Advice and Recommendations

The UIAA Medical Commission produces comprehensive recommendation papers, translated into several languages, which act as a valuable resource for climbers and medical staff alike. An emphasis is put on health problems that only occur at high altitude. Among the issues included are acute mountain sickness, nutrition, water disinfection and drug use and misuse in mountaineering.

The recommendations are pertinent particularly for charity and gap year treks, expeditions, challenges and adventure holidays. Many are very well run but there are still too many who offer unsafe ascent profiles guaranteeing illness and some who have little or no mountain medicine training for their leaders. Many people who undertake these trips are mountain naïve and do not know how to access medically-based advice. Every year, the UIAA Medical Commission is aware of unnecessary injuries and deaths often as a result of poor leadership and planning. The advice provided in these documents is ultimately designed to help prevent injury and save lives.

Library of Recommendations

1. 4 x 4 Health Rules for Mountaineers

These general suggestions are designed to guide those who are unfamiliar or less experienced with mountain terrain and who wish to hike or climb. 16 tips for what to do when you are in the mountains, before the tour, during the tour and in case something happens.


2. AMS, HAPE, HACE – Emergency field management

Acute mountain sickness (AMS), high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema (HACE) are the most important and most common altitude related diseases. Primary prevention is considered the gold standard to avoid altitude illness. Learn how to diagnose, treat and most important how to prevent.


3. Portable Hyperbaric Chambers

A portable hyperbaric chamber is a small inflatable chamber made of fabric, which can fit one person. When it is inflated, pressure is created inside the chamber which simulates a descent of 1500-2500 altitude meters. It is used to stabilise patients with serious altitude illness, so that their condition improves and they can descend to lower altitudes to recover. This paper gives advice on the use of such chambers.


4. Nutritional Considerations in Mountaineering

There are many additional nutritional issues that must be considered when preparing for any mountaineering pursuit, especially those of longer duration. Therefore the aim of this paper is to briefly outline evidence-based nutritional considerations and strategies that can be adopted to minimise weight loss, and improve health and performance.


5. Traveller’s Diarrhoea

Traveller’s diarrhoea is one of the most important medical problems for trekkers and those taking part in expedition mountaineering. Although the details of the data are still being discussed there is no question that the loss of body water and electrolytes impairs the physical and mental capacity significantly and dehydration increases the risk of Acute Mountain Sickness (AMS).


6. Water Disinfection in the Mountains

Infected water is the most common risk for diarrhoea. This UIAA MedCom recommendation summarises advantages and disadvantages of the several procedures of water disinfection with special regard to the situation in the mountains or at high altitude; and will advise mountaineers on how to prepare safe water while minimising the environmental damage. May 2021: English version updated


7. How to Check the Quality of a Commercially Organized Trek or Expedition

As the number of mountaineers who are joining organised treks or expeditions continues to increase, so too does incidence of altitude-related diseases. The following recommendations should assist the mountaineering tourists to check as far as is reasonably possible, whether their organisation has taken into account potential health risks when planning the trip itinerary.


8. Model Contract for Health Care on Trekking and Expeditions for Doctors

Being an Expedition or Trekking Doctor is more than being merely a member which advises others in case of a health problem during the trip and who may get a discount on organized trips! An expedition doctor has specific responsibilities, has to provide special skills, and must always accept responsibility for any diagnosis made, whether right or wrong. This contract document attempts to clarify the rights and obligations of the tour operator, the expedition doctor and the expedition, to avoid trouble and misunderstandings during the trip.


9. Children at Altitude

Each year many thousands of lowland children travel to high altitude uneventfully. The majority of these ascents involve trips to mountain resorts, especially in North America and Europe. While altitude travel is without incident for most, some of these children develop symptoms that may be attributed to altitude exposure. The following consensus view described here provides the conservative recommendations that should be helpful for mountaineers and physicians who are required to offer advice about ascent to high altitude with children.


