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Swiss Mountain Guides: Medical Education, Knowledge, and Practice
Pierre Métrailler1,2,3, Jens Greiser1, Gilles Dietrich4
1Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
High Altitude Medicine & Biology
|August 3, 2019
Summary
Swiss mountain guides require better training in altitude medicine. While aware of altitude illnesses like AMS, HAPE, and HACE, their knowledge gaps in treatment, especially for high-altitude guides, necessitate curriculum updates.
Area of Science:
- Expedition Medicine
- Wilderness Medicine
- Altitude Physiology
Background:
- Mountain guides operate in remote, high-altitude environments where medical emergencies may require self-sufficiency due to delayed rescue.
- International Federation of Mountain Guides Associations (IFMGA)-recognized Swiss mountain guides receive specialized medical training and carry dedicated medical kits.
- The effectiveness and content of this specific medical education for mountain guides have not been previously evaluated.
Purpose of the Study:
- To evaluate the current medical education and knowledge of IFMGA-recognized Swiss mountain guides regarding altitude-related illnesses.
- To assess the frequency and types of medical events encountered by mountain guides.
- To identify specific areas for improvement in the medical training curriculum and equipment for mountain guides.
Main Methods:
- A questionnaire was distributed to all Swiss mountain guides via their national association.
- The survey assessed guide activities, encountered medical events, training received, and medical kit usage.
- Clinical vignettes were employed to objectively and subjectively evaluate knowledge on preventing and treating altitude-related diseases.
Main Results:
- Out of 467 respondents, 54 (11.6%) were identified as high-altitude guides (HA-guides) spending ≥10 nights/year above 4000m.
- Guides, particularly HA-guides, face more altitude-specific pathologies (AMS, HAPE, HACE) than general medical conditions and deem altitude knowledge essential but their training insufficient.
- While guides recognize altitude illnesses and are confident in treatment, objective assessments revealed knowledge gaps, especially concerning medications like nifedipine and dexamethasone for severe conditions.
Conclusions:
- Swiss mountain guide training in altitude medicine requires enhancement, particularly in recognizing and managing severe conditions like High-Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema (HACE).
- Improved medical knowledge is crucial for all guides, with a particular emphasis needed for HA-guides.
- Study findings have prompted experts to revise the guides' teaching curriculum and update their medical kits.
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