Features of establishing and operating a medical service at remote high‑altitude sites: A review

Introduction. The development of a system for organizing health protection for workers at remote industrial sites (including high-altitude ones) is a relevant priority for both the Russian Federation and the Kyrgyz Republic. Due to the absence of unified standards in the remote health-care system, a priority is the analysis of principles and approaches in organizing an adequate and effective model of medical care delivery for personnel in these industrial production sectors.

Objective. Analysis and synthesis of data on the organization of medical care at remote industrial sites (RIS) in extreme high-altitude conditions.

Discussion. Labor activity at RIS in high-altitude conditions involves the impact on workers’ health of extreme climatic and geographic factors, adverse socio-psychological factors, as well as harmful and dangerous factors of the industrial environment, which necessitates the implementation of a specialized medical support system for workers. Medical care for RIS workers may be provided by the company’s own medical service or by hired medical service providers (outsourcing). In the Kyrgyz Republic, all mining enterprises have their own medical services. The medical service at a high-altitude RIS consists of two units: the main medical station of the RIS (paramedic or physician-staffed) and a medical station at the central checkpoint. A distinctive feature of the medical station’s work in high-altitude conditions is the high number of patient visits for acute mountain sickness (AMS). For example, among shift workers at a mining enterprise in the Kyrgyz Republic at an altitude of 3800 m, the AMS incidence was 25%. The main approaches to AMS preventing in the general worker population are altitude acclimatization, pharmacological support, rehydration, prevention of electrolyte imbalances, protection against light-induced eye and skin damage, and prevention of cold injury. For further medical care provision to workers with AMS, a two-stage evacuation system is used when the RIS is located at an altitude above 3500 m and at a significant distance from populated areas, which involves establishing an intermediate medical station at an altitude of 1700–1800 m above sea level.

Conclusions. Medical support for shift workers in extreme high-altitude conditions is part of a developing field — remote healthcare. The issues of organizing medical care at remote industrial sites in mountainous areas are relevant due to the intensive development of the mining industry in the Kyrgyz Republic. The need is shown for special training of medical personnel in remote healthcare, improvement of the regulatory framework governing the procedures and algorithms for providing medical care to RIS workers, in order to enable the construction of a new model of medical support that complies with unified standards of medical care, including through the introduction of telemedicine and mobile components.

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