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Risk Management and First Aid Knowledge of Trekkers in Nepal

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Lechner K., Scharfenberg C., Hettlich E. M., Giet S., Morrison A., Schöffl V., Küpper T.

2020

vol. 13

issue 4

21-24

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.

The need for specific first aid and emergency knowledge whilst trekking in remote areas – results of the ADEMED (Aachen DEntal and MEDical) Expedition to the Annapurna region, Nepal

100%

Scharfenberg C., Lechner K., Giet S. v. d., Hettlich M., Schöffl V., Morrison A., Küpper T.

Health Promotion & Physical Activity

2021

vol. 14

issue 1

17-24

Introduction: Fellow trekkers are often the first responders to their comrades in remote settings. Not everyone undertakes First Aid (FA) training when travelling to remote settings away from comprehensive healthcare, whether travelling independently or in a group. The syllabus of standard urbanised FA courses does not fully cover the needs of such trekkers (ie altitude illnesses). We evaluated the FA and emergency knowledge of trekkers en route in the remote Nepalese Himalayas.Material and methods: A questionnaire about FA, trekking emergencies and water hygiene knowledge was completed by a cohort of 453 trekkers passing through Manang (3,519 m), Nepal, who volunteered their participation. A previously validated questionnaire consisted of 20 multiple choice questions (each using a five-point Likert scale) was used, followed by a subjective self-assessment of 17 key topics using a 5-point rating scale from very good to unsatisfactory knowledge. Demographic data including FA and climbing experience was also collected.Results: The participants generally showed a poor knowledge in FA and trekking emergencies, even though 20.8% had some occupational medical training. In total 59.5% of possible answers were answered correctly. On average each participant managed to answer only one out of 20 questions (5.4%) completely correct. The most unsatisfactory results concerned the following topics, each with only 2.4% correct answers: hypothermia/resuscitation, rescue strategies and rip fractures. The best results were for HACE 33.8%, cranio-cerebral injury 33.6%, angina pectoris/heart attack 31.8% and hypovolemic shock 28.7%. The majority of participants had very limited experience of climbing mountains, rock climbing or ice climbing.Conclusions: This study provides essential data identifying deficiencies in standard FA courses that are targeted for urban settings, and not for trekkers in a remote setting far away from comprehensive health care and rescue. There is a need to develop readily accessible FA curriculums specific to trekkers that would provide education on preventative care prior to, during, and after treks, and to improve their knowledge of medical care of trekking injuries and emergencies.

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Risk Management and First Aid Knowledge of Trekkers in Nepal

The need for specific first aid and emergency knowledge whilst trekking in remote areas – results of the ADEMED (Aachen DEntal and MEDical) Expedition to the Annapurna region, Nepal