Risk Management and First Aid Knowledge of Trekkers in Nepal
DOI:
https://doi.org/10.55225/hppa.174Keywords:
trekking, mountaineering emergencies, acute mountain sickness, acclimatization, risk managementAbstract
Background: Trekking in Nepal is popular and generally safe. However preventable trekking injuries and deaths are often the result of poor risk managementand lack of skills – i.e. acute mountain sickness (AMS) and specific First Aid (FA). Shlim and Gallie’s reviews in 1992 and 2004 of trekking deaths here found a fivefold higher risk for fatal outcomes in organized trekking tours (OT) compared to independently organised trekkers (IT), including preventable deaths (i.e. AMS). Our survey sought to identify the AMS, FA and risk management knowledge/skills of OT and IT whilst trekking in Nepal. Methods: Based on previous pilot studies at the Khumbu region in Nepal, and on risk management information provided by leading German trekking operators, a survey was conducted using two questionnaires: one each for OT and IT.The study site was Manang (3,500m) in Annapurna region, Nepal. All trekkers passing through this site who volunteered their participation were included. For evaluation descriptive statistical methods and non-parametric tests were used. Results: 442 questionnaires were completed (155 OT; 287 IT). Mean agewas 36.4 +/– 12.0y and 61% were male. Mountaineering experience was low and FA training was scarce in both groups. IT (92.7%) followed acclimatization recommendations and 59.2% carried AMS medication, compared respectively to OT at 63.2% and 25.2%. Only 27.1% of OT had repatriation plans for a medical emergency. Conclusions: Most of OT and IT were inexperienced in mountaineering and in mountain emergencies. The preparedness of OT overall was inadequate and over-reliant on the organisers whose skills may also be inadequate when responding to an emergency. Responsible trekking should require that more than one person in a group have adequate, up-to-date riskassessment/management and FA skills specific to the trek, and in particular an understanding of altitude profile, AMS, and individual abilities.
Downloads
References
Gaillard S, Dellasanta P, Loutan L, Kayser B. Awareness, prevalence, medication use, and risk factors of acute mountain sickness in tourists trekking around the Annapurnas in Nepal: a 12-year follow-up. High Alt Med Biol. 2004;5(4):410-419. DOI: https://doi.org/10.1089/ham.2004.5.410 Google Scholar
Schoene RB. Illnesses at high altitude. Chest. 2008;134(2):402- 416. DOI: https://doi.org/10.1378/chest.07-0561 Google Scholar
Schmitz S. Trekkers with Non-Cardiopulmonary Preexisting Diseases in the Everest Region. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2018. Google Scholar
Gschwandtl C. Trekker and Expedition Climber as Comrade Rescuers in the Solo Khumbu–Mt. Everest Region, Nepal:Development of A Target Group Specific Training Concept for First Aid and Risk Management in Remote High Mountain Regions: Results of the ADEMED Expedition 2011. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2019. Google Scholar
Haunolder M. Trekkers with Cardiopulmonary Preexisting Diseases in the Everest Region. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2020. Google Scholar
Shlim DR, Gallie J. The causes of death among trekkers in Nepal. Int J Sports Med. 1992;13 Suppl1:S74-76. DOI: https://doi.org/10.1055/s-2007-1024601 Google Scholar
Eggert J. Safety Aspects in Commercial Trekking with Special Regard to Altitude. [bachelor thesis]. Bayreuth: University of Bayreuth, Institute of Sport Sciences; 1998. Google Scholar
Scharfenberg C. First Aid Knowledge of Trekkers. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2013. Google Scholar
