Fighting in Thin Air: Operational Wilderness Medicine in High Asia

Abstract

Objective The current conflict in Afghanistan is the first major military action in which the United States and other North Atlantic Treaty Organization (NATO) forces have found themselves regularly engaged in combat at high altitudes. However, high altitude warfare is not a new concept in Asia by any means. Methods This article will offer a short general historical review of high altitude warfare in Asia and then specifically address some of the operational challenges faced by troops carrying out missions at high altitude in the ongoing conflict in Afghanistan. Additionally, there will be discussion of evidence-based interventions being used to attempt to maintain optimal health of the warfighter at high altitude in this theater of operations. Conclusions Years of research into how to alleviate the problematic nature of military operations in the high altitude environment has resulted in extensive risk management recommendations from the US Army, specifically aimed at preventing altitude-related casualties.

Efficacy of Residence at Moderate Versus Low Altitude on Reducing Acute Mountain Sickness in Men Following Rapid Ascent to 4300 m

“…Un-fortunately, military operations often require unacclimatized troops to ascend rapidly to higher altitudes and then immediately perform intense and sustained physical activity. The result is a substantial increase in the severity and prevalence of AMS (Roach et al, 2000) and a high probability of a lifethreatening reduction in troop effectiveness (Rodway et al, 2011).…”

Predicting physiological capacity of human load carriage – A review

“…Military and firefighting operations often require the deployment of personnel into mountainous environments with minimal or no time for physiological acclimatisation (Ruby et al, 2002;Muza, 2007;Rodway and Muza, 2011). In 2002, 85% of armed conflicts across the world were being fought in mountainous regions, i.e.…”

“…In 2002, 85% of armed conflicts across the world were being fought in mountainous regions, i.e. > 1500 m (Rodway and Muza, 2011). A progressive decline in maximal oxygen uptake has been observed from low to extreme altitudes (i.e.…”

Acute Mountain Sickness Prophylaxis

“…In 2002, the U.S. Army's 101st Airborne division conducted a helicopter insertion to 11,000 ft in Afghanistan, during ''Operation Anaconda.'' Their success, and astonishing lack of any significant AMS symptoms within the task force during the operation, was attributed directly to acetazolamide prophylaxis (18,21).…”