PERFORMANCE IMPROVEMENT (PI) MONITORING

POPULATION OF INTEREST

Individuals and units traveling to high altitude locations 2500 meters (8202 feet) or above.

INTENT (EXPECTED OUTCOMES)

1. Conduct pre-mission planning and implement altitude illness risk mitigation strategies. This includes:

- Implementation of pre-acclimatization strategies (staged ascent, gradual ascent, and daily intermittent exposures).
- Screening of individuals for preexisting medical conditions listed in Table 1.
- Education on signs and symptoms of altitude illnesses.
- Plan for adequate nutrition and hydration.
- Outfit unit with altitude illness-specific medications (ibuprofen, acetaminophen, acetazolamide, dexamethasone, nifedipine, phosphodiesterase inhibitors, salmeterol) and equipment (oxygen, PHC/Gamow™ bag).
- When indicated, implement rapid ascent medication prophylaxis protocol using acetazolamide and/or dexamethasone.

2. Conduct surveillance of symptoms throughout expedition using Lake Louise AMS Score.

3. Apply recommended treatment to individuals exhibiting symptoms of HAI according to Altitude Emergencies Initial Management Algorithm.

PERFORMANCE/ADHERENCE METRICS

1. Number and percentage of patients in the population of interest diagnosed with AMS are prescribed Acetazolamide per protocol.

2. Number and percentage of patients in the population of interest diagnosed with HACE are prescribed Acetazolamide per protocol.

3. Number and percentage of patients in the population of interest diagnosed with HAPE are prescribed Nifedipine or Phosphodiesterase inhibitors per protocol.

DATA SOURCES

- Patient record
- DoD Trauma Registry

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The JTS Chief and the JTS PI Branch will perform the systems review and data analysis.

RESPONSIBILITIES

The trauma team leader is responsible for ensuring familiarity, appropriate compliance, and performance improvement monitoring at the local level with this CPG.