Wilderness Environ Med. 2018 Jun;29(2):266-274

# Challenges of military health service support in mountain warfare.

Lechner R, Küpper T, Tannheimer M

INTRODUCTION: History is full of examples of the influence of the mountain environment on warfare. The aim of this article is to identify the main environmental hazards and summarize countermeasures to mitigate the impact of this unique environment.

METHODS: A selective PubMed and Internet search was conducted. Additionally, we searched bibliographies for useful supplemental literature and included the recommendations of the leading mountain medicine and wilderness medicine societies.

RESULTS: A definition of mountain warfare mainly derived from environmental influences on body functions is introduced to help identify the main environmental hazards. Cold, rugged terrain, hypoxic exposure, and often a combination and mutual aggravation of these factors are the most important environmental factors of mountain environment. Underestimating this environmental influence has decreased combat strength and caused thousands of casualties during past conflicts. Some marked differences between military and civilian mountaineering further complicate mission planning and operational sustainability.

CONCLUSIONS: To overcome the restrictions of mountain environments, proper planning and preparation, including sustained mountain mobility training, in-depth mountain medicine training with a special emphasize on prolonged field care, knowledge of acclimatization strategies, adapted time calculations, mountain-specific equipment, air rescue strategies and makeshift evacuation strategies, and thorough personnel selection, are vital to guarantee the best possible medical support. The specifics of managing risks in mountain environments are also critical for civilian rescue missions and humanitarian aid.