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EH 1_2015

Continued on page 2 THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK CONTENTS NEWS & MANAGEMENT 1-4 ECR-SPECIAL 5-28 LABORATORY 29-30 INTENSIVE CARE 31-32 V O L 2 4 I S S U E 1 / 1 5 • F E B R U A R Y / M A R C H 2 0 1 5 For people living in Chamonix-Mont Blanc medical services at the near- by community hospital have been reduced to little more than a stopo- ver visit before being referred down the mountain to larger facilities in the network of the Hospitals of Mont Blanc Country. Yet the small facility continues to hold a specialty for treating frost- bite victims that is unique in the world and puts it at the centre of a European-funded study to test a new technique for treating victims of severe frostbite who are in dan- ger of losing fingers, toes or even all of a foot. The hospital holds the distinc- tion of each year seeing the highest number of cases of frostbite in the world, not only in full winter, but in summer as well. With this steady flow of frost bit- ten hikers and skiers, Emmanuel Cauchy MD, is in a unique posi- tion at the Centre for Training and Research in Mountain Medicine (IFREMMONT) that is housed at the hospital to study the effects of the condition, to conduct randomised trials for therapies, and to publish findings that advance protocols for treatment. idly increasing blood circulation in the bone, but the technique lacks any clinical evidence to support wider use. For the GELOX study, the Chamonix Hospital is working in close collaboration with the University Hospital of Geneva to test the treatment of 20 patients and compare results with outcomes for 50 patients who underwent stand- ard protocols. The hyperbaric chamber is locat- ed at the University Hospital of ing our visit to IFREMMONT. ‘Where some physicians may see one case of frostbite each year, or perhaps one severe case in all of their career, we see between 80 and 100 such cases every year – an average that Mont Blanc is reputed to be the most accessible summit in the world, which explains why more than 20,000 mountaineers, often 500 on a single day, can be found marching in Indian file to the top. Reaching the roof of Europe from the French side is described as more of a long walk that an arduous alpine climb. It is easy to forget the local wis- dom that it is always winter up there among the glaciers and multiple peaks surrounding the massif of Mont Blanc. Three-fourths of frostbite cases arriving at the Mountain Medicine centre are superficial, Cauchy point- ed out, and even the frostbitten hiker or skier doesn’t realise until the following day that some extrem- ity has gone numb, and they turn up at the clinic. One-in-four people have been bitten more deeply by glacial cold, more than half with frozen feet. Hands are almost as frequent and while facial frostbite is more rare, some 17% of cases he sees touch noses and ears. On aver- age one in 12 patients will need an amputation. ‘Often you see the tissue is red and you think you’re going to be alright,’ Cauchy said. But after a scintigraph scan that shows there is no vascularization of the bone ‘…it’s finished in this case, there is noth- ing we can do.’ Restoring blood flow to the bone tissue of frost-bitten fingers and toes is the critical factor for averting an amputation of the member and encouraging such reperfusion in a hyperbaric chamber is at the heart of a clinical study begun at this alpine hospital in November 2014. Hyperbaric oxygen therapy has been suggested as a treatment for severe frostbite that may help lower the rate of amputation by more rap- Chilled to the bone!Treating severe frostbite in high-pressure chambers may reduce amputations, John Brosky reports A hair-raising mountain rescue by helicopter hovering around Mont-Blanc massif. Source:MathieuRobin NEWS & MANAGEMENT 1-4 • Plasma therapy from a power socket • Release trainee surgeons from stress • Home monitoring seen in action INTENSIVE CARE 31-32 • Sky-high Ebola isolation • The new two-in-one ventilator • 35 years of ISICEM – Medical ethics Dr Emmanuel Cauchy holds a unique position at the Centre for Training and Research in Mountain Medicine Mont Blanc is the deadliest mountain in the Western world His 2011 paper updating and detailing a classification of frostbite in four distinct stages is a landmark reference. ‘There are more and more cases of frostbite in the largest cities, with the number of homeless peo- ple, very bad cases, but there isn’t always a good awareness of the proper treatment,’ Cauchy said dur- goes back over the past 20 years.’ The reason for the exceptional traffic of frostbite cases in Chamonix stands just outside the hospital door. Towering at 15,780 feet, Mont Blanc is not only the highest point in Europe, it is also the deadliest mountain in the Western world with an average of 100 trekkers perishing somewhere up there each year. INSIDE: ECR 2015 special issue V O L 24 I S S U E 1 / 15 • F E B R U A R Y / M A R C H 2015

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