Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Emergency Service, Lausanne University Hospital, Switzerland.
High Alt Med Biol. 2019 Sep;20(3):251-261. doi: 10.1089/ham.2018.0124. Epub 2019 Aug 2.
Mountain guides work daily in remote areas and high-altitude locations where specific hypoxia-related and common medical problems may occur. Arrival of rescue teams can be delayed, so mountain guides often have to rely on their own capabilities to provide first aid. Therefore, IFMGA-recognized Swiss mountain guides receive a specific medical education and are equipped with a dedicated medical kit. This specific education has never been evaluated. A questionnaire was sent to all Swiss mountain guides through their national association. This questionnaire evaluates guides' activity, type, and frequency of medical events encountered, medical education, and use of the medical kit. Furthermore, clinical vignettes were used to evaluate their subjective and objective knowledge about prevention and treatment of specific altitude-related diseases. A total of 467 guides completed the questionnaire, 54 (11.6%) of them were identified as high-altitude guides (HA-guides), because they spent ≥10 nights above 4000 meters each year. Mountain guides are more exposed to altitude-specific pathologies, such as Acute Mountain Sickness (AMS), High-Altitude Pulmonary Edema (HAPE), and High-Altitude Cerebral Edema (HACE) than to general medical conditions. A majority of participants (in particular HA-guides) considered altitude-related medical knowledge essential but judged their own education as insufficient. A majority of mountain guides were aware of nonpharmacological preventive measures and able to recognize altitude-related diseases. Mountain guides declared themselves as very confident in treating altitude-related diseases. Objective assessment of their knowledge showed some gaps, in particular related to the use of specific medications like nifedipine and dexamethasone. Swiss mountain guides' education in altitude medicine may be improved, in particular concerning the recognition and treatment of severe conditions such as HAPE and HACE. Better knowledge may be especially important for HA-guides. These data have induced experts in the field to adapt the guides teaching curriculum and medical kit.
登山向导每天都在偏远地区和高海拔地区工作，在这些地方可能会出现特定的高原相关和常见的医疗问题。救援队伍的到达可能会延迟，因此登山向导通常不得不依靠自己的能力提供急救。因此，IFMGA 认可的瑞士登山向导接受了专门的医学教育，并配备了专用的医疗包。这种专门的教育从未经过评估。通过他们的国家协会向所有瑞士登山向导发送了一份问卷。这份问卷评估了导游的活动、类型和遇到的医疗事件的频率、医学教育以及医疗包的使用情况。此外，还使用了临床病例来评估他们对预防和治疗特定高原相关疾病的主观和客观知识。共有 467 名导游完成了问卷，其中 54 名（11.6%）被确定为高海拔导游（HA 导游），因为他们每年在海拔 4000 米以上的地方度过≥10 个晚上。登山向导比一般医疗条件更容易接触到特定于海拔的疾病，如急性高原病（AMS）、高原肺水肿（HAPE）和高原脑水肿（HACE）。大多数参与者（特别是 HA 导游）认为与海拔相关的医学知识是必不可少的，但认为自己的教育不足。大多数登山向导都知道非药物预防措施，并能够识别与海拔相关的疾病。登山向导表示自己对治疗与海拔相关的疾病非常有信心。对他们知识的客观评估显示出一些差距，特别是与使用硝苯地平和地塞米松等特定药物有关。瑞士登山向导的高原医学教育可能需要改进，特别是在识别和治疗 HAPE 和 HACE 等严重疾病方面。更好的知识可能对 HA 导游尤为重要。这些数据促使该领域的专家调整了导游的教学课程和医疗包。
