During Yushu Earthquake,a large number of rescuers flocked to the mountainous quake areas. Under such a very specific circumstance,a high incidence of acute altitude illness was observed in rescuers who rapidly traveled from near sea level to an altitude of 4 000 m. It is evident that acute altitude illness leads to a significant human and economic toll,and also seriously influences the mountain rescue operation. So what does this teach us about mountain rescue in Yushu? Professor Wu Tianyi and many other authors collected shining points of the experiences and drew the lessons from the Yushu Earthquake into this special issue in Engineering Sciences which is like to thread pearl beads for a necklace. What readers learn from this special issue will have implications for the health and well-being of all high altitude populations all over the world.
On April 14,2010,an earthquake reaching Richter scale 7.1 struck Jiegu Town of Yushu,a mountain rescue operation promptly launched. All injurers had a direct assess to take medical care,and were immediately rescued and rapidly evacuated by air to Xining and Golmud at lower altitudes and admitted to advanced hospitals. Almost all of the injurers have been completely recovered. Yushu Earthquake was one of the highest earthquakes in the world,with a high incidence of acute altitude illness,which was observed in about 80 % of the lowland rescuers at an altitude of 4 000 m."Rescue the rescuers"became the major task of Qinghai-Tibetan rescue teams,all the severe patients were rapidly descended to Xining and treated promptly and effectively. The outcome was excellent,all patients survived. After the earthquake,it is a long and arduous task to reconstruct what has been destroyed. Medical teams continue to work in the Yushu Earthquake area because about 30 000 workers and carders are now here for rebuilding the earthquake center. Thus the prevention and treatment of altitude illness are still critical tasks for medical teams. Although all the fights are successful,there are more experiences and lessons we have learned from the medical mountain rescue during the earthquake and the reconstruction,and reports here are to sum up our experiences from the medical mountain rescue operation in Yushu Earthquake and draw the lessons that we should learn. With the increasing of earthquake probability occurring in the Qinghai-Tibetan Plateau,we also should prepare against earthquake disasters and for further rescue training in the high mountains.
During the Yushu Earthquake on April 14,2010,a large number of rescuers from sea level or lowlands ascended to the quake areas very rapidly or rapidly less than 24 h. However,Yushu Earthquake is the highest quake in the world at altitudes between 3 750 m and 4 878 m where is a serious hypoxic environment. A high incidence of acute altitude illness was found in the unacclimatized rescuers;the mountain rescue operation changed as "rescue the rescuers". Lesson from the Yushu Earthquake is that the occurrence of acute altitude illness may be closely related to the ascent schedules. This prompted us to study the relationship between ascent rate and the incidence and severity of acute altitude illness;five different groups were compared. The first group was 42 sea level male young soldiers who ascended to quake area very rapidly within 8 h at 4 000 m;the second group was 48 sea level male young soldiers who ascended to 4 000 m rapidly less than 18 h;the third group was 66 acclimatized medical workers from 2 261 m who ascended to 4 000 m rapidly within 12 h;the fourth group was 56 Tibetan medical workers from 2 800 m who ascended to 4 000 m rapidly within 8 h;the fifth group was 50 male sea level workers who ascended to 4 000 m gradually over a period of 4 d. The results showed that the sea level rescuers ascended to 4 000 m very rapidly or rapidly had the highest incidence of acute mountain sickness (AMS) with the greatest AMS scores and the lowest arterial oxygen saturation (SaO2);the sea level workers ascended to 4 000 m gradually had moderate incidence of AMS with moderate AMS scores and SaO2 values;whereas the acclimatized and adapted rescuers had the lowest incidence of AMS,lowest AMS scores and higher SaO2;especially none AMS occurred in Tibetan rescuers. AMS score is inversely related to the ascent rate (r=-0.24,p< 0.001). Additionally,acute altitude illness is significantly influenced by altitude acclimatization. The ascent rate is inversely re- lated to the period of altitude acclimatization whereas the time o
During the Yushu Earthquake on April 14,2010,a high incidence of acute high altitude illness was observed in the mountain rescuers,and 0.73 % of these patients suffered from high altitude pulmonary edema,of which 12 patients developed subclinical pulmonary edema and concomitantly contracted acute mountain sickness. Symptoms and signs were atypically high heart rate with high respiratory rate,striking cyanosis,and significantly low oxygen saturation,whereas no moist rates were heard on auscultation,and Chest X-ray showed peripheral with a patchy distribution of mottled infiltrations in one or both lung fields. We believe that subclinical high altitude pulmonary edema is an earliest stage of pulmonary edema at high altitude. The possible pathogenesis and the diagnosis were discussed.
