Skip to main content
Erschienen in: Current Pulmonology Reports 2/2017

15.05.2017 | Pulmonology in Combat Medicine (G Eapen, Section Editor)

Impact of High Altitude on Military Operations

verfasst von: Cameron W. McLaughlin, Andrew J. Skabelund, Amaya D. George

Erschienen in: Current Pulmonology Reports | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

High-altitude combat and medical evacuation pose special challenges to military operations. We aim to summarize the physiologic changes that occur at altitude, as well as review the altitude-related diseases with emphasis on the impact on the military population. Finally, the impact of high-altitude exposure during transportation of combat trauma will be reviewed.

Recent Findings

There is increasing awareness that high-altitude exposure has an impact on mission readiness and could place mission success at risk. High-altitude headache and acute mountain sickness have affected warfighters in both training and combat. Prophylaxis of altitude illness with acetazolamide has been shown to reduce symptoms of altitude exposure; dexamethasone is utilized for the same purpose.
Though not without risk, long-range high-altitude transport of critically ill trauma and medical patients has been found to be safe and effective.

Summary

Hypobaric hypoxia is the primary driving force behind the physiologic effects altitude has on the human body. When combined with the stress of combat and AE, altitude can pose a difficult obstacle when caring for critically ill patients. Awareness of altitude-related disease and its impact when caring for non-altitude-related illness is a crucial component of optimizing healthcare to wounded warriors.
Literatur
1.
Zurück zum Zitat •• Rodway GW, Muza SR. Fighting in thin air: operational wilderness medicine in high Asia. Wilderness Environ Med. 2011;22(4):297–303. doi:10.1016/j.wem.2011.08.009. A historical review of high altitude conflicts and evidence based discussion of interventions to maintain optimal health of the warfighter.CrossRefPubMed •• Rodway GW, Muza SR. Fighting in thin air: operational wilderness medicine in high Asia. Wilderness Environ Med. 2011;22(4):297–303. doi:10.​1016/​j.​wem.​2011.​08.​009. A historical review of high altitude conflicts and evidence based discussion of interventions to maintain optimal health of the warfighter.CrossRefPubMed
2.
Zurück zum Zitat Honigman B, Theis MK, Koziol-McLain J, Roach R, Yip R, Houston C, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med. 1993;118(8):587–92.CrossRef Honigman B, Theis MK, Koziol-McLain J, Roach R, Yip R, Houston C, et al. Acute mountain sickness in a general tourist population at moderate altitudes. Ann Intern Med. 1993;118(8):587–92.CrossRef
4.
Zurück zum Zitat West JB. American College of P, American Physiological S. The physiologic basis of high-altitude diseases. Ann Intern Med. 2004;141(10):789–800.CrossRef West JB. American College of P, American Physiological S. The physiologic basis of high-altitude diseases. Ann Intern Med. 2004;141(10):789–800.CrossRef
14.
Zurück zum Zitat Norris JN, Viirre E, Aralis H, Sracic MK, Thomas D, Gertsch JH. High altitude headache and acute mountain sickness at moderate elevations in a military population during battalion-level training exercises. Mil Med. 2012;177(8):917–23.CrossRef Norris JN, Viirre E, Aralis H, Sracic MK, Thomas D, Gertsch JH. High altitude headache and acute mountain sickness at moderate elevations in a military population during battalion-level training exercises. Mil Med. 2012;177(8):917–23.CrossRef
23.
Zurück zum Zitat Gertsch JH, Lipman GS, Holck PS, Merritt A, Mulcahy A, Fisher RS, et al. Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT). Wilderness Environ Med. 2010;21(3):236–43. doi:10.1016/j.wem.2010.06.009.CrossRefPubMed Gertsch JH, Lipman GS, Holck PS, Merritt A, Mulcahy A, Fisher RS, et al. Prospective, double-blind, randomized, placebo-controlled comparison of acetazolamide versus ibuprofen for prophylaxis against high altitude headache: the Headache Evaluation at Altitude Trial (HEAT). Wilderness Environ Med. 2010;21(3):236–43. doi:10.​1016/​j.​wem.​2010.​06.​009.CrossRefPubMed
