More and more persons are exposed to hypoxia while working at altitude, e.g. when working for cable cars or ski areas in the Alps, for business in South America or Asia, as airline crews, or in rooms with reduced oxygen pressure for hypoxia training or fire protection. Unfortunately, the different countries have a multitude of regulations for occupational health and safety concerning hypoxia -most of them with major deficiencies and a significant lack of knowledge about hypoxia and possible specific risks. So far, no national regulation differentiates the different types of hypoxia and the environment, both having significant influence on the specific risk profile of employees and consequences for occupational health and safety.As the world's umbrella body for preventive medicine at altitude / hypoxia, the Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MedCom) recently established a recommendation to enable the national bodies to establish knowledge-based pragmatic procedures for occupational health and safety [1]. The most important message is as follows: Any environment with oxygen concentration of 14.0% or more or an altitude of 3,000 m or less is safe for any non-acclimatized person without severe cardiopulmonary disease (10 g/dl) and an exposure limited to a few hours (one work shift). These environments include most alpine cable cars, ski areas, aircrafts flying on long-range distances, most towns or villages where businessmen might go to, and rooms for fire protection. For longer exposure (sleep at high altitude) or higher environments the persons should be acclimatized or exposed for a short time only. Details how to manage health and safety in such environments are given.

Traveller's diarrhoea may impair mountaineers significantly more than other travellers as they are often dehydrated, water is limited and they have to manage themselves in a harsh environment where any decrease of performance may be dangerous, e.g. onset of acute mountain sickness (AMS) or decreased fitness -both may be induced by diarrhoea. Therefore the problem should be managed more aggressively than in normal travellers.This guideline of the Medical Commission of the International Climbing and Mountaineering Federation (Union Internationale des Associations d'Alpinisme, UIAA) is designed to be used by mountaineers worldwide. It is a compromise between detailed and differentiated ("tactical") treatment and the principle "keep it simple".

Objectives: The Commission gives recommendations on how to provide health and safety for employees in different kinds of low oxygen atmospheres. So far, no recommendations exist that take into account the several factors we have outlined in this report.Methods: The health and safety recommendations of several countries were analysed for their strength and deficiencies. The scientific literature was checked (Medline, etc.) and evaluated for relevance of the topic. Typical situations of work in hypoxia were defined and their specific risks described. Specific recommendations are provided for any of these situations.Results: We defined four main groups with some subgroups (main risk in brackets): short exposure (pressure change), limited exposure (acute altitude disease), expatriates (chronic altitude disease), and high-altitude populations (re-entry pulmonary oedema). For healthy unacclimatized persons, an acute but limited exposure down to 13% O 2 does not cause a health risk. Employees should be advised to leave hypoxic areas for any break, if possible. Detailed advice is given for any other situation and pre-existing diseases.Conclusions: If the specific risk of the respective type of hypoxia is taken into account, a pragmatic approach to provide health and safety for employees is possible. In contrast to other occupational exposures, a repeated exposure as often as possible is of benefit as it causes partial acclimatization. The consensus statement was approved by written consent in lieu of a meeting in July 2009.

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<p><b>Introduction: </b>The Borg Scale for perceived exertion is well established in science and sport to keep an appropriate level of workload or to rate physical strain. Although it is also often used at moderate and high altitude, it was never validated for hypoxic conditions. Since pulse rate and minute breathing volume at rest are increased at altitude it may be expected that the rating of the same workload is higher at altitude compared to sea level. <p> <b>Material and methods: </b>16 mountaineers were included in a prospective randomized design trial. Standardized workload (ergometry) and rating of the perceived exertion (RPE) were performed at sea level, at 3,000 m, and at 4,560 m. For validation of the scale Maloney-Rastogi-test and Bland-Altmann-Plots were used to compare the Borg ratings at each intensity level at the three altitudes; p < 0.05 was defined as significant. <p><b>Results: </b>In Bland-Altmann-Plots more than 95% of all Borg ratings were within the interval of 1.96 x standard deviation. There was no significant deviation of the ratings at moderate or high altitude. The correlation between RPE and workload or oxygen uptake was weak. <p><b>Conclusion: </b>The Borg Scale for perceived exertion gives valid results at moderate and high altitude – at least up to about 5,000 m. Therefore it may be used at altitude without any modification. The weak correlation of RPE and workload or oxygen uptake indicates that there should be other factors indicating strain to the body. What is really measured by Borg’s Scale should be investigated by a specific study.