Alpine Rescue & Mountain Emergency Medicine

The History of ICAR MedCom

“I’m very happy that this commission has survived, considering the difficulties it experienced  becoming a Commission of world importance for Mountain Emergency Medicine.
This would not have been possible without the friendship and collaboration of old and present members of the Commission: I wish to express my thanks! Thank you friends.”

                                                                                                      Urs Wiget (August 2019)

A short history of ICAR MedCom

Authors: Urs Wiget, Giancelso Agazzi, Ken Zafren and John Ellerton
When we look at photos of current meetings and workshops of the ICAR MedCom we should remember that the commission has come a very long way! Publications in internationally recognised medical journals, stunning international expertise and research in all fields of mountain emergency medicine have developed over many years of hard work and exceptional leadership.
Let us go back in history to discover how the ICAR MedCom has grown up to be what it is today….

The Beginning (1954 - 1987)

The first recorded international mountain rescue meeting took place in 1948 in the beautiful Tyrolean region of the ‘Wilder Kaiser’ (Austria) by invitation of the Austrian Alpine Club. Only delegates of European alpine countries were invited. Mountain rescuers from Austria, France, Germany, Italy (including South Tyrol) and Switzerland gathered to plan an international project.
In 1954 led by Scipio Stenico from Italy and Rudi Campell, a Swiss physician from Pontresina, the Commission Internationale de Sauvetage Alpine / Internationale Kommission für alpines Rettungswesen  (CISA-IKAR) was formed. Rudi Campell became the president of the Medical Commission, a job he continued in until 1964. Gottfried (“Goggi”) Neureuther from Garmisch-Partenkirchen (Germany), Chief of Internal Medicine at the hospital in Garmisch-Partenkirchen, became the second president of ICAR MedCom in 1964 and held the position for a quarter of a century.

The Transformation (1987- 2009)

In 1987, the language of the commission was mainly German. In that year, the Swiss Air Rescue Service REGA (Garde Aérienne Suisse de Sauvatage) asked Urs Wiget, one of its mountain rescue doctors, to participate at the ICAR General Meeting at Megève (France) as the German-French translator. As an emergency doctor, Urs joined the Medical Commission, but most of his work consisted of translating to and from German during the meetings. He was assisted by Felix Meier, who took care of the German-English translation. There was no common language that was understood by all; most of the participants were German, Swiss-German and Austrian doctors.
The early scientific work had diminished and annual meetings had become principally a gathering of old friends who shared a common passion for mountain emergency medicine. For 3 years, two participants joined the Commission who could speak no German. They were Jacques Foray from Chamonix, France and José Ramòn Morandeira from Zaragoza, Spain, two eminent specialists in frostbite. Long scientific discussions ensured with Gerhard Flora from Innsbruck, Austria who advocated fibrinolytic snake venom in contrast with Jacques Foray who recommended rapid warming and scintigraphy. The ‘new boys’ were able to present excellent results on famous mountaineers, who had suffered from frostbite in the Himalayas and in the Alps near Chamonix. The discussions would often leave Urs Wiget with a headache from having to translate and language translations made the meetings long and tiresome.

In 1989, during the General Meeting of the ICAR at Garmisch-Partenkirchen, Germany, Goggi Neureuther expressed his intention to resign as President of the Medical Commission. This led to discussions regarding a successor. Two candidates were considered. The first was Walter Phleps, an Austrian physician at a pharmaceutical company and mountain rescue doctor for many years. He was strongly supported by the German-speaking members and particularly by Professor Gerhard Flora, who had remained as a very influential member of the Commission. The second candidate was Urs Wiget who was openly supported by the non-German speakers, many of whom had travelled to Garmisch in great numbers in order to participate in the election. The voting was clear. Urs was catapulted to the presidency of the ICAR MedCom. (For the next twelve years, Urs recognised and appreciated the fair play of his opponents. Indeed, he was soon supported by all the members of the commission and developed a close friendship with Gerhard Flora.)
Urs enthusiastically entered into transforming the Commission for which he had strong support from José Ramòn Morandeira, Carlo Vettorato and Georg Rammlmair. Three priorities emerged:
All meetings and work should be based on friendship and respect among the participants. After heated medical discussions all members would join together for a drink. Urs would say: “The most important thing is that we all be friends.”
The Commission should issue recommendations on mountain emergency medicine that would be accepted by the international community.
The members of the Commission should participate actively in the work. It was out of the question for the president could do all the work by himself, as he had a medical practice and a large family! This led to some work rules: proposed revisions of the working documents were to be discussed at the next meeting by the proponents. If there were no revisions brought forward between meetings, the working documents were to be accepted.