Li ShuzhiZheng BihaiWu TianyiChen HuixingZhang Ming
To study monitoring hemodynamics and oxygen dynamics of adult respiratory distress syndrome (ARDS) secondary to high altitude pulmonary edema (HAPE),we performed clinic and laboratory studies in 8 patients who preliminarily developed high altitude cerebral edema (HACE) and then ARDS occurred at an altitude of 4 500 m. After an initial emergency treatment on high mountains,all the patients were rapidly transported to a hospital at a lower altitude of 2 808 m. The right cardiac catheterizations were carried out within 5 h after hospitalized. The monitoring hemodynamics and oxygen dynamics were studied via a thermodilution Swan-Gaze catheter. The results showed that before treatments at the beginning of monitoring,there presented a significant pulmonary artery hypertension with a decreased cardiac function,and a lower oxygen metabolism in all the 8 patients. However,after some effective treatments,including mechanical ventilation and using dexamethasone,furosemide,etc,four days later the result of a repeated monitoring showed that their pulmonary artery pressure had been decreased with an improved cardiac function with all the oxygen metabolic indexes increased significantly. Our studies suggested that performing monitoring hemodynamics in patients with ARDS secondary to HAPE will define the clinical therapeutic measures which will benefit the outcome.
Previous investigations suggest that ataxia is common and often one of the most reliable warning signs of high altitude cerebral edema(HACE). The aim of this study was to investigate the diagnostic role of ataxia in acute mountain sickness(AMS)and HACE among mountain rescuers on the quake areas,and in approaching the relation between AMS and HACE. After the earthquake on April 14,2010,approximately 24 080 lowland rescuers were rapidly transported from sea level or lowlands to the mountainous rescue sites at 3 750 ~ 4 568 m,and extremely hardly worked for an emergency treatment after arrival. Assessments of acute altitude illness on the quake areas were using the Lake Louise Scoring System. 73 % of the rescuers were found to be developed AMS. The incidence of high altitude pulmonary edema(HAPE)and HACE was 0.73 % and 0.26 %,respectively,on the second to third day at altitude. Ataxia sign was measured by simple tests of coordination including a modified Romberg test. The clinical features of 62 patients with HACE were analyzed. It was found that the most frequent,serious neurological symptoms and signs were altered mental status(50/62,80.6 %)and truncal ataxia(47/62,75.8 %). Mental status change was rated slightly higher than ataxia,but ataxia occurred earlier than mental status change and other symptoms. The earliest sign of ataxia was a vague unsteadiness of gait,which may be present alone in association with or without AMS. Advanced ataxia was correlated with the AMS scores,but mild ataxia did not correlate with AMS scores at altitudes of 3 750~4 568 m. Of them,14 patients were further examined by computerized tomographic scanning of the brain and cerebral magnetic resonance imagines were examined in another 15 cases. These imaging studies indicated that the presence of the cerebral edema was in 97 % of cases who were clinically diagnosed as HACE(28/29). Ataxia seems to be a reliable sign of advanced AMS or HACE,so does altered mental status.
The aim was to measure the incidence of high altitude headache （HAH） and to determine clinical features, as well as the relation between acute mountain sickness （AMS） and HAH through a prospective study. We conducted a questionnaire-based study among construction workers in Yushu after a serious earthquake ; they were under reconstruction using a structured questionnaire incorporating International Headache Society （IHS） and AMS Lake Louise Scoring System. A total of 608 workers were enrolled after their first ascent to altitudes of 3 750-4 528 m. The results showed that 96 % reported at least 1 HAil（median 3.8, range from 1 to 10） in workers at a mean altitude of 4 250 m. The magnitude of headache was divided as mild（38 %）, moderate （44 % ） and severe （18 %）. This study indicates that HAH is the most common symptom of acute altitude exposure and closely corre- lated with altitude （r=0.165, p〈0.001）. However, 52 % of headache was one of the main symptoms of AMS, while the other 48 % was the sole symptom of HAH. On the contrary we found that 2 % of AMS without headache, thus the ＂painless AMS＂ actually existed. The clinical features of HAH are presented, and the relationship between AMS and HAH is discussed.