10. The Effect of Extremes of Temperature on Drugs

Harsh environmental factors “especially heat and cold” can significantly affect drugs, the substances as well as stabilisers, solvents etc. Temperatures inside emergency medical bags have been reported to be between -40°C and +80°C. Such temperature extremes may be even harsher in a mountaineering environment. The following recommendations are given on how to handle drugs under such circumstances, side effects and other drug related matters in the mountains.


11. The Use of Hiking Sticks in the Mountains

Hiking sticks have become popular among many who walk in the mountains. This document explains the right technique for using telescopic sticks and outlines the advantages and disadvantages of hiking with them. It also explains the correct walking techniques which make the use of sticks unnecessary for healthy hikers.


12. Women Going to Altitude

This document gives advice to women about their risk of altitude illness, the effect of altitude on the menstrual cycle and the use of birth control pills. It also gives advice to pregnant women about the effects high altitudes can have on their health and gives recommendations on how to prevent complications.


13. People with Pre-Existing Conditions Going to the Mountains

This document gives advice to people with medical conditions who want to go to the mountains. It describes the affects altitude can have on conditions such as asthma, heart problems and migraine. It also takes into consideration other risk factors connected to mountain holidays, such as strenuous exercise, lack of nearby medical facilities and change of culture and lifestyle.


14. Contraception at altitude

A large proportion of women do not principally use contraception during their travel for contraceptive reasons but for regulating and controlling their periods.This paper focuses specifically on the use of contraception during altitude sojourns and reflects the official standard recommendation of UIAA MedCom, which is based on current literature.


15. Work in Hypoxic Conditions

Until recently only mountaineers and high altitude residents were exposed for prolonged periods to a low oxygen (hypoxic) environment. Over the last decade artificial hypoxic rooms have been built as a fire preventative environment for libraries and are now also used for Hypoxic training for athletes and other purposes.


16. Travel to Altitude with Neurological Disorders

The present review examines several neurological conditions and the problems posed by travelling to high altitude, and in particular whether the underlying disease is likely to worsen. The neurological conditions include migraine and other types of headaches, transient ischemia of the brain, occlusive cerebral artery diseases, intracranial hemorrhage and vascular malformations, intracranial space occupying mass, multiple sclerosis, peripheral neuropathies, neuromuscular disorders and epileptic seizures.


17. Injury Classification for Mountaineering and Climbing Sports

In the past 20 years several studies (pro- and retrospectively) were conducted to evaluate the injury and fatality risk of rock, ice and mountain climbing. A simple and common protocol was developed, by the UIAA MedCom to report injuries in mountaineering and climbing studies. This protocol includes the use of a single climbing grade reference that converts UIAA climbing grades into a standardised metric form.


18. Blood Borne Infections in Climbing

Climbing often involves travel to foreign and remote destinations, whether for competitions or personal pursuits. Sustaining cuts, abrasions or lacerations, typically on the fingertips in contact with holds, is a common occurrence in climbing. Therefore what is the risk of blood borne infections being transmitted to the climber following – i.e. whether seconding or in a competition?


19. Recommendation for prevention and control of Legionella infections

Legionnaires’ Disease or Legionellosis is the term used for infections caused by Legionella pneumophila and other related bacteria. Legionella bacteria are only dangerous in respirable form and generally only in susceptible individuals for whom inhalation of the bacteria in aerosols or water droplets (showers) may cause severe pneumonia and, in extreme cases, death.


20. Eye problems in Expeditions

Excessive sunlight and white snow can be a very big problem when going in expeditions. Precaution and use of special glasses can help. But what if…


21. Cardiovascular diseases

Mountain activity addictive, therefore mountaineers and climbers usually cross the barrier of comfort to achieve goals and to be on the mountain. Going to high altitude can be a risk for those which suffer from cardiovascular diseases because of the low pressure, oxygen and extreme weather conditions.


22a. Drug Use and Misuse in Mountaineering

The UIAA Medical Commission has developed a new layperson’s advice sheet on drug use in the mountains. This paper, which you can ready by clicking on the flag below, is the result of five years of discussion and consensus building between experts on the Commission and the international mountain medicine community.

Disclaimer: The UIAA is signatory of World Antidoping Code and does not tolerate the use of drugs and methods that are on the Prohibited List among UIAA registered athletes.