24.
Zurück zum Zitat Burtscher M, Likar R, Nachbauer W, Philadelphy M, Puhringer R, Lammle T. Effects of aspirin during exercise on the incidence of high-altitude headache: a randomized, double-blind, placebo-controlled trial. Headache. 2001;41(6):542–5.CrossRef Burtscher M, Likar R, Nachbauer W, Philadelphy M, Puhringer R, Lammle T. Effects of aspirin during exercise on the incidence of high-altitude headache: a randomized, double-blind, placebo-controlled trial. Headache. 2001;41(6):542–5.CrossRef
25.
Zurück zum Zitat Alizadeh R, Ziaee V, Aghsaeifard Z, Mehrabi F, Ahmadinejad T. Characteristics of headache at altitude among trekkers; a comparison between acute mountain sickness and non-acute mountain sickness headache. Asian J Sports Med. 2012;3(2):126–30.CrossRef Alizadeh R, Ziaee V, Aghsaeifard Z, Mehrabi F, Ahmadinejad T. Characteristics of headache at altitude among trekkers; a comparison between acute mountain sickness and non-acute mountain sickness headache. Asian J Sports Med. 2012;3(2):126–30.CrossRef
27.
Zurück zum Zitat Peoples GE, Gerlinger T, Craig R, Burlingame B. The 274th Forward Surgical Team experience during Operation Enduring Freedom. Mil Med. 2005;170(6):451–9.CrossRef Peoples GE, Gerlinger T, Craig R, Burlingame B. The 274th Forward Surgical Team experience during Operation Enduring Freedom. Mil Med. 2005;170(6):451–9.CrossRef
28.
Zurück zum Zitat Roberts MJ. Acute mountain sickness—experience on the roof of Africa expedition and military implications. J R Army Med Corps. 1994;140(1):49–51.CrossRef Roberts MJ. Acute mountain sickness—experience on the roof of Africa expedition and military implications. J R Army Med Corps. 1994;140(1):49–51.CrossRef
29.
Zurück zum Zitat Department of the Army. TB MED 505. Altitude Acclimatization and Illness Management. 2010. Available at wwwusariemarmymil/assets/docs/partnering/TB-Med-505-Sept-2010pdf. Department of the Army. TB MED 505. Altitude Acclimatization and Illness Management. 2010. Available at wwwusariemarmymil/assets/docs/partnering/TB-Med-505-Sept-2010pdf.
31.
Zurück zum Zitat Midla GS. Lessons learned: operation anaconda. Mil Med. 2004;169(10):810–3.CrossRef Midla GS. Lessons learned: operation anaconda. Mil Med. 2004;169(10):810–3.CrossRef
32.
Zurück zum Zitat DeLellis SM. Acetazolamide or not, prior to ascent? J Spec Oper Med. 2010;10(4):38–40.PubMed DeLellis SM. Acetazolamide or not, prior to ascent? J Spec Oper Med. 2010;10(4):38–40.PubMed
33.
Zurück zum Zitat O’Hara R, Serres J, Dodson W, Wright B, Ordway J, Powell E, et al. The use of dexamethasone in support of high-altitude ground operations and physical performance: review of the literature. J Spec Oper Med. 2014;14(4):53–8.PubMed O’Hara R, Serres J, Dodson W, Wright B, Ordway J, Powell E, et al. The use of dexamethasone in support of high-altitude ground operations and physical performance: review of the literature. J Spec Oper Med. 2014;14(4):53–8.PubMed
34.
Zurück zum Zitat US Special Operations Command. Altitude illness. J Spec Oper Med. 2011; Suppl:31-32. US Special Operations Command. Altitude illness. J Spec Oper Med. 2011; Suppl:31-32.
35.
Zurück zum Zitat Grissom CK, Roach RC, Sarnquist FH, Hackett PH. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med. 1992;116(6):461–5.CrossRef Grissom CK, Roach RC, Sarnquist FH, Hackett PH. Acetazolamide in the treatment of acute mountain sickness: clinical efficacy and effect on gas exchange. Ann Intern Med. 1992;116(6):461–5.CrossRef
36.
Zurück zum Zitat Hackett PH, Roach RC, Wood RA, Foutch RG, Meehan RT, Rennie D, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988;59(10):950–4.PubMed Hackett PH, Roach RC, Wood RA, Foutch RG, Meehan RT, Rennie D, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988;59(10):950–4.PubMed
