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Volume , Issue

Featuring an Interview with David Hillebrandt, President, UIAA Medical Commission

Posted on October 15, 2014

The Union Internationale des Associations d'Alpinisme (UIAA), better known in the United States as the International Climbing and Mountaineering Federation, is the world governing body of mountaineering. Yet many people do not recognize the organization or their mission beyond the label, stamp, or marking of ‘UIAA’ that occasionally shares space with the ‘CE’ label on climbing equipment today.

Organized in 1932, the UIAA’s mission “is to promote the growth and protection of mountaineering and climbing worldwide, advance safe and ethical mountain practices, and promote responsible access, culture, and environmental protection.” It accomplishes this mission in a variety of ways. With members from over 50 nations, this organization completes most of its work through commissions, each with a specific goal. Of particular interest to readers of Wilderness Medicine are the Safety Commission and the Medical Commission.

The Safety Commission

The first and best known of the UIAA commissions is the Safety Commission. This is the group that first put together safety standards for climbing equipment in the 1960s. The UIAA standards are developed by climbers and mountaineers around the world and are the accepted standard within the field. The climbing industry has direct input through being able to participate in the UIAA, and thus helps to define what constitutes quality materials and designs as climbing gear evolves. The UIAA commission works with the European Standards organization (CEN) and often these standards are comparable. Most often gear is stamped with a ‘CE’ rather than the ‘UIAA’ label, but in reality they are very similar and the CEN takes on many of the UIAA standards as their own. The exception to this is usually found on climbing rope or accessory cord. Almost all labeling for ropes will display the UIAA name and symbol.

In addition to setting the standards for climbing equipment around the world, the safety committee has a website that is extremely useful yet frequently overlooked. This includes a searchable database of equipment that meets the UIAA standards, another database of all active climbing gear recalls, a link that details how to carefully inspect gear, and another of recommendations on when to retire equipment. These resources are of great use to climbers spanning the full range of abilities and disciplines.

The following videos exemplify some of the rigorous testing and catastrophic failures of climbing gear during testing by the UIAA:

 

 

The Medical Commission

The medical commission, or Medcom, of the UIAA was created in 1981 with the mission to "increase the knowledge about mountain medicine among doctors and mountaineers all over the world." In the 23 years since its formation, it has certainly accomplished this mission and continues to provide valuable information to climbers.

Resources for Mountaineers

The UIAA has developed a robust selection of recommendations for climbers and mountaineers on a variety of topics. In addition to the wonderful (and free) document mentioned in the interview below (Travel at High Altitude), the committee has a series of articles available for free and in a range of languages.

These Recommendations include

  • 4X4 Rules for Mountaineers
  • AMS, HAPE, HACE - Emergency Field Management
  • Portable Hyperbaric Chambers
  • Nutritional Considerations for Mountaineering
  • Traveller's Diarrhea
  • Water Disinfection in the Mountains
  • How to Check the Quality of a Commercially Organized Trek or Expedition
  • Model Contract for Health Care on Trekking and Expeditions for Doctors
  • Children at Altitude
  • The Effect of Extremes of Temperature on Drugs
  • The Use of Hiking Sticks in the Mountains
  • Women Going to Altitude
  • People with Pre-existing Conditions Going to the Mountains
  • Contraception at Altitude
  • Work in Hypoxic Conditions
  • Travel to Altitude with Neurological Disorders
  • Injury Classification for Mountaineering and Climbing
  • Travel at High Altitude
  • Blood Borne Infections in Climbing
  • Recommendation for Prevention and Control of Legionella Infections
  • Eye Problems in Expeditions
  • Cardiovascular Diseases
  • Safety and Success on Kilimanjaro

Additionally, the Medical Commission has a Frequently Asked Questions (FAQ) portion of their website that addresses common questions both in mountaineering and climbing, with answers directed to the lay climber. Some examples of the common queries include: "What are the signs of overuse injuries, and how can they be prevented?" and "I tend to give up very often at night at high altitude with a 'choking sensation' causing me to be very anxious. What can I do?"

Diploma in Mountain Medicine

Most WMS members are now familiar with the Diploma in Mountain Medicine (DiMM) offered by the Society and its valuable curriculum for members. The UIAA Medical Commission, in conjunction with the International Commission for Alpine Rescue (ICAR) and the International Society of Mountain Medicine (ISMM), created and developed standards for the program in 1997. The DiMM is further divided into three separate offerings: the basic or common course, the rescue course, and the expedition course. The Diploma is now offered by 24 different organizations in 12 different countries. If you have not looked into the course programming, you can do so at the following Websites:

General UIAA Diploma Information

USA:

-Wilderness Medical Society
-US Army Austere and Wilderness Medicine Fellowship and Madigan Army Medical Center Emergency (No informational link available)

Canada

-Canadian Society of Mountain Medicine

Nepal

-Mountain Medicine Society of Nepal (MMSN)

Switzerland

-Alpine Rescue Center, Zermatt

United Kingdom

-Medical Expeditions (Medex) and University of Leicester

To get a more in depth look at what the Medical Commission does and some of its current projects, I asked my friend, David Hillebrandt, a few questions about the group.