Haunolder M.Trekkers with Preexisting Cardiopulmonary Diseases in the Everest Region. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2020. Google Scholar
Moraga FA, Osorio JD, Vargas ME. Acute mountain sickness in tourists with children at Lake Chungara (4400 m) in northern Chile. Wilderness Environ Med. 2002;13(1):31-35. DOI: https://doi.org/10.1580/1080-6032(2002)013[0031:AMSITW]2.0.CO;2 Google Scholar
Cheng FY, Jeng MJ, Lin YC, Wang SH, Wu SH, Li WC, et al. Incidence and severity of acute mountain sickness and associated symptoms in children trekking on Xue Mountain, Taiwan. PLoS One. 2017;12(8):e0183207. DOI: https://doi.org/10.1371/journal.pone.0183207 Google Scholar
Moraga FA, Pedreros CP, Rodriguez CE. Acute mountain sickness in children and their parents after rapid ascent to 3500 m (Putre, Chile). Wilderness Environ Med. 2008;19(4):287-292. DOI: https://doi.org/10.1580/06-WEME-BR-084.1 Google Scholar
Southard A, Niermeyer S, Yaron M. Language used in Lake Louise Scoring System underestimates symptoms of acute mountain sickness in 4- to 11-year-old children. High Alt Med. Biol. 2007;8(2) 124-130. DOI: https://doi.org/10.1089/ham.2006.1014 Google Scholar
Theis MK, Honigman B, Yip R, McBride D, Houston CS, Moore LG. Acute mountain sickness in children at 2835 meters. Am J Dis Child. 1993;147(2):143-145. DOI: https://doi.org/10.1001/archpedi.1993.02160260033017 Google Scholar
Wagner DR, Tatsugawa K, Parker D, Young TA. Reliability and utility of a visual analog scale for the assessment of acute mountain sickness. High Alt Med Biol. 2007;8(1):27-31. DOI: https://doi.org/10.1089/ham.2006.0814 Google Scholar
Yaron M, Waldman N, Niermeyer S, Nicholas R, Honigman B. The diagnosis of acute mountain sickness in preverbal children. Arch PediatrAdolesc Med. 1998;152(7):683-687. DOI: https://doi.org/10.1001/archpedi.152.7.683 Google Scholar
Yaron M, Niermeyer S, Lindgren KN, Honigman B. Evaluation of diagnostic criteria and incidence of acute mountain sickness in preverbal children. Wilderness Environ Med. 2002;13(1):21-26. DOI: https://doi.org/10.1580/1080-6032(2002)013[0021:EODCAI]2.0.CO;2 Google Scholar
Basnyat B, Litch JA. Medical problems of porters and trekkers in the Nepal Himalaya. Wilderness Environ Med. 1997;8(2):78-81. DOI: https://doi.org/10.1580/1080-6032(1997)008[0078:MPOPAT]2.3.CO;2 Google Scholar
Ren Y, Fu Z, Shen W, Jiang P, He, Y, Peng S, et al. Incidence of high altitude illnesses among unacclimatized persons who acutely ascended to Tibet. High Alt Med Biol. 2010;11(1):39-42. DOI: https://doi.org/10.1089/ham.2009.1049 Google Scholar
Roth HJ, Gaham A, Juchems R.Evaluating the knowledge of lay helpers following a single completed course in cardiopulmonary resuscitation. Med Klin. 1988;83(11):367-369. Google Scholar
Safar P, Berkebile P, Scott MA, Esposito G, Medsger A, Ricci E, et al. Education research on life-supporting first aid (LSFA) and CPR self-training systems (STS). Crit Care Med. 1981;9(5):403-404. DOI: https://doi.org/10.1097/00003246-198105000-00026 Google Scholar
Spitzer G. [Effectiveness surveillance of first aid education of lay persons]. HefteUnfallheilkd. 1978;132:92-94. Google Scholar
Stratmann D, Nolte H, Sämann S.An investigation of the effectiveness of the training of ambulance personnel. MMW Munch MedWochenschr. 1974;116(50):2199-2204. Google Scholar
Kupper T. Organisierte Berg- und Trekkingtouren – ein faires Geschäft? [Organized mountaineering and trekking – a fair business?]. Rundbrief der Österr. Ges. f. Alpin- &Höhenmed, 1998;18:5. Google Scholar
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 University of Applied Sciences in Tarnow, Poland & Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