37.
38.
Zurück zum Zitat Hall DP, Duncan K, Baillie JK. High altitude pulmonary oedema. J R Army Med Corps. 2011;157(1):68–72.CrossRef Hall DP, Duncan K, Baillie JK. High altitude pulmonary oedema. J R Army Med Corps. 2011;157(1):68–72.CrossRef
41.
Zurück zum Zitat Arora R, Jha KN, Sathian B. Retinal changes in various altitude illnesses. Singap Med J. 2011;52(9):685–8. Arora R, Jha KN, Sathian B. Retinal changes in various altitude illnesses. Singap Med J. 2011;52(9):685–8.
46.
Zurück zum Zitat Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S4–14. doi:10.1016/j.wem.2014.06.017.CrossRefPubMed Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S4–14. doi:10.​1016/​j.​wem.​2014.​06.​017.CrossRefPubMed
47.
Zurück zum Zitat Raitt S. High altitude cerebral oedema during adventure training on Mount Kenya. J R Army Med Corps. 2012;158(3):245–7.CrossRef Raitt S. High altitude cerebral oedema during adventure training on Mount Kenya. J R Army Med Corps. 2012;158(3):245–7.CrossRef
50.
Zurück zum Zitat •• Lairet J, King J, Vojta L, Beninati W. Short-term outcomes of US Air Force Critical Care Air Transport Team (CCATT) patients evacuated from a combat setting. Prehosp Emerg Care. 2013;17(4):486–90. doi:10.3109/10903127.2013.811564. This study suggest long range AE of critically ill trauma and medical patients is safe and effective.CrossRefPubMed •• Lairet J, King J, Vojta L, Beninati W. Short-term outcomes of US Air Force Critical Care Air Transport Team (CCATT) patients evacuated from a combat setting. Prehosp Emerg Care. 2013;17(4):486–90. doi:10.​3109/​10903127.​2013.​811564. This study suggest long range AE of critically ill trauma and medical patients is safe and effective.CrossRefPubMed
55.
Zurück zum Zitat Turkan H, Sener S, Tugcu H, Pauldine R. Considerations in the aeromedical evacuation of a critically ill blast victim: lessons learned. Mil Med. 2006;171(7):586–8.CrossRef Turkan H, Sener S, Tugcu H, Pauldine R. Considerations in the aeromedical evacuation of a critically ill blast victim: lessons learned. Mil Med. 2006;171(7):586–8.CrossRef
56.
57.
Zurück zum Zitat Allan PF, Osborn EC, Bloom BB, Wanek S, Cannon JW. The introduction of extracorporeal membrane oxygenation to aeromedical evacuation. Mil Med. 2011;176(8):932–7.CrossRef Allan PF, Osborn EC, Bloom BB, Wanek S, Cannon JW. The introduction of extracorporeal membrane oxygenation to aeromedical evacuation. Mil Med. 2011;176(8):932–7.CrossRef
58.
Zurück zum Zitat • Fang R, Allan PF, Womble SG, Porter MT, Sierra-Nunez J, Russ RS, et al. Closing the “care in the air” capability gap for severe lung injury: the Landstuhl acute lung rescue team and extracorporeal lung support. J Trauma. 2011;71(1 Suppl):S91–7. doi:10.1097/TA.0b013e3182218f97. This article describes the long range lung rescue capabilities of the US Air Force.CrossRefPubMed • Fang R, Allan PF, Womble SG, Porter MT, Sierra-Nunez J, Russ RS, et al. Closing the “care in the air” capability gap for severe lung injury: the Landstuhl acute lung rescue team and extracorporeal lung support. J Trauma. 2011;71(1 Suppl):S91–7. doi:10.​1097/​TA.​0b013e3182218f97​. This article describes the long range lung rescue capabilities of the US Air Force.CrossRefPubMed
60.
61.
Zurück zum Zitat Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805–13. doi:10.1097/TA.0b013e3181271ba3.CrossRefPubMed Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805–13. doi:10.​1097/​TA.​0b013e3181271ba3​.CrossRefPubMed
62.
Zurück zum Zitat Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Niles SE, McLaughlin DF, et al. Effect of plasma and red blood cell transfusions on survival in patients with combat related traumatic injuries. J Trauma. 2008;64(2 Suppl):S69–77. doi:10.1097/TA.0b013e318160ba2f. discussion S-8.CrossRefPubMed Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Niles SE, McLaughlin DF, et al. Effect of plasma and red blood cell transfusions on survival in patients with combat related traumatic injuries. J Trauma. 2008;64(2 Suppl):S69–77. doi:10.​1097/​TA.​0b013e318160ba2f​. discussion S-8.CrossRefPubMed