The Medical Commission

Q&A with David Hillebrandt, President of the UIAA Medical Commission

What does the UIAA Medical Commission do, how is it organized, and who are members?

The UIAA is the world governing body of mountaineering. So if mountaineering was an Olympic sport, the UIAA would represent our sport on the Olympic committee. It has commissions to look at environmental issues, safety of equipment (look at the logo on your helmet or carabineer), mountain access, youth participation, and medicine. We advise and produce advice sheets on many preventative aspects of mountain medicine, such as climbing with coexisting conditions, safe acclimatization, water purification, how to choose a commercial expedition company, and sometimes we advise individuals on personal health issues. We also work closely with the International Commission for Alpine Rescue (IKAR) medical commission and the International Society of Mountain Medicine (ISMM) to run the international aspects of the Diploma of Mountain Medicine. We are currently working with the safety commission on designs of bouldering mats and with the ice climbing commission on para ice climbing competitions. We have also worked with the medical expeditions charity from the UK to support their free downloadable booklet on keeping healthy in the mountains. We welcome members from any UIAA affiliated country who are elected by their home organization. They give us an international perspective on many issues and also disseminate information in their own country. We can also invite people to join us as experts on specific medical topics. We meet face-to-face once a year, normally combining our meeting with a mountain medicine conference in a climbing area. In the last few years we have met in the USA, Peru, Poland, Nepal, and Italy, and try to move so all interested groups can participate. Most of our other work is conducted by email.

What is the primary mission of the Medical Commission?

We are responsible for preventative work in mountain medicine, whereas our colleagues in ICAR (International Commission for Alpine Rescue) are responsible for field treatment. We work closely together and as president of the UIAA Medcom I try to attend ICAR Medcom meetings once a year.

What are some of the ways the Medcom assists climbers and mountaineers?

We produce our advice sheets for all climbers translated into many different languages, including Chinese, Japanese, Farsi, and most European languages including English that should be understandable for climbers in the USA despite the fundamental language differences! Go log onto our website and see what I mean. These advice sheets are becoming more sophisticated and are revised every four or five years. Originally they were primarily designed for use by lay people, but with advances in medicine we are now planning to do two on most subjects, one technical and one in medical language, and one in simpler language understandable by lay climbers.

Do you have any current projects underway? If so, can you describe them?

Our Medcom covers many different countries, cultures, and mountaineering attitudes. For years we have discussed the use of drugs in mountaineering. At last we seem close to reaching a compromise by being totally non-judgmental and simply making facts available to mountaineers on most of the drugs that have been used over the years. We avoid the use of the term "doping" or "performance enhancing," but that's for you to decide and make your own personal decisions. We encourage openness and honesty when declaring any aid used on a climb be it a bolt, fixed rope, or drug.

I find the international aspects of the work fascinating. We pride ourselves in working across international borders. Sometimes when international politicians are arguing between nations at the UN and bombs are being dropped, we are still working closely in the background with scientific medical cooperation in the spirit of the mountains.

Did you know that most active mountaineers in Japan are aged over 60? It is a cultural thing regarding their work ethic and the need to wait for retirement to have time available. This results in many people climbing with pre-existing medical conditions.

Did you know the emerging middle-class of China is now flocking to Nepal to go trekking? Most of them are so new to the mountain environment that they have little personal knowledge of altitude problems.

Did you know that pilgrims in Nepal rapidly go to high altitude shrines with no knowledge of how to care for themselves at altitude and in the cold? Nepali doctors running volunteer medical camps will routinely deal with over 200 cases of altitude illness per day during a pilgrimage. This is why we try to disseminate information in so many languages.

What ways can someone volunteer to assist the medical commission?

The main way is to be elected by your national body with one representative per organization. However, the most important thing is to be willing to contribute, work hard for no reward, and buy me and the rest of the team a few beers. I also often need a tight rope on a climb and like to have all the heavy gear carried for me. The Medical Commission's efforts have produced a large number of lasting contributions to the mountaineering and climbing community. From the development of the diploma curriculum to the recommendations for mountaineers, these efforts continue to meet the commission's goals and go far beyond the gear tag with which most climbers associate the UIAA.

UIAA advice sheet on risks of drug use in the mountains.

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