Abstract
After the relaxation of English restrictions to indoor gatherings, the twice-postponed Birmingham Medical Research Expeditionary Society (BMRES) and British Mountain Medicine Society (BMMS) conference took place on September 11, 2021 in Birmingham, United Kingdom. The BMRES has a 45-year history of pioneering high-altitude research, last hosting a conference in 2016 (Gault et al., 2017). The BMMS is the national body representing active mountaineering health care providers and supports training, professional development, guidelines, and indemnity. This was the first academic collaboration between these two influential groups.
Delegates were requested to provide evidence of COVID-19 vaccination or of negative lateral flow test. A reduced venue capacity reflected local risk assessment, and seating in the conference hall was generously spaced. Facemasks and alcohol gel were freely available for participants. In testimony to the diligence of organizers and attendees, no cases of transmission have been reported after the event.
The day began with updates from various U.K. groups, including the BMMS, BMRES, University of Bangor, APEX-6 (Altitude Physiology Expeditions, University of Edinburgh) and Leeds Beckett University, with the latter two groups presenting remotely. Although research activity and access to facilities have been considerably restricted for the past 18 months most groups have used this time productively to collate and analyze previous experimental data, and to prepare for future projects.
A series of enjoyable lectures completed the morning session. In tribute to the group's research endeavors, Prof. Jo Bradwell (BMRES) delivered a colorful account of the history of the BMRES, sharing pictures and anecdotes from his recently published book Gasping Thin Air. Dr. Sam Oliver (Bangor University) summarized recent work surrounding changes in cerebral percussion (Horiuchi et al., 2021; Rossetti et al., 2021). Dr. Jonathan Moore (Bangor University) highlighted important differences in autonomic activity between acclimatized and unacclimatized individuals when presenting his team's insights into blood pressure control at altitude (Berthelsen et al., 2020; Simpson et al., 2021).
Unable to travel from Switzerland, Dr. Peter Bärtsch (Heidelberg University) shared highlights of his career's innovative work on high altitude pulmonary edema through live videoconferencing technology.
The afternoon's oral presentations were charismatically chaired by Dr. David Hillebrandt (BMMS), with animated discussion after each talk. First prize was awarded to Dr. Catherine Campbell (NHS Education for Scotland) for her assessment of the environmental impact of medical field-based altitude research. Carbon dioxide emissions from aviation represented the greatest environmental burden of a recent expedition to Sikkim, India. Efforts to reduce reliance on a fossil fuel generator to power research equipment caused greater harm when the group's solar powered battery inadvertently became a single-use item due to obstructive customs regulations, highlighting the complexities of achieving environmental responsibility. The expedition's environmental impact was offset through local environmental tax contributions and the planting of 360 trees.
Other noteworthy presenters included Dr. Helen Blamey (University of Oxford), who shared her experience of supporting a unilateral transtibial amputee in undertaking an endurance mountaineering event. In subsequent discussion, the vascular surgeons in the audience explored how stump formation affected performance; the wider role of health care providers in supporting athletes with disabilities and overcoming barriers to sport participation was explored. Dr. Kelsey Joyce (University of Birmingham) presented findings that glomerular permeability is related to the clinical presentation of acute mountain sickness; Dr. Benjamin Talks (Newcastle University) reported that psychological traits influence Lake Louise Scores.
From the poster presentations, Dr. Diggory North (Queen Mary University of London) was recognized for his review of outcomes after finger flexor pulley injuries in climbing.
The afternoon concluded with three keynote speakers. Philip Meredith (Alpine Club) gave an engaging presentation on the organization's history and major achievements, informed by his role as librarian. The successes of women in mountaineering endeavors were recognized, with the Pinnacle Club celebrating its centenary. Dr. Jeremy Windsor (Chesterfield Royal Hospital) shared an emotive talk on the subject of Deaths on Everest, drawing on his own experiences of reaching the summit and personal loss. Prof. Chris Imray (University Hospitals Coventry and Warwickshire) rounded off the day by sharing stories, reflections, and footage after reaching each of the seven continents' highest peaks.
Part of the Xtreme Everest project, his arterial blood gas at 8,400 m contained the second lowest partial pressure of oxygen ever recorded in a living human—a study that gave insight into the limitations of pulmonary diffusion, and an inspiring reminder of the extraordinary physiological derangements tolerated by healthy and well-acclimatized mountaineers (Grocott et al., 2009).
Despite the technological success of video-linked presentations, the benefits of in-person meetings were eminently clear throughout the day. Engaging and enthusiastic dialogue followed each presentation, future research partnerships were discussed over refreshment breaks, and professional and personal relationships were forged and reinforced.
One of the most fruitful aspects of the conference was an unscheduled, lively, and passionate discussion on the subject of the climate emergency. Although reducing travel represents a particular sacrifice to a community of avid mountaineers, there was unopposed recognition of the urgent need to reduce carbon emissions and environental pollution—and of our responsibility to lead by example. It was noted that working with commercial organizations represents an endorsement of practice; members were encouraged to challenge unsustainable behaviors. Having enjoyed privileged careers embellished by rich travel experiences, many senior members of the conference expressed unease at the idea of suggesting limitations on younger generations. Younger representatives were unperturbed: extreme weather events and accelerating biodiversity losses demand radical action.
This conversation was undoubtedly constructive. In addition to a renewed focus on local hypoxic chamber studies, the BMRES has recently pledged to offset its entire carbon footprint through an accountable and sustainable U.K.-based reforesting scheme. The BMMS is actively preparing an environmental responsibility statement and recommendations for its members.
Amy Cogswell, Dr. Kelsey Joyce, and Dr. Alex Wright were thanked for their hard work in organizing the conference, which provided a pause for collective reflection and reinvigoration in these clinically, academically, and politically challenging times. The partnership between BMRES and BMMS reinforces the collaborative strength of the British high altitude medical community and paves the way for future joint ventures.