A review of trekking deaths from 1984 to mid-1987 showed a death rate of 15/100,000 trekkers. Altitude sickness deaths accounted for 3/23 (13%) of these deaths. Recently, we followed up on our original study by compiling the number and causes of trekking deaths in Nepal from mid-1987 through 1991. The overall number of deaths was 40, out of 275,950 trekkers (death rate 14/100,000). Illness accounted for 14 deaths, trauma was the cause of 12 deaths, altitude sickness was the cause of 10 deaths, 3 people were found dead after being reported missing, and one person is still missing and presumed dead. Eight out of 10 altitude sickness deaths occurred in organized trekking groups, even though only 40% of trekkers trek in organized groups. Four people were reported to have died from heart attacks, and 3 people died from apparent diabetic ketoacidosis above 4000 meters in altitude. Trekking in Nepal is a relatively safe holiday that currently attracts more than 60,000 people each year. Monitoring the causes of death among trekkers can help generate advice that could make trekking even safer.

Rock climbing has become increasingly popular in the past decade. However, the increased participation exposes a greater number of climbers to potential injury. The risks involved with climbing increase in proportion to the skill-level of the climber: the higher the skill-level, the more hours are required for training and on more difficult routes. The hands are used as tools for the ascent, with much of the climber's weight placed upon the fingers and also distributed through the wrist, elbow and shoulders. The combination of repetitive climbing and the excessive weight-bearing demands of the sport result in cumulative trauma to the upper limbs. Prevention should begin with educating climbers on the potential risk for injury. Although adequate rest between climbs and decreased training when pain is first encountered would aid in alleviating numerous problems, additional search directed towards improving training, treatment and rehabilitation programmes is warranted.

Because the practise conditions put the ski-mountaineering athletes potentially at risk for exercise-induced bronchoconstriction (EIB), this study was conducted to estimate the prevalence of EIB in this population. Thirty-one highly-trained ski-mountaineers with racing experience participating in the race were evaluated. EIB was determined after a European race at high altitude and frigid conditions. Pre-race investigations included pulmonary function measurements and a questionnaire enquiring about i) training habits, ii) respiratory history during training and/or competition. Pulmonary function was also tested after the race. None of the athletes reported a basal airway obstruction. Two groups were determined after post-race airway response: i) EIB (+) group exhibiting a fall in FEV (1)> or = 10 %(n = 15) and ii) EIB (-) without fall in FEV (1) or fall < 10 %(n = 16). Neither training habits nor baseline lung function were associated with the post-race airway response. Six of the 31 ski-mountaineers had a previous physician-made diagnosis of asthma and/or EIB, nevertheless 23 of our athletes complained about at least one characteristic symptom of asthma during practise. Four of our 15 EIB (+) had a previous physician-made diagnosis of asthma/EIB indicating that 73 % of EIB (+) athletes were undiagnosed for EIB. The proportion of allergic athletes was not significantly different between EIB (+) and EIB (-). This study showed that approximatively half of highly-trained ski-mountaineers with racing experience can develop EIB after a race and that 73 % of them are unaware of the problem.

The fall of a climber is analyzed by realistic and comprehensive model calculations. Various parameters that define such a fall and the action of the belaying system to stop it are included in an equation describing the balance between the energy gained by the fall and the various channels of dissipation. The result is a representative overview about the interplay between the various parameters. From this understanding, important consequences and recommendations for safety in climbing are deduced.

Between spring and autumn 1990 a study was performed with the goal of recording and classifying overstrain injuries due to rock-climbing and to define their causes. Of the 332 climbers participating in the study, 114 (34.4%) had suffered from at least one overstrain injury. The degree of climbing skill proved to be the main risk factor; with increasing climbing skills of the observed persons the percentage of injuries increased very substantially. The degree of climbing skill also was the only significant difference between injured and non-injured persons--injured persons had a climbing skill which was 1.3 degrees (UIAA) higher. Warming up was unable to prevent most overstrain injuries. A total of 237 injuries were described. 34.6% of these were long-term defects such as foot deformations and nail dystrophies of the toes. 65.4% were overstrain injuries; 90.3% of these cases concerned the upper part of the body and the upper extremities including the thoracic girdle, areas which are particularly strained in climbs of high degrees of difficulty. The areas affected were almost exclusively tendons, joint capsules and ligaments. By far the most frequent injury of the upper extremity was the proximal interphalangeal joint injury, followed by injuries to the proximal phalanx, the flexor tendons of the forearm and the distal interphalangeal joint. With regard to training injuries, finger injuries occurred most frequently in addition to elbow injuries. 51% of the overstrain injuries were severe, with healing times of months to years. Only 30% of the injured persons consulted a physician.

To investigate the determinants of acute mountain sickness (AMS) and of summiting in expedition-style mountaineering, 919 mountaineers (15.4% female) leaving Aconcagua Provincial Park at the end of an expedition to Mt. Aconcagua (6962 m) via the normal route were retrospectively evaluated by questionnaires. Symptoms of AMS were reported from the day when mountaineers felt worst. The prevalence of AMS, defined as a Lake Louise Score (self-assessment)> 4, was 39%. Low AMS scores were associated with faster ascent rates. The following parameters were independent predictors for AMS: no susceptibility for AMS (odds ratio, OR, 0.24; 95% confidence interval 0.17 to 0.35) more than 10 exposures per year above 3000 m (OR 0.60; 0.41 to 0.86), and previous exposures above 6000 m (OR, 0.48; 0.33 to 0.68). This last variable increased the OR for summiting 3.7-fold while female gender reduced this OR to 0.41 (0.25 to 0.67). Susceptibility and few exposures to high altitude are major predictors for AMS on Aconcagua, but AMS does not substantially reduce the chances for summiting. Those who are often in the mountains and who have already climbed to altitudes above 6000 m and are not susceptible for AMS have the best options for summiting Aconcagua.