For large entertainment tours composed of 100 to 200 personnel moving from one city (or country) to another every few days over several months’ time, the odds of numerous untoward health events occurring, some very serious, become reasonably high. Beyond rigorous schedules and living/dining in close quarters, understandable reticence to abandon one’s post can occasionally delay timely care. Accordingly, having veteran medical specialists as part of the touring team has been found to be invaluable, not only for pre-emptive minor interventions and continuity of care, but also for immediate, expert handling of serious emergencies. Experienced, well-connected touring medical specialists also provide prospective contingency plans for each destination city and venue. These medical advance plans detail the most-knowledgeable local physicians or facilities for best managing any respective medical condition. They also identify the local “point-persons” to contact for coordination of true emergencies and especially if there is a need for multi-casualty incident management at the venue. They anticipate health risks such as air quality, altitude sickness, endemic disease vectors and other concerning threats at each destination. They also train touring staff in basic life support, bleeding control and emergency equipment readiness. Touring specialists should also be well-integrated into security team functions.

The medical officer on a high-altitude expedition will be consulted about the prevention and treatment of highaltitude medical problems, as well as the effects of altitude on preexisting medical conditions and fitness for travel to these demanding destinations. Although there have been numerous recent advances in the field of highaltitude medicine, significant morbidity and mortality persist (Table 19.1), and it is essential to better prepare and educate the at-risk population. In this chapter, we review basic physiology of altitude ascent, recognition and management of high-altitude medical problems, altitude effects on chronic medical conditions, and suggested components of a high-altitude medical kit. The reader is also referred to a recent publication for a more detailed review (Hackett and Roach, 2007). See Table 19.2 for online resources. For discussions about children and pregnancy at altitude, see Chapter 9, and for treatment of other conditions that commonly occur on cold weather expeditions (ultraviolet keratitis, hypothermia, frostbite and other cold injuries), please see Chapters 16 on polar medicine, 31 on environmental injuries, and 36 on the eye.

DEFINITIONS

At high altitude (1,500–3,500 m), decreased exercise performance and increased ventilation (lower arterial PCO2) develop due to diminished inspired oxygen. Arterial PO2 is significantly diminished, but saturation levels (SaO2) remain 90% or greater. Because of the large number of tourists who are frequenting ski resort and adventure destinations and pursuing rapid ascents to 2,500–3,500 m, high-altitude illness is common in this range (Tables 19.1 and 19.3).