Future working projects had to be led by selected authors : Georg Rammlmair (Italy) – Immobilisation in the mountains; Jaques Foray (France) – Practical key points; Alfred Thomas (Germany) – Clinical cases illustrating principles of modern emergency medicine in the mountains; Dr Schandert- Qualifications necessary to practise mountain emergency medicine and  Urs Wiget (Switzerland) – Modular pharmaceutical rucksack for mountain doctors, mountain guides and mountaineers.
Following Urs’s first meeting as President, he prepared a report in German and French using his first laptop computer. He also proposed changing the name of the Commission to the ‘Commission of Mountain Emergency Medicine in the Mountains’ – the preferred name of the Commission – though one that to this day (2020) has not been realised by ICAR. By statute, we are still officially ‘Alpine Emergency Medicine’! The number of members of the Commission grew and important changes were made:
The Commission began to meet twice a year with the addition of a ‘Spring’ meeting. Whilst the ‘Autumn’ General Assembly of ICAR involved all the ICAR commissions, the Spring meeting was a smaller affair of just the MedCom. It allowed more time to work without the distraction of meeting the needs of the wider agendas of ICAR.
English was adopted as the official language of the Commission. The vote was 19 to 1. The dissenting voice accepted the decision without bitterness, and spoke in English. His English was actually better than that of some of the other members!

A happy collaboration developed between the Medical Commissions of ICAR and the UIAA (International Mountaineering and Climbing Federation) with Bruno Durrer, the President of the UIAA MedCom, becoming an ICAR MedCom member. Bruno and Urs were very close friends, who came from the same village in central Switzerland. They defined the respective domains of the two Commissions. The UIAA MedCom deals with issues of mountaineering such as altitude and expeditions, while ICAR MedCom’s domain is mountain rescue. Productive collaborations between the two commissions produced a joint book of recommendations, the ‘Consensus Guidelines on Mountain Emergency Medicine and Risk Reduction’ edited by Fidel Elsensohn, published in 2001. Both Commissions also supported the International Society of Mountain Medicine. Formed in 1985 as a home for the scientists and national mountain medicine societies, the three organisations began to have joint meetings at ISMM World Congresses and more recently joined with the Wilderness Medical Society (WMS) for a joint Congress in Telluride, USA in 2016. Four international mountain medicine groups all together; what a platform that was.

Under Urs’s direction, the discussions and the resulting recommendations became more and more scientific and sophisticated. He was supported by experienced anaesthetists, such as Alfred Thomas and Xavier Ledoux and many others. Though Urs was a general practitioner who described himself as a simple mountain doctor, he was involved in many heated debates with the specialists! Controversies included the use of ketamine in the field by doctors who are not anaesthetists and the administration of local anaesthetics for regional pain relief. Even the most passionate debates ended with a friendly get-together, calming the spirits and underlining the friendship on which all the work of the Commission is based.

Urs was a strong advocate of a limited term Presidency. The commission opted for a maximum tenure of 8 years and Urs had to consider his successor. The fact that one highly active member of the Commission had distinguished himself more and more internationally in the field of avalanche research facilitated this task. Hermann Brugger published the scientific paper on survival in an avalanche that became the basis of all modern research on death and survival in avalanches. He succeeded Urs as President in 2001.

