Pharmacological Prophylaxis and Supplemental Oxygen for Unacclimatized Rescuers at Very High Altitude: Scoping Review and 2025 Joint Recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine.

McLaughlin, Kyle, Steve Roy, Marika Falla, Giacomo Strapazzon, Andrew M. Luks, Ken Zafren, Hermann Brugger, Martin Musi, Iztok Tomazin, John Ellerton, Ghan Bahadur Thapa, and Peter Paal. Pharmacological prophylaxis and supplemental oxygen for unacclimatized rescuers at very high altitude: scoping review and 2025 joint recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine.

The Effect of Aging at Moderate Altitude on Cognition and Symptoms of Depression and Anxiety.

Background: Minor and major neurocognitive disorders, depression, and anxiety are common in older adults. The brain, and specifically the aging brain, relies heavily on oxygen and is highly sensitive to reductions in oxygen availability. Hypoxia occurs during both acute and prolonged exposure to altitude.

Drones reduce the time to defibrillation in a highly visited non-urban area: A randomized simulation-based trial.

Introduction: Out-of-hospital cardiac arrest (OHCA) has a high global incidence and mortality rate, with early defibrillation significantly improving survival. Our aim was to assess the feasibility of autonomous drone delivery of automated external defibrillators (AED) in a non-urban area with physical barriers and compare the time to defibrillate (TTD) with bystander retrieval from a public access defibrillator (PAD) point and helicopter emergency medical services (HEMS) physician performed defibrillation.

Methods: This randomized simulation-based trial with a cross-over design included bystanders performing AED retrievals either delivered by automated drone flight or on foot from a PAD point, and simulated HEMS interventions.

Vital parameter monitoring in harsh environment by the MedSENS in-ear multisensor device.

Accurate assessment of vital parameters is essential for diagnosis and triage of critically ill patients, but not always feasible in out-of-hospital settings due to the lack of suitable devices. We performed an extensive validation of a novel prototype in-ear device, which was proposed for the non-invasive, combined measurement of core body temperature (Tc), oxygen saturation (SpO), and heart rate (HR) in harsh environments. A pilot study with randomized controlled design was conducted in the terraXcube environmental chamber.

Effect of oxygen supplementation on cognitive performance among HEMS providers after acute exposure to altitude: the HEMS II randomized clinical trial.

Importance: Emergency medical services (EMS) providers transiently ascend to high altitude for primary missions and secondary transports in mountainous areas in helicopters that are unpressurised and do not have facilities for oxygen supplementation. The decrease in cerebral oxygen saturation can lead to impairment in attention and reaction time as well as in quality of care during acute exposure to altitude.

Objective: The primary aim of the current study was to investigate the effect of oxygen supplementation on cognitive performance in Helicopter EMS (HEMS) providers during acute exposure to altitude.

Isolated high altitude psychosis, delirium at high altitude, and high altitude cerebral edema: are these diagnoses valid?

Psychosis is a psychopathological syndrome that can be triggered or caused by exposure to high altitude (HA). Psychosis can occur alone as isolated HA psychosis or can be associated with other mental and often also somatic symptoms as a feature of delirium. Psychosis can also occur as a symptom of high altitude cerebral edema (HACE), a life-threatening condition.

Personal Protective Equipment Protocols Lead to a Delayed Initiation of Patient Assessment in Mountain Rescue Operations.

van Veelen, Michiel J., Giulia Roveri, Ivo B. Regli, Tomas Dal Cappello, Anna Vögele, Michela Masè, Marika Falla, and Giacomo Strapazzon.

Comparative Effectiveness of an Artificial Air Pocket Device to Delay Asphyxiation in Supine Individuals Critically Buried in Avalanche Debris.

Importance: Approximately 70% of individuals critically buried in avalanche debris die within 35 minutes as a result of asphyxial cardiac arrest. An artificial air-pocket device (AAPD) that separates inhaled air from exhaled air may delay the onset of severe hypoxemia and eventual asphyxia during snow burial.

Objective: To investigate the efficacy of a new AAPD during snow burial in a supine position.

Surgical masks and filtering facepiece class 2 respirators (FFP2) have no major physiological effects at rest and during moderate exercise at 3000-m altitude: a randomised controlled trial.

Background: During the COVID-19 pandemic, the use of face masks has been recommended or enforced in several situations; however, their effects on physiological parameters and cognitive performance at high altitude are unknown.

