Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study

Frostbite and Mortality in Mountaineering Women: A Scoping Review-UIAA Medical Commission Recommendations

Kriemler, Susi, Kastė Mateikaitė-Pipirienė, Alison Rosier, Linda E. Keyes, Peter Paal, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, and Dominique Jean; for the UIAA MedCom Writing Group on Women's Health in the Mountains. Frostbite and mortality in mountaineering women: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 24:247-258, 2023. Background: The harsh environment of high altitudes (HA) poses many serious health risks for mountaineers, including cold injuries and death. The aim of this work was to review whether female mountaineers are at special risk for frostbite or death at HA compared with their male counterparts. Methods: The UIAA Medical Commission convened an international author team to review women's health issues at HA and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified with additional publications found by hand search. The primary search focus was for articles assessing cold injuries and death in women mountaineers at HA. Results: We reviewed the literature and identified 20 relevant studies: 2 studies on frostbite at HA, plus 7 studies and 1 report for death at HA. An additional 10 studies about frostbite at low altitude were included. We found that female mountaineers at HA were at lower risk of death than their male counterparts, but sex differences in frostbite were inconclusive. Conclusions: The frequency of cold injuries and mortality in female mountaineers is not yet well studied, and the studies that have been published tend to lack precise exposure data. More studies and registries with sex-differentiated data are needed.

The collective vs individual nature of mountaineering: a network and simplicial approach

Mountaineering is a sport of contrary forces: teamwork plays a large role in mental fortitude and skills, but the actual act of climbing, and indeed survival, is largely individualistic. This work studies the effects of the structure and topology of relationships within climbers on the level of cooperation and success. It does so using simplicial complexes, where relationships between climbers are captured through simplices that correspond to joint previous expeditions with dimension given by the number of climbers minus one and weight given by the number of occurrences of the simplex. First, this analysis establishes the importance of relationships in mountaineering and shows that chances of failure to summit reduce drastically when climbing with repeated partners. From a climber-centric perspective, it finds that climbers that belong to simplices with large dimension were more likely to be successful, across all experience levels. Then, the distribution of relationships within a group is explored to categorize collective human behavior in expeditions, on a spectrum from polarized to cooperative. Expeditions containing simplices with large dimension, and usually low weight (weak relationships), implying that a large number of people participated in a small number of joint expeditions, tended to be more cooperative, improving chances of success of all members of the group, not just those that were part of the simplex. On the other hand, the existence of small, usually high weight (i.e., strong relationships) simplices, subgroups lead to a polarized style where climbers that were not a part of the subgroup were less likely to succeed. Lastly, this work examines the effects of individual features (such as age, gender, climber experience etc.) and expedition-wide factors (number of camps, total number of days etc.) that are more important determiners of success in individualistic and cooperative expeditions respectively. Centrality indicates that individual features of youth and oxygen use while ascending are the most important predictors of success. Of expedition-wide factors, the expedition size and number of expedition days are found to be strongly correlated with success rate.

Mountaineers on Mount Everest: Effects of age, sex, experience, and crowding on rates of success and death

Mount Everest is an extreme environment for humans. Nevertheless, hundreds of mountaineers attempt to summit Everest each year. In a previous study we analyzed interview data for all climbers (2,211) making their first attempt on Everest during 1990–2005. Probabilities of summiting were similar for men and women, declined progressively for climbers about 40 and older, but were elevated for climbers with experience climbing in Nepal. Probabilities of dying were also similar for men and women, increased for climbers about 60 and older (especially for the few that had summited), and were independent of experience. Since 2005, many more climbers (3,620) have attempted Everest. Here our primary goal is to quantify recent patterns of success and death and to evaluate changes over time. Also, we investigate whether patterns relate to key socio-demographic covariates (age, sex, host country, prior experience). Recent climbers were more diverse both in gender (women = 14.6% vs. 9.1% for 1990–2005) and in age (climbers ≥ 40 = 54.1% vs. 38.7%). Strikingly, recent climbers of both sexes were almost twice as likely to summit–and slightly less likely to die–than were comparable climbers in the previous survey. Temporal shifts may reflect improved weather forecasting, installation of fixed ropes on much of the route, and accumulative logistic equipment and experience. We add two new analyses. The probability of dying from illness or non-traumas (e.g., high-altitude illness, hypothermia), relative to dying from falling or from ‘objective hazards’ (avalanche, rock or ice fall), increased marginally with age. Recent crowding during summit bids was four-fold greater than in the prior sample, but surprisingly crowding has no evident effect on success or death during summit bids. Our results inform prospective climbers as to their current odds of success and of death, as well as inform governments of Nepal and China of the safety consequences and economic impacts of periodically debated restrictions based on climber age and experience.

Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review

Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.

Mountain neurology

Mountain climbers may develop specific illnesses that largely depend on the altitude reached and the rate of ascent. The popularity of travel to high altitude destinations, extreme tourist activities and mountain climbing means that neurologists in low-altitude countries are increasingly likely to encounter neurological problems and disorders in people exposed to high altitude. Additionally, they may have to advise patients with pre-existing neurological conditions on the risks of ascent to altitude. This article focuses on neurological-related high-altitude illnesses: acute mountain sickness and high-altitude cerebral oedema, as well as high-altitude retinopathy and other neurological disorders. This overview combines current understood pathogenesis with the experience of managing altitude-related illness at the foot of Mount Kilimanjaro in northern Tanzania, the tallest free-standing mountain in the world.

From Matterhorn to Mt Everest: empowering rescuers and improving medical care in Nepal

This article describes a private initiative in which professional Swiss rescuers, based at the foot of the Matterhorn, trained Nepalese colleagues in advanced high altitude helicopter rescue and medical care techniques. What started as a limited program focused on mountain safety has rapidly developed into a comprehensive project to improve rescue and medical care in the Mt Everest area for both foreign travelers and the local Nepalese people.

High-altitude mountaineering made safer

Mountains all over the world are attracting a steadily growing number of visitors due to the increasing number of cheap flights; the construction of new roads, railways, and cable cars; and commercial offers of trekking tours and expeditions to attempt even the world's highest peaks. However, one must not forget that mountains are typically inhospitable areas characterised by cold and hypoxic environments and rapidly changing weather and track conditions associated with a relatively high risk of accidents and emergencies. Beside the objective hazards, subjective hazards, for example physical fitness and health status, mountaineering skills, and equipment, contribute substantially to the risk. Whereas in some regions, for example the Alps, rescue operations and medical emergency interventions can be performed rapidly and effectively, this is absolutely not the case in most of the very remote areas and on very high mountains. Therefore, the understanding of the risk associated with the various modes of mountaineering as well as knowledge about how to optimise prevention is of the utmost importance. Ultimately, it is the informed mountaineer who has to decide whether the risks are acceptable or not. Continuing joint efforts of scientists, medical and alpine institutions, expedition organisers, and mountaineers will help to make high-altitude mountaineering safer.