábororvos-képzés sikere, melynek folyamán a résztvevők nemcsak az orvosi elméleti alapokat sajátították el, hanem hivatásos síoktatók is javították az orvosok sítechnikai tudását. A képzés része volt még a síbalesetek jogi és biztosítói oldalról való elemzése is. A nagy érdeklődésre való tekintettel a sítábororvosi tanfolyamot rendszeressé kell tenni, a képzésbe belevonva a külföldi hegyi mentőszolgálatokat is. Az iskoláscsoportok síbaleseteinek megelőzésében nagy szerepe lehet a kiképzett tábororvosoknak, akik névsora az utazási irodák rendelkezésére bocsátható. Remélhető, hogy a kezdeményezést az utazási biztosítók is felkarolják, mert a sítábororvos jelenléte nagyban csökkentheti a kárhányadot és a károsodás mértékét.

A Survey of Emergency Medical Services in Mountain Areas of Europe and North America

Survey of on-site treatment of patients in mountain areas of 14 countries in Europe and North America (nonresponder rate 33%) to compare emergency medical services. Around 37,535 ground rescuers and 747 helicopters are ready for evacuation of casualties and patients in mountain areas. And 1316 physicians and 50,967 paramedics take part in ground and air mountain rescue operations. In Europe, 63.2% of helicopters have a physician on board, 17.8% are staffed with a paramedic, and 19% have no medically trained personnel on board. In North America, 31.6% (p < 0.001) of helicopters are staffed with a doctor, 59.3% (p < 0.001) with a paramedic, and 9.1% (p < 0.001) have no medical personnel. The percentage of on-site treatment according to the recommendations of the International Liaison Committee on Resuscitation (ILCOR) or International Commission for Alpine Rescue (ICAR) varies among all countries (p < 0.001) and is positively related to the percentage of physician-staffed helicopters (r = 0.76, p < 0.001). Paramedics in 90.9% countries are obliged to be medically trained, but physicians only need to have a standardized training in emergency medicine in 50% (p < 0.042). On-site treatment according to ILCOR or ICAR recommendations is performed more often in countries where physicians are regularly involved in mountain rescue operations. However, no conclusions can be drawn from the data as to the efficiency of treatment. The data show a lack of medical education in specific, mountain rescue-related problems. Physicians involved should undergo suitable training.

Wilderness medicine education for the physician

As more Americans venture into the wilderness, physicians will be called upon to provide care in the backcountry or austere setting. Additionally, more isolated regions of the world are becoming accessible for trekking and mountaineering. These facts imply a higher rate of injuries and medical problems within a distinct spectrum of disease that are best treated by the well-prepared and continuously educated physician. This article discusses the educational resources that are currently available for physicians to meet these needs in the United States.

Practical aspects in mountain medicine education

Mountain medicine education is provided through many different courses. The newest developments include an international Union Internationale des Associations Alpinistes--Internationale Kommission für Alpines Rettungswesen--International Society of Mountain Medicine (UIAA-IKAR-ISMM) label for mountain medicine courses that comply with certain minimal requirements in theoretical and practical educational aspects. Participants in the courses that fulfill these specific conditions are eligible to obtain the International Diploma of Mountain Medicine, which is recognized by the above-mentioned international bodies governing mountain sports and mountain medicine. The Swiss course cycle, and especially the structure and content of the Swiss summer course 1999, which was organized by the Swiss Alpine Club and the Swiss Society for Mountain Medicine, are described in this article and some annotations are given. Theoretical and practical requirements for obtaining the International Diploma of Mountain Medicine in Switzerland are also presented.