63.
Zurück zum Zitat Mora AG, Ervin AT, Ganem VJ, Bebarta VS. Aeromedical evacuation of combat patients by military critical care air transport teams with a lower hemoglobin threshold approach is safe. The journal of trauma and acute care surgery. 2014;77(5):724–8. doi:10.1097/TA.0000000000000446.CrossRefPubMed Mora AG, Ervin AT, Ganem VJ, Bebarta VS. Aeromedical evacuation of combat patients by military critical care air transport teams with a lower hemoglobin threshold approach is safe. The journal of trauma and acute care surgery. 2014;77(5):724–8. doi:10.​1097/​TA.​0000000000000446​.CrossRefPubMed
65.
Zurück zum Zitat •• Dukes SF, Bridges E, Johantgen M. Occurrence of secondary insults of traumatic brain injury in patients transported by critical care air transport teams from Iraq/Afghanistan: 2003-2006. Mil Med. 2013;178(1):11–7. This study suggests CCATT is safe despite the risk of secondary insult of traumatic brain injury during CCATT evacuation.CrossRef •• Dukes SF, Bridges E, Johantgen M. Occurrence of secondary insults of traumatic brain injury in patients transported by critical care air transport teams from Iraq/Afghanistan: 2003-2006. Mil Med. 2013;178(1):11–7. This study suggests CCATT is safe despite the risk of secondary insult of traumatic brain injury during CCATT evacuation.CrossRef
67.
Zurück zum Zitat Minnick JM, Bebarta VS, Stanton M, Lairet JR, King J, Torres P, et al. The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010. J Emerg Nurs. 2013;39(6):e101–6. doi:10.1016/j.jen.2013.02.001.CrossRefPubMed Minnick JM, Bebarta VS, Stanton M, Lairet JR, King J, Torres P, et al. The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010. J Emerg Nurs. 2013;39(6):e101–6. doi:10.​1016/​j.​jen.​2013.​02.​001.CrossRefPubMed
72.
Zurück zum Zitat Holley AB, Petteys S, Mitchell JD, Holley PR, Collen JF. Thromboprophylaxis and VTE rates in soldiers wounded in Operation Enduring Freedom and Operation Iraqi Freedom. Chest. 2013;144(3):966–73. doi:10.1378/chest.12-2879.CrossRefPubMed Holley AB, Petteys S, Mitchell JD, Holley PR, Collen JF. Thromboprophylaxis and VTE rates in soldiers wounded in Operation Enduring Freedom and Operation Iraqi Freedom. Chest. 2013;144(3):966–73. doi:10.​1378/​chest.​12-2879.CrossRefPubMed
Metadaten
Titel
Impact of High Altitude on Military Operations
verfasst von
Cameron W. McLaughlin
Andrew J. Skabelund
Amaya D. George
Publikationsdatum
15.05.2017
Verlag
Springer US
Erschienen in
Current Pulmonology Reports / Ausgabe 2/2017
Elektronische ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-017-0181-0

Weitere Artikel der Ausgabe 2/2017

Current Pulmonology Reports 2/2017 Zur Ausgabe

Sleeping and Breathing (T Lee-Chiong, Section Editor)

Overlap Syndrome

Sleeping and Breathing (T Lee-Chiong, Section Editor)

Screening Programs for Obstructive Sleep Apnea

Nutrition and Critical Care (J Patel, Section Editor)

Immunonutrition in Acute Respiratory Distress Syndrome

Pulmonology in Combat Medicine (G Eapen, Section Editor)

Traumatic Brain Injury in Combat Trauma

Sleeping and Breathing (T Lee-Chiong)

Hypoventilation Syndromes

Pulmonology in Combat Medicine (G Eapen, Section Editor)

Non-traumatic Pulmonary Emergencies in the Deployed Setting

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Strenge Blutdruckeinstellung lohnt auch im Alter noch

30.04.2024 Arterielle Hypertonie Nachrichten

Ältere Frauen, die von chronischen Erkrankungen weitgehend verschont sind, haben offenbar die besten Chancen, ihren 90. Geburtstag zu erleben, wenn ihr systolischer Blutdruck < 130 mmHg liegt. Das scheint selbst für 80-Jährige noch zu gelten.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.