Field Research on Mount Everest
About 400000 tourists a year from Central Europe participate in a trekking trip in Europe, South America, North Africa, or Asia, making trekking one of the most popular recreational sports. Many of the adventurers, however, are not sufficiently prepared for activity thousands of meters up in the air. This pertains above all to safety management and first-aid knowledge, but also dental prevention. For this reason, Professor Dr. med. Thomas Küpper from the RWTH Aachen Institute of Occupational Medicine started a project: In the Aachen Dental and Medical Expedition, ADEMED for short, doctoral candidates learn how field research in remote areas is organized. "Data has to be collected there, where it originates. Field research also includes working with local offices and carriers, budgeting, and public relations," reports Küpper. Research is being conducted at 5550 meters above sea level in the Himalayas. Students investigate the hygiene of travelers' drinking water, their pre-existing conditions, the travel pharmacy, and the consumption of performance enhancing drugs or supplements. The German-Nepalese collaboartion with doctors and students on location works well.Copyright: RWTH Aachen
Special First-Aid System for Alpine Sports
One of the biggest problems in trekking is altitude sickness. As height increases, the oxygen supply in the air decreases. At a height of 5500 meters, the oxygen partial pressure is 50 percent smaller than at sea level. Less oxygen is delivered to arterial blood as a result of the low pressure – one is more quickly out of breath, and performance drops. Additionally, lack of oxygen leads to deficiency symptoms in tissues, so called hypoxia. The brain is affected the most, the water content in brain cells increases, so that they swell. The increase in brain pressure leads to disorders in the nervous system: lighter symptons include headache, dizziness, breathlessness, and abnormal mental behavior. Starting at about 2500 meters, the difference in height till the next camp site should not be more than 300 meters a day or 500 to 600 meters every second day.
"We always observe that people climb too quickly," said Küpper. "The body can only take in enough oxygen if one slowly acclimates to the height." Slow altitude acclimatization is no guarantee for avoiding altitude sickness, but it is the most well-known and effect preventative method. People's ability to acclimate varies from person to person. It has generally been proven that people who have been at higher heights without any symptons will also have little trouble at high altitudes.
If impairments do arise, mountain climbers often do not know how to administer first aid. "The courses that are part of the driver's license exam are not transferable to every situation," explains Küpper. For this reason the institute in Aachen is creating a modular first-aid system for alpine sports disciplines, that can be transferred and targeted to certain groups. It will consist of a basic module and an additional discipline specific module.
Dental Prevention is Important
Until now there has been hardly an data about dental problems when trekking and little knowledge about how these can be avoided with prophylaxis. Thus, the doctoral candidates investigated trekkers' mouth and dental hygiene. They determined the frequency of the difficulties or emergencies that arose and created suggestions for prevention. "Every person supervised first had the state of their teeth measured and their papillary bleeding and plaque index determined," said Küpper.
WIth small special paper sticks, samples were taken from the sulci, the furrow between the tooth and gum. These were air dried and later examined in the RWTH lab. Analysis revealed a very clear result within the large sample size: mouth flora changes significantly during trekking. There are "indicator bacteria" – at least one bacterium is present in exclusively those individuals who developed bacterial, inflamed, dental problems. "Dental prevention is an important component before every trip into high altitudes," emphasizes Küpper. He points out that RWTH occupies a unique selling point, by creating a bridge between medicine and dentistry within travel medicine.
Doctors who give advice on preventative medicine are becoming more important in an increasingly mobile, active, but also older society, that is traveling more often to very remote locations. For this reason, ADEMED has become a main part of medical teaching and research at RWTH Aachen. About every three years more and more doctoral candidates are able to go on the trip. "They learn not only how good field research is done in areas with little infrastructure, but they also carry it out in a team. In unfamiliar conditions, they have to be able to depend on one another," emphasizes Küpper.