Introduction of Telemedicine in a Prehospital Emergency Care Setting: A Pilot Study.

Background: Advances in information and communication technology have led to telemedicine applications that could support paramedics in the prehospital field. In an effort to optimise the available resources like prehospital emergency physicians (PHP), the State Health Services of a Swiss state decided to launch a pilot study on the feasibility of using telemedicine in the prehospital emergency setting. Objective: The primary objective was to measure the number of missions completed without technical problems with remote PHP support through telemedicine (tele-PHP). The secondary objectives were to evaluate the safety of this protocol and to describe the actions and decisions that clinicians can make by using tele-PHP. Methods: This was a prospective observational pilot study on all missions involving the dispatch of ground PHP or tele-PHP. The severity score, dispatch criteria, actions, and decisions made by ground PHP and tele-PHP were collected. Results: PHP were dispatched simultaneously with an ambulance on 478 occasions, including 68 (14%) situations that started directly with tele-PHP. Among those situations, three had to be transformed into on-site PHP missions after the on-site evaluation by paramedics. Fifteen missions were cancelled by paramedics once they were on site, and six missions encountered a connection issue. Forty-four PHP missions that were dispatched simultaneously with paramedics were completed by tele-PHP only without any connection problems. Paramedics and PHP estimated that actions or decisions were provided by PHP in 66% of the on-site PHP missions and 34% of the tele-PHP missions. Conclusions: This is the first experience of tele-PHP regarding PHP dispatch in Switzerland. Despite the small number of missions carried out, tele-PHP could be used for well-selected situations to reduce the need for a PHP on site.

Crevasse accidents in the Swiss Alps Epidemiology and mortality of 405 victims of crevasse accidents from 2010 to 2020.

INTRODUCTION: The clinical spectrum of injuries in crevasse accidents can range from benign to life-threatening, even including death. To date, little is known about incidence and causes. METHODS: We retrospectively analyzed mountain rescue missions that included crevasse accidents and took place in Switzerland from 2010 to 2020. Demographic and epidemiological data were collected. Injury severity was graded according to the National Advisory Committee for Aeronautics (NACA) score. Winter season was defined as December to May, and summer season as June to November. RESULTS: A total of 321 victims of crevasse falls were included in the study. The median age of victims was 41.2 years (interqauartile range [IQR] 31.3 to 51.6), with 82% (n=260) being male and 59% (n=186) foreigners. The typical altitude range at which rescue missions were performed was between 3000 and 3499m (44% of all cases). The median depth of the fall was 15 meters (IQR 8 to 20) during the winter season compared to 8 meters (IQR 5 to 10) during the summer, p<0.001. Overall mortality was 6.5%. The NACA score was ≥4 for 9.4% (n=30) of the victims. 55% (n=177) had a NACA score of 0 or 1. There was a significant positive correlation between the depth of fall and the injury severity (Pearson`s correlation r=0.35, 95%- confidence interval: 0.18 to 0.51), p<0.001. CONCLUSION: More than half of victims fallen into a crevasse are uninjured or sustain mild injury. Life-threathening injuries were found in about 10% of victims and the crevasse fall was fatal in 6.5% of cases. Injury severity positively correlates with the depth of fall, which is higher during winter season.

Swiss Mountain Guides: Medical Education, Knowledge, and Practice.

Background: Mountain guides work daily in remote areas and high-altitude locations where specific hypoxia-related and common medical problems may occur. Arrival of rescue teams can be delayed, so mountain guides often have to rely on their own capabilities to provide first aid. Therefore, IFMGA-recognized Swiss mountain guides receive a specific medical education and are equipped with a dedicated medical kit. This specific education has never been evaluated. Methods: A questionnaire was sent to all Swiss mountain guides through their national association. This questionnaire evaluates guides' activity, type, and frequency of medical events encountered, medical education, and use of the medical kit. Furthermore, clinical vignettes were used to evaluate their subjective and objective knowledge about prevention and treatment of specific altitude-related diseases. Results: A total of 467 guides completed the questionnaire, 54 (11.6%) of them were identified as high-altitude guides (HA-guides), because they spent ≥10 nights above 4000 meters each year. Mountain guides are more exposed to altitude-specific pathologies, such as Acute Mountain Sickness (AMS), High-Altitude Pulmonary Edema (HAPE), and High-Altitude Cerebral Edema (HACE) than to general medical conditions. A majority of participants (in particular HA-guides) considered altitude-related medical knowledge essential but judged their own education as insufficient. A majority of mountain guides were aware of nonpharmacological preventive measures and able to recognize altitude-related diseases. Mountain guides declared themselves as very confident in treating altitude-related diseases. Objective assessment of their knowledge showed some gaps, in particular related to the use of specific medications like nifedipine and dexamethasone. Conclusions: Swiss mountain guides' education in altitude medicine may be improved, in particular concerning the recognition and treatment of severe conditions such as HAPE and HACE. Better knowledge may be especially important for HA-guides. These data have induced experts in the field to adapt the guides teaching curriculum and medical kit.

Indications and Outcomes of Helicopter Rescue Missions in Alpine Mountain Huts: A Retrospective Study.

Pasquier, Mathieu, Louis Marxer, Hervé Duplain, Vincent Frochaux, Florence Selz, Pierre Métrailler, Grégoire Zen Ruffinen, and Olivier Hugli. Indications and outcomes of helicopter rescue missions in alpine mountain huts: A retrospective study. High Alt Med Biol 18:355-362, 2017. AIMS: This retrospective study describes the rescue indications and outcome of patients rescued by helicopter from mountain huts in the Swiss Alps. The hospital course and operational data were also studied. RESULTS: Among 14,872 helicopter rescue missions undertaken during the 10-year study period, 309 (2.1%) were performed from mountain huts at a mean altitude of 2794 ± 459 m. The mean age of the patients was 43 ± 16 and 66% were male. Thirty-four percent of the patients had a National Advisory Committee for Aeronautics score ≥3. Most (89%) patients were transported to hospital and only 12 (3.9%) patients had to stay more than 48 hours. Hospital diagnoses were extremely varied. Trauma accounted for 50% and altitude diseases for 7% of the cases. A winching procedure was performed 18 times and 19 missions included a night flight. CONCLUSIONS: Helicopter rescue missions in mountain huts are a small part of all rescue missions. Our study provides a better understanding of medical emergencies arising in mountain huts. The diagnoses encountered are extremely varied in their type and severity. Hut keepers should be prepared for these situations as they will often have to act as first responders in the case of medical problems.

[2015 highlights in hospital-based internal medicine by chief residents]. / L'année 2015 mise en perspective par les internistes hospitaliers.

The year 2015 gave us many scientific publications, among whom some will have an impact on our daily practice and some will influence our way of considering some well known diseases. Chief residents in the Service of internal medicine of the Lausanne University hospital, gathered like every year, to share their readings together in order to presentyou a small part of the many publications of 2015, which have been considered to have an impact on our future daily practice.