‘Hypoxia and Cold’, the tenth World Congress on High Altitude Medicine and Physiology and Mountain Emergency Medicine took place in Bolzano, Italy from 25-31 May this year. We present two perspectives on the week. One is from David Hillebrandt, President of the UIAA Medical Commission and the other is from our very own Student Representative Naomi Dodds, who was presenting at the conference.
Introduction – David Hillebrandt
The idea of 500 mountaineering doctors, physiologists and mountain rescuers meeting for a full week in the shadow of the Dolomites may sound over technical for some climbers. However, the Tenth World Congress on High Altitude Medicine and Physiology and Mountain Emergency Medicine, organised by the International Society of Mountain Medicine (ISMM), was a great gathering – the hard core research balanced by a buzzing social scene.
It was the largest gathering of the great, the good, the bad and the ugly of the international mountain medicine world. Thirty nations were represented amongst the 500 attendees, with delegations from China, Japan, Nepal and the Americas from Alaska to Chile. At last, there were also representatives from the African continent this year. The conference ran from 25-31 May at the European Academy (EURAC) in Bolzano, Italy but many delegates arrived early or stayed on to enjoy the local crags and mountains.
The first couple of days were highly physiological with the most up to date research on performance at altitude and most emphasis at the cellular and sub cellular level. Over the next few years we can expect these concepts to be translated into lessons relevant to the active climber and mountaineer. The conference then gradually morphed into more practical concepts related to both altitude and sport climbing and mountain trauma and rescue, including avalanche burial and hypothermia.
Delegates’ accommodation varied from free camping provided by Salewa at their factory and climbing wall on the edge of town to five star hotels. Every night the town was thronged with delegates sharing ideas over beers in bars and cafes and restaurants. On one evening many made their way up to Messner’s Castle overlooking the city to peruse his museum and centre of mountain culture, followed by a pleasantly informal but very memorable talk by both Reinhold and Dr Oswald Oltz on climbing Everest without oxygen.
The UK punches well above its weight in the mountain medicine field and some excellent papers were presented by UK research teams, but as always, it is the chats between presentations that bore the real fruits of the conference in terms of new friends made and climbs planned.
Naomi’s Week at Bolzano
The week was action-packed, full of new innovative research, inspirational talks, interactive clinical discussions, hands-on workshops and social networking events.
The joy of having so many experts and enthusiasts together was lively debate regarding cases and treatments. It quickly became clear that there were varying opinions, and that management of complex cases would never be black and white. One interactive discussion highlighted interesting differential diagnoses for High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE), stressing the importance of a broad mindset and adaptive approach when working as an expedition medic.
Exercise induced bronchospasm, cerebrovascular events and mood disturbances on expedition were example cases discussed, emphasising that common things are common regardless of altitude.
There was also much debate over the appropriate use of drugs for prophylaxis, performance enhancement and treatment at altitude, especially as related to the commercialisation of mountaineering. The challenges of achieving a balance between the safety of your team and helping them successfully summit as a doctor on commercial climbing expeditions were deliberated.
I had always assumed that the development of HAPE signified the end of a climbers voyage, however the use of nifedipine, rest and successful re-ascent was used as an example to describe how such a scenario could be alternatively managed.
Our Research
I was lucky enough to be invited to present two pieces of research at the Congress, speaking on behalf of the Bangor Mountain Medicine Project. One study focussed on the pre-hospital use of intranasal diamorphine in UK mountain casualties. Summarising, we found that intranasal diamorphine can be used as a safe and effective alternative to intravascular analgesia, especially when access is difficult to achieve in the mountain rescue environment.
Our other study looked at the epidemiology of fallers in Snowdonia, and empirically confirmed the anecdotal finding that fallers were predominantly young male walkers, with incidents occurring towards the end of the day, during the summer months, on the most accessible mountains. For example, Snowdon and Tryfan. Importantly it highlighted the need for public education and the value of epidemiological data to aid mountain rescue team training.
Collaboration
Throughout the congress there was a great deal of focus on building relationships to further collaboration. Adequate training and education for doctors practicing in the mountain environment was a common theme, with emphasis on the development and success of mountain medicine educational initiatives across the globe. Additionally, there are now international registries for HAPE, Alpine Trauma, Frostbite and Hypothermia, and everyone is encouraged to report cases to these databases. The International Mountaineering and Climbing Federation (UIAA) Medical Commission have also published a classification for mountaineering and climbing injuries to help aid inter-study comparison and epidemiological analysis.
Speaking at a conference as a medical student
Talking at an international conference can be quite a daunting experience as a medical student, particularly when they put you in the ‘Meet the Expert’ section. It feels like you have extremely big boots to fill. These would be my tips for anyone in a similar situation.
Passion / Be ambitious and choose a research area you are passionate about. An enthusiastic speaker is much more fun to listen to.
Confidence / Don’t be scared to submit an abstract, usually organisers are pleased to see research produced by new young people interested in the field.
Imagery / Use plenty of scenic pictures to keep your audience entertained.
Practice / Practice talking in front of colleagues, friends and family.
Preparations / Think of all the likely questions you may be asked and try to pre-empt any tricky questions. People usually ask questions because they have a genuine interest in your subject they are not trying to catch you out, don’t be afraid to admit if you don’t know the answer.
Enjoyment / Enjoy the experience! It may feel terrifying at the time but looking back on it you will be really proud of your accomplishments.
Go to the next one…
The XI Congress with be held in Telluride, Colorado in 2016, hosted jointly by the International Society of Mountain Medicine and Wilderness Medicine Society. Joining the International Society for Mountain Medicine now will get you advance details of the next congress, as well as reduced delegate rates.
