Climbers who have suffered a previous episode of high altitude pulmonary edema (HAPE) are at significantly increased risk of developing it again on return to high altitude. In spite of the high mortality associated with HAPE, some climbers are willing to take this risk in order to summit the tallest mountains in the world. This is a case report of a climber who suffered an episode of HAPE partway up Mount Everest. He was determined to complete his summit attempt that same climbing season, which would involve a return to extreme altitude less than 3 weeks following recovery. Based on experimental evidence suggesting that sildenafil, salmeterol, and acetazolamide may have therapeutic value for both the prevention and treatment of HAPE, he used these medications for secondary prevention. He was able to successfully reach the summit of Mount Everest and return to base camp without any evidence of recurrence of pulmonary edema. This provides clinical evidence that medication can be used to increase the safety margin for HAPE-susceptible individuals traveling to extremely high altitudes.

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In spite of need, there is a lack of published guidelines for potential international health sector responders to natural disasters. Learning about disaster response may occur only after joining a team. Dunin-Bell O . What do they know? Guidelines and knowledge translation for foreign health sector workers following natural disasters. Prehosp Disaster Med. 2018;33(2):139-146.

Study/Objective: Willingness to work, promoting factors, and hospital disaster management, including the role of the hospital disaster coordinator. Background: Following a disaster, hospitals are at-risk for sudden crowding of victims. However, can they recruit extra staff willing to work? Is disaster management a daily concern? Methods: This mixed-method study encompasses an explanatory sequential design with a quantitative data collection and analysis, followed by a second phase with a qualitative research track to explore the willingness to work. A quantitative survey with 11 different virtual disaster situations was offered at four different hospital staff groups (nurses, doctors, administrative, and supporting staff). In the qualitative part, we performed focus groups and semistructured face-to-face interviews with a purposeful sample of staff members. A "within" the cases analysis was performed to retain the uniqueness of each setting, followed by a cross-case analysis. Results: Twenty-two Belgian hospitals participated from March 2014 to July 2016. The willingness to work differs between doctors (33.8%), supporting staff (28.1%), nurses (23.6%), and administrative staff (23.1%). Both quantitative and qualitative research at three regional hospitals, from February 2016 to July 2016, confirmed a high willingness to work in all groups. Willingness was strongly related to the disaster type. The greatest willingness detected was with a seasonal influenza epidemic, the lowest for Ebola and nuclear incidents. Four facilitators increased the willingness to work: availability of personal protective equipment, insurance that their family is safe, feedback on the incident, and previous training. The hospital disaster coordinator is the key figure concerning "awareness" and "preparedness" within the hospital. Conclusion: Although differences in willingness to work depending the context, specific measures, and a concerned, dutiful hospital disaster coordinator all play an important role to enhance this willingness. Hospital disaster planning must reflect continuously on quality and safety policies within the organization. Study/Objective: To identify international guidelines for foreign health care workers and determine if there is knowledge translation in order to highlight gaps and aid progress to better disaster response. Background: Following natural disasters, the health sector response has been disorganized and at times harmful to affected populations. Ensuring quality care and effective use of scarce resources depends, in part, on the international workers who participate in the response. Methods: A literature search and semi-structured interviews of participants in the health sector response to the 2015 Nepal earthquake was used to examine the existence, awareness, and utilization of international guidelines for health care workers responding to disasters. Results: The literature search revealed no guidelines directly addressing the appropriateness of potential responders. International guidelines contained on...