贺启莲，冯书娥，金先革，支颜霄，孙 丽，樊辉娟，玛丽莲·史密斯-斯托纳

(1.青海大学医学院；2.美国加州州立大学圣贝纳迪诺分校)

Introduction

Nurses，cooperated with other members of the multidisciplinary team，provide crucial care in different situations.One of the most challenging is caring for people who live in and visit high altitude areas.The promotion of health in populations at high altitudes is not one size fits all.The area，the environmental，lifestyle and other factors lead to different high altitude illnesses.Nursing leaders who work in areas with people to live in or visit high altitudes have responsibility to help clinicians，politicians，citizens and others understand the unique risks of the area they live in and address their risks accordingly.Staying currently with scientific developments related to the etiology，surveillance，prevention，diagnosis，treatment and follow-up care related to the range of altitude illnesses is critical for nurse leaders to effectively connected with personnel，financial and others resources[1-3].

Many areas of shared responsibility for population health include advocating for resources to address Acute Mountain Sickness(AMS) throughout the continuum of care，from researches to expanding the knowledge base such as being done at the Medical College，Qinghai University，Xining，Qinghai，China，educate the world community on ways to prevent the incidence，and care for those who have altitude sickness and work with other members of the interdisciplinary team.Nursing leaders in acute care，academics，public health and public policy can collaborate on regionally appropriate educational material and assist with media campaigns to keep the public informed about the signs and symptoms and locations of resources available regarding[4-6].

There are many indigenous people such as Tibetans，Peruvians，Ethiopians，and Andeans who live at high altitude.Other populations that spend intermittent periods of time at altitudes above 2500 meters are athletes who seek out high altitudes to compete for a wide variety of elite sporting events，including some who take advantage of altitude acclimatization to increase their performance as the same changes that help the body cope with high altitude will increase their performance back at sea level[7-9].These changes are the basis of altitude training which forms an integral part of the training of athletes in a number of endurance sports including track and field，distance running，triathlon，cycling and swimming.The third general group of people who can be found in high altitude mountains can be classified as athletes，climbers and trekkers who are not competing with others but rather on a pilgrimage to achieve a personal goal[10-13].Any of these people may need medical care from skilled and knowledgeable clinicians.This review focuses on the third general group of people mentioned above.

Methodology

A narrative review of English language research articles and studies that were quantitative，qualitative and clinical guidelines was conducted to obtain a general description of nursing related knowledge that can be used in education were collected.The search terms were high altitude sickness，high altitude medicine，high altitude nursing focused on the last 5 years.The focus was on studies and resources that involved human subjects.The content derived for the review can be integrated into all levels of basic，emergency，public health and disaster preparedness nursing.

Best Practice

Reports of high altitude sickness existed in the late 1800 s.A more defined body of knowledge started to develop in the 1940s onward，mostly describing the people from the Peruvian Andes.For the purpose of this short review，the Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness：2014 update(following as 2014 Guidelines)will be used to provide an overview of physical patient care needs[14].Ensuring well-trained nurses and others who work at referral centers where climbers and support staff are likely to be evacuated to is important for a seamless transition of care.Since a seamless transition of care means multiple languages will be spoken，apps on a phone will make it easier to communicate with anyone who finds themselves injured and evacuated to a trauma center.A nurse leader who could develop a customer friendly center with well qualified staff could establish themselves and their staff as international experts and bring much publicity to their center.

A basic vocabulary is necessary.By knowing how patients had traveled，nurses could assist physicians in preparing for immediate and lifesaving care.The 2014 Guidelines provides valuable information to guide a general understanding of the needs of climbers and knowledge bases of healthcare workers[14].

Triad of Acute High Altitude Sickness[15]includes AMS，High-Altitude Pulmonary Edema(HAPE)and High Altitude Cerebral Edema(HACE).AMS typically occurs over above 2500 meters，primary symptom is headache，Valsalva maneuver，nausea，anorexia，dizziness and disrupted sleep and can progress to life limiting condition.Symptoms common to all conditions include：headache，dizziness，nausea，vomiting，dyspnea and ataxia.Lake Louise Diagnostic Criteria is used as a self-assessment and others to indicate the presence of acute mountain sickness when the patient has a score of 3 or more[16].

Genetics

The progress made in genetics is breathtaking.Zhou et al[17]reported on the whole genome sequencing in Andean Highlanders.The researcher points out many life-saving benefits of knowing the genetic makeup of chronic mountain sickness and report the significant decrease in mortality as a result.With over 140 million people living at high altitude，this is a significant population for nurse leaders to know about and educate nurses and community leaders on how to care for them.Since the negative effects of altitude vary from region to region，leaders will want to understand the specific effects of altitude in their area.

Interplay of Environment and Lifestyle at Nigh Altitude

There are well known risks taught in nursing and medical schools that are affected by high altitude that can be stress when educating local people，policy makers and health care workers[18].These include chronic lung disease，smoking，UV radiation and convection，etc.Besides，at high altitude，atmospheric pressure is lower than that at sea level[18].At high altitude，atmospheric pressure is lower than that at sea level.This is due to two competing physical effects：gravity，which causes the air to be as close as possible to the ground；and the heat content of the air，which causes the molecules to bounce off each other and expand.

Treatment

Behavioral interventions to prevent mountain sickness include regulating the rate of assent to prevent symptoms，mainly a headache to indicate early signs of altitude sickness.It is recommended to climb gradually by stopping for 1 to 2 days of rest for every 2 000 feet(about 610 meters)of ascent.For pharmacological interventions，adequate evidence exists supporting the use of acetazolamide 125 mg and 250 mg twice daily for preventing AMS of which acetazolamide 125 mg twice daily could be the best.Besides，dexamethasone and ibuprofen reduce the incidence of AMS in high altitudes[19].Headache can be reduced with low flow nasal oxygen，aspirin，acetaminophen or ibuprofen.Nausea and vomiting can be treated by prochlorperazine 5 mg oral administration or venous transfusion.It is important to ensure there is an adequate supply.This is a simple introduction，and is not meant to be a comprehensive review of treatment of the range of high altitude illness.

Emergency Care

There is a small“Everest ER”where some climbers are treated[20].The most common conditions requiring evacuations between 2003 and 2012 were pulmonary conditions(HAPE)，frostbite related skin conditions and neurological condition(HACE).Critically ill climbers may be transported off the mountain via helicopter，ground evaluation and other methods.

There will be times the body of a climber is transported from the mountain.Knowing how to respectively and carefully handle the body is critical to keep the body stored，along with their belonging until the family makes arrangements for transfer home.Knowledge of postmortem care is also important for staff to use so that family members who may arrive to see their loved one will feel supported，especially if the body of the loved one has been altered by extreme cold temperature and transport.Education of staff on how to communicate with and support family of a climber who has died is as important as those who are living.

Conclusion

Nursing leaders have a long history of improving the health of people through innovation，developing evidence and organizing nursing and healthcare workers to provide care in new and effective ways.Leadership has already been shown by the high number of nurses in China who have received the Florence Nightingale Award from the International Red Cross.Other nursing leaders who are advancing their education to the doctoral level and adding to the genetic and other knowledge about the susceptibility to，treatment and other aspects of cellular change related to high altitude are making important changes for the more than 140 million people who live in high altitude[17].These types of integrate research will save lives of patients through advancing nursing science.

Conflict of Interests

The authors declare no conflict of interest regarding the publication of this paper.