Hermann pushed on with increasing the scientific output of the Medcom. The goal was to always have recommendations peer review outside the commission and to get them published in peer-reviewed journal. The natural home for the work of the Commission was the American journal, High Altitude Medicine and Biology, though some were also published in Resuscitation and the Wilderness and Environmental Medicine journals. The DVD ‘Time is Life’ (2006) was produced and transformed the knowledge and teaching of avalanche rescue medicine. Along with the sale of the Consensus Guidelines, Hermann was able to start a Medcom fund directed at supporting course in mountain emergency medicine in developing rescue systems. The first was in Bariloche, Argentina, then Kathmandu, Nepal and finally Arequipa, Peru. Funding for continued education of fledging mountain rescuers and doctors in Nepal continued for many years under Hermann’s South Tyrolean influence.
The numbers of Medcom members rose in response to the international prestige of the group. North American, Scandinavian, new-Europe and Japan were increasingly present and gave our work a true international perspective. Despite the larger numbers and more diverse opinions, Hermann always managed to gain consensus for all our recommendations and list of signatories at the end of the papers showed how widely spread the contributors were in place, rescue system and profession. He was fortunate to be ably assisted and supported by Ken Zafren. Ken splits his medical work between Alaska and California, and somehow this gives him time and energy to review and correct many, if not most, of the MedCom papers. He served as a Vice President through both Hermann’s and Fidel’s presidencies. The Spring meetings always involved a day outside; a ski tour, a climb or walk in an iconic place. A highlight was Spitzbergen in 2011. We were delayed a whole year by the eruption of an Icelandic volcano but for the members present the ski-touring/walking under the midnight sun with a gun (to protect against polar bears) will forever be etched in their memories. ‘Gege’ Agazzi, a longstanding member for the Italian Mountain Medicine Society cemented his unofficial role as our photographer in Spitzbergen, a role that inevitably led him to be formally asked to record and archive our activities in 2017.

As Hermann was coming to the end of his Presidency, he announced the formation of the Institute for Mountain Emergency Medicine at EURAC, Bolzano, Italy. This facility continued Hermann’s massive influence in mountain medicine and has been a great asset to Medcom. We were honoured to be there at the opening of the TerraXcube in 2019.

Consolidation and Expansion (2009 - )

Fidel Elsensohn, an Austrian doctor, succeeded Hermann Brugger and served as President from 2009 to 2017. Fidel’s tenure coincided with a rapid expansion of ICAR with sometimes 10 new members joining in a year. MedCom attendance reach the dizzy heights of 50 plus by 2014 and then cantered on to a high of 89 in 2018. Even Spring meetings climbed from less than 20 members to over 30 on regular occasions. Managing these numbers of people required patience, planning and focus. Work patterns had to be changed and priorities set and adhered to. Instead of ICAR Medcom acting alone, the best science was now being done by ICAR MedCom members along with international experts from EURAC and other specialised institutes. Fidel reached out to eastern Europe and brought in the Americas. We even got to Africa as Cape Town hosted a Spring meeting in their Autumn of course! He supported the diverse and expanding number of UIAA / ICAR / ISMM Diploma in Mountain Medicine courses. He took us to Peru, Nepal, the USA, and Bulgaria to name a few. Always looking at ways to get involved in education and training of mountain rescuers, the ICAR group had great experiences and developed deep friendships.
Of course as we aged, we also saw the loss of longstanding friends and collaborators; some from illness and some from accidents. The loss of Bruno Durrer (died December 2016) and Emmanuel Cauchy (died April 2018). Many rescuer’s deaths during missions have also occurred and these have stimulated the MedCom to try to establish a registry of such deaths with ICAR. We hope to learn the lessons from these sad accidents and also pay tribute to our colleagues.
John Ellerton, a British doctor, took over the reigns of the Presidency in 2017. John had been supporting Fidel at the ICAR executive board as an assessor (representing the interests of the ICAR members) since 2012. His vision for ICAR is that it becomes truly representative of its international members, and that all types of mountain rescue organisations feel they have a voice in the ICAR knowledge platform and that ICAR becomes the default ‘go to’ place when there is a mountain rescue question wherever you are. His priorities for the MedCom mirror these aspirations. Updating our recommendations, supporting and initiating mountain emergency medicine research, and reaching out to all corners of our community are actively being pursued.
Today the ICAR Medical Commission has more than 80 members, mostly emergency physicians and paramedics, with experience in pre-hospital management of injuries and illnesses in the mountains. The main goal of the Commission remains to improve medical treatment and outcomes for casualties in the mountains.
The promulgating of guidelines that deal with medical and practical aspects of mountain rescue and emergency treatment is a focus of our work though it now shares our attention with research and education. And, of course, friendship and mutual support underpins our professional lives.