Canmore General Hospital

Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131-140, 2018. INTRODUCTION: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. MATERIALS AND METHODS: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. RESULTS: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. DISCUSSION: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. CONCLUSIONS: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

The courage and willingness to walk alongside families in grief calls forth particular beliefs and practices in nurses and other health care professionals. In this second phase of a study on grief and grief interventions, the researchers examine experiences of bereaved family members who received care in a grief support program and explore program clinicians'explanations of the work that they do with the bereaved. Findings of this interpretive study suggest that it is not so much models of grief intervention but maps that most guide the clinicians--maps that are drawn out of experience and with awareness of their limitations. The family members and the clinicians bring us to an understanding that, often, it is the willingness to step off of the map that makes for the best traveling companion in the spiritual walk of grief.

Acne affects approximately 95% of the population at some point during their lifetime.1 This common disorder can range from mild to severe forms, cause sometimes extensive scarring, and can last well into the fourth and fifth decades. Effective therapeutic agents are available to both treat acne and prevent ongoing disease. Despite this, dermatologists frequently see patients with significant acne scarring because many patients delay seeking medical attention for acne and many practitioners procrastinate over using effective antiscarring options. In patients who already demonstrate scarring, repeated courses of antibiotics only result in recurring acne and additional scarring. This, in turn, exacerbates the despair and other adverse psychosocial effects of the disease. There are a variety of agents and devices to help acne patients with scarring. However, successful treatment cannot be guaranteed, and in most cases residual scarring will be evident. Thus, the most effective way of managing acne scarring is to prevent its occurrence in the first place. Although we currently have a number of effective antiacne agents to control the disease, such as antibiotics and hormonal agents, isotretinoina is the only agent that has been shown to induce long-term drug-free remission and curative potential.

This study examined the dynamic interplay between subjective pain, pain behavior and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm) and transition (greater than or equal to 8 cm) phases of labor in 115 nulliparous women. Subjects received no analgesia during the latent phase and either no analgesia or epidural analgesia during the active and/or transition phase. Data were analyzed according to phase and analgesic condition. For subjects with no epidural analgesia, both the Present Pain Intensity (PPI) and the Present Behavioral Intensity (PBI) scores were correlated within and between phases. In contrast, Coping/Distress scores were weakly correlated between the latent and active labor phases and were unrelated between the active and transition phases. PPI and Coping/Distress scores were highly correlated within the latent phase but were independent within the active and transition phases of labor. PBI and Coping/Distress scores were moderately correlated within the latent and active phases and were unrelated during the transition phase. Epidural techniques reduced subjective pain and pain behavior significantly but had no apparent effect on the coping or distress-related cognitive activity characteristic of active labor. We concluded that coping and distress-related cognitive activity in labor may follow a phase-specific pattern which is relatively independent of pain or pain relief after labor has become active.

Abstract A review of social work's early history reveals a gradual struggle to develop a unifying professional identity. This process has been influenced by numerous factors, but best evidenced by the lasting impact of the Flexner paper, delivered at the Conference of Charities and Corrections in Baltimore in 1915. The paper challenged the professional status of social work, and is still referred to in current literature about the status and identity of the social work profession. This lasting uncertainty about social work's identity is reviewed from the perspective of Lacanian analytic theory. Jacques Lacan, a European analyst, was an influential and controversial figure in the field of psychoanalysis during the mid-twentieth century. Lacan's theory of the Mirror Stage and the Name of the Father are used to provide insight and consideration of social work's protracted identity crisis.

This article is excerpted from a research interview completed as part of the second phase in a hermeneutic research study around grief and clinical practice. This phase involved the examination of clinicians“ and families” understandings of support and interventions with the bereaved as they occurred in the Calgary Health Region Grief Support Program. In this interview, Reverend Bob Glasgow, the founder and coordinator of the Grief Support Program, offers his perspective on the powerful call of grief to health and human services professionals and the obligation we have to answer the call with skill and love.