Methods: Eight healthy participants (four females) rested and exercised (cycling, 1 W/kg) while wearing no mask, a surgical mask or a filtering facepiece class 2 respirator (FFP2), both in normoxia and hypobaric hypoxia corresponding to an altitude of 3000 m. Arterialised oxygen saturation (SaO2), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), heart and respiratory rate, pulse oximetry (SpO2), cerebral oxygenation, visual analogue scales for dyspnoea and mask's discomfort were systematically investigated.

Drones reduce the treatment-free interval in search and rescue operations with telemedical support - A randomized controlled trial.

Introduction: Response to medical incidents in mountainous areas is delayed due to the remote and challenging terrain. Drones could assist in a quicker search for patients and can facilitate earlier treatment through delivery of medical equipment. We aim to assess the effects of using drones in search and rescue (SAR) operations in challenging terrain.

Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events.

Study Objective: We analyzed occupational accidents reported among Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS) providers during mountain search and rescue operations and training events in Italy (1999 to 2019).

Methods: We extracted anonymized data from the CNSAS accident database for all cases of injured mountain search and rescue providers that activated CNSAS insurance (1999 to 2019). We report epidemiological characteristics, mechanisms, type, and severity of injury or illness, clinical outcome, and recovery time.

Simulated Acute Hypobaric Hypoxia Effects on Cognition in Helicopter Emergency Medical Service Personnel - A Randomized, Controlled, Single-Blind, Crossover Trial.

Objective: To evaluate, under replicable, blinded and standardised conditions, the effect of acute exposure to hypobaric hypoxia (HH) (equivalent to 200 or 3000 or 5000 m above sea level (asl)) on selected cognitive domains and physiological parameters in personnel of helicopter emergency medical service (HEMS).

Methods: We conducted a randomized clinical trial using a single-blind crossover design in an environmental chamber () to induce HH in 48 HEMS personnel. Participants performed cognitive tests (CT) before the ascent, after 5 min at altitude, and after simulated cardiopulmonary resuscitation (SCR).

Low Ambient Temperature Exposition Impairs the Accuracy of a Non-invasive Heat-Flux Thermometer.

Background: Indirect core body temperature (CBT) monitoring from skin sensors is gaining attention for in-field applications thanks to non-invasivity, portability, and easy probe positioning. Among skin sensors, heat-flux devices, such as the so-called Double Sensor (DS), have demonstrated reliability under various experimental and clinical conditions. Still, their accuracy at low ambient temperatures is unknown.

Freezing of gait: overview on etiology, treatment, and future directions.

Background: Freezing of gait (FOG) is a disabling motor symptom occurring mainly in the advanced stage of Parkinson's disease (PD).

Methods: This review outlines the clinical manifestation of FOG and its relationship with levodopa treatment, the differential diagnosis with respect to other neurodegenerative and secondary forms and the available treatment.

Results: We report the proposed models explaining the FOG phenomenon and summarize the available knowledge on FOG etiology's potential genetic contribution.

Effect of Acute Exposure to Altitude on the Quality of Chest Compression-Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single-Blind Crossover Trial.

Background Helicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)-CPR after acute exposure to altitude under repeatable and standardized conditions. Methods and Results Forty-eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5 minutes of CCO-CPR on manikins at 2 of 3 altitudes in a randomized controlled single-blind crossover design (200, 3000, and 5000 m) in a hypobaric chamber.

Impact of Nutritional Intervention on Taste Perception-A Scoping Review.

The aim of the present scoping review was to evaluate the impact of experimental meal loads or observational diet changes/habits on taste tests in both healthy subjects and patients. A systematic search performed in PubMed, Scopus, and Institute for Scientific Information (ISI) Web of Science electronic databases retrieved, respectively 2981, 6258, and 7555 articles from January 2000 to December 2020. A total of 17 articles were included for full-text review.

The Effect of Cold Exposure on Cognitive Performance in Healthy Adults: A Systematic Review.

Several aspects of cognition can be affected after cold exposure, but contradictory results have been reported regarding affected cognitive domains. The aim of the current systematic review was to evaluate the effects of specific cold exposure on cognitive performance in healthy subjects. A systematic search was performed using MEDLINE (through PubMed), EMBASE (Scopus) and PsycINFO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Long-Term Sequelae of Frostbite-A Scoping Review.

Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing, electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon rewarming, inflammatory reperfusion injury and thrombosis may lead to further tissue damage.