Table 2.
Suggested guidelines for the optimal management of high-altitude frostbite and the prevention of sequelae.
| Guideline | Procedure | Evidence |
|---|---|---|
| (1) Evaluate risk for severe frostbite injuries with regard to ascent and team characteristics: | Consider the possibility of frostbite in spite of a high degree of expertise in winter mountaineering, regarding the level of exposure to the cold environment as a risk in itself. | Present study |
| Consider the strong influence of altitude on amputation and sequelae (see Equation (1) AI in previous lines) if frostbite occurs. | Present study | |
| Consider the influence of the mountain range on amputation and sequelae, considering rescue timing to reference hospitals (Pyrenees/Alps < Himalayas < Karakoram). | Present study | |
| Consider the influence of logistics and the characteristics of each ascent (mountain, range, climbing style, etc.) leading to different complexities in providing prompt and adequate field treatment. | Present study | |
| (2) Minimize risks of amputation and sequelae if frostbite occurs | Consider first-aid training for frostbite injuries as a must among all members of the expedition. | Hubell [26] |
| Include in your fist aid kits those medications and resources needed in cases of frostbite. | Tek [27] | |
| Design and be aware of an evacuation schedule to first aid field installations, intermediate medical points (if they exist) and hospital or clinical settings, considering weather and local limitations for rescue. | Bowman and Kummerfeldt [28] | |
| Try to have effective communication with an expert in case you need advice or no medical staff are included in your expedition. | State of Alaska CIG [29] | |
| (3) Act correctly if frostbite occurs | Learn to make correct and prompt identification of frostbite. | Zafren [5] |
| Enact rapid rewarming if there is no reasonable possibility of secondary exposure to cold. | Syme [30] | |
| Provide optimal care for injuries and later treatment. | State of Alaska CIG [29] | |
| (4) Minimize time course before receiving advanced treatments and medical advice if required | Provide the shortest evacuation time for severe injuries. | Linford et al. [31] |
| Evacuate to a hospital where proper treatments can be administered. | State of Alaska CIG [29] | |
| Try to ensure correct management during rescue and transport. | State of Alaska CIG [29] |