McLaughlin, Kyle, Steve Roy, Marika Falla, Giacomo Strapazzon, Andrew M. Luks, Ken Zafren, Hermann Brugger, Martin Musi, Iztok Tomazin, John Ellerton, Ghan Bahadur Thapa, and Peter Paal. Pharmacological prophylaxis and supplemental oxygen for unacclimatized rescuers at very high altitude: scoping review and 2025 joint recommendations of the International Commission for Mountain Emergency Medicine and the International Society for Mountain Medicine. High Alt Med Biol. 27:60–77, 2026. Background: Mountain rescuers and pilots rapidly ascending to altitudes above 3,500 m are exposed to the detrimental effects of hypobaric hypoxia, including cognitive and physical impairment, as well as high-altitude illness (HAI). We conducted a scoping review of oxygen supplementation and pharmacologic measures to improve cognitive and physical performance and prevent HAI in unacclimatized rescuers rapidly ascending above 3,500 m during rescue missions. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 723 articles were screened, 133 reviewed and a total of 50 articles were included for data extraction, based on the intervention: 6 on oxygen, 29 on acetazolamide (AZ), 17 on dexamethasone (DEX), 3 on nifedipine, and 5 on phosphodiesterase-5 inhibitors. Discussion: Supplemental oxygen improves physical and cognitive performance at high altitude and is recommended for rapid ascent rescues >30 minutes between 3,500 and 4,000 m, and for rescues of any duration above 4,000 m. If oxygen is administered, pharmacological prophylaxis is not required. If oxygen is unavailable, AZ or DEX can be used for rapid ascent rescues above 3,500 m for longer than 3 hours to reduce the incidence and severity of acute mountain sickness. At altitudes above 5,000 m or for rescues requiring prolonged physical work, the use of both AZ and DEX is recommended. Conclusions: To enhance the safety and effectiveness of high-altitude rescues, we provide recommendations for the use of supplemental oxygen and pharmacologic prophylaxis to reduce the risk of HAI and improve cognitive and physical performance during rapid ascents to altitudes >3,500 m.

Objective: Our study aimed to compare the outcome of engaged versus unengaged fetal head in primigravida at term. Methods: The study was conducted at the obstetrics & gynaecology unit, FGPC Hospital, Islamabad. The duration of the study was 6 months with a total of 130 women included & divided into two groups. Females were followed till the delivery of the fetus. Results: A total of 130 women were observed & divided into two equal groups. The average age was 28.71 years± 6.80SD with a range of 18-43 years. Mode of delivery was measured and showed that there is a significant association between mode of delivery and unengaged fetal head in primigravida at term with p-value = 0.000. Relative risk shows that C Section was 2.93 times more in unengaged as compared to patients with engaged fetal heads. Conclusions: The frequency of a surgical intervention is significantly higher in cases with unengaged fetal heads among primigravida at term. Keywords: unengaged, engaged, primigravida, term

Giant cell arteritis (GCA) is a form of vasculitis characterized by symptoms that often lead a patient to consult a general dentist. Its rarity in the dental setting and serious life-altering effects make it a formidable diagnosis. We discuss a case of a 60-year-old female with GCA presenting with primary symptoms of excruciating tooth and jaw pain on the left side. We also report secondary symptoms of headache and partial vision loss and engage in a review of the relevant literature. Jaw pain, unexplained toothache, or tissue necrosis in patients aged over 50 years can be misdiagnosed as joint arthritis or temporomandibular disease (TMD), which could lead to severe consequences. Accurately diagnosing this ophthalmic emergency is critical for implementing therapy promptly and preventing ischemic complications. Dentists should maintain a high index of suspicion about its signs and symptoms, which will aid in making an early diagnosis and prompt referral.

McLaughlin, Kyle, Charley Shimanski, Ken Zafren, Ian Jackson, Gerold Biner, Maurizio Folini, Andreas Hermansky, Eric Ridington, Peter Hicks, Giacomo Strapazzon, Marika Falla, Alastair Hopper, Dave Weber, Ryan Jackson, and Hermann Brugger. Helicopter rescue at very high altitude: recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom) 2025. High Alt