22b Drug Use and Misuse in Mountaineering – A UIAA MedCom Consensus Guide for Medical Professionals

This document can be downloaded here.

23. Alpine Helicopter Rescue Operations

The UIAA Medical Commission has decided to erase the appendix at No.15 and to include its content in an independent recommendation to address those who are active in helicopter rescue at altitude or who are responsible for the health of the crews.


24. Zika Virus

In the early weeks of 2016 media led with stories of the increasing awareness that infection with the Zika virus may be linked to an increase in children being born with birth defects such as microcephaly in some South American countries.


25. Adventure Travel & the Covid-19 Pandemic (May 2021)

In the modern world local and international travel was taken for granted and this has enabled the adventure travel industry to thrive. This concept is now threatened by the Covid-19 pandemic. Many individual mountaineers and those in the industry see the pandemic in simplistic terms and do not appreciate the many additional risks that have to be taken into account when planning a trip. Our medical knowledge of the SARS-CoV-2 virus is constantly evolving so this advice paper has applied the general principles of travel and expedition medicine to give insight into the many varied medical and political risk factors to be considered when planning any venture.

26. Recommendations for Mountaineers, Hillwalkers, Trekkers, and Rock and Ice Climbers with Diabetes (November 2018)

The object of this advice article is not only to give the diabetic mountaineer general guidance but also to inform his or her medical team of practical aspects of care that may not be standard for non-mountaineers. The guidelines are produced in seven sections. The paper can be viewed here.

Specific High Altitude Advice Sheet

The following guide was not produced by the UIAA MedCom:

17a Travel at high altitude

An easy to understand leaflet for people going to high altitudes. It gives advice on how to avoid serious altitude illness and other health problems. The leaflet is prepared by Medex with support from the UIAA. It describes going from sea level to anywhere above 2,000m.

This booklet is available here in many languages.

Opinion Paper: Preacclimatisation for expeditions to extreme altitude’

The paper tackles the subjects of Acute Mountain Sickness (AMS) prevention and intermittent normobaric hypoxia preacclimatisation. The full article, made freely available online (until spring 2021) courtesy of High Altitude Medicine & Biology, can be viewed here.

Mountain-Specific High Altitude Advice Sheets

Dr Jeremy Windsor and Dr George Rodway, UIAA Medical Commission President, have written four information sheets for popular high altitude mountains. They are for Aconcagua, Denali, Kilimanjaro and Mera Peak.


At 6,962m, Aconcagua is the tallest mountain in the Americas. Despite its modest description as a “trekking peak” it is an enormous undertaking. Care needs to be taken if illness and injury are to be avoided. High altitude illnesses such as AMS, HAPE and HACE are seen on a daily basis during the busiest times of the season. Given the weather conditions close to the summit, cold injuries are common too. Each year a small number of deaths occur. Many of these are altitude related and can be avoided. This article describes an ascent that offers an excellent opportunity for a safe and successful climb of Aconcagua.



Denali is the highest peak on the North American continent and as such is a highly desired objective for more than a 1,000 aspirants each year. Even in the face of relatively large numbers, mainly on the West Buttress route, the United States National Park Service (NPS) has tried to encourage a philosophy of self-sufficiency amongst mountaineers whenever possible. In this article we’ll discuss a logical and tried approach to an ascent of the West Buttress route, and identify many of the problems you’re likely to encounter along the way.



A paper on how to stay safe and healthy when ascending Kilimanjaro. The document can be downloaded here.


Mera Peak

At 6462m, Mera is one of the tallest “trekking” peak in Nepal. Despite this label, reaching the summit remains a challenging objective and shouldn’t be underestimated. Whilst technically straightforward, the high elevation means that mountaineers are subject to extremes of temperature and a significant risk of developing high altitude illnesses such as Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE).



UIAA Partner


The International Commission for Alpine Rescue ICAR was founded in 1948. ICAR is incorporated as an association under Swiss law, with its seat in Kloten, Switzerland. ICAR does not pursue any commercial purposes and is not profit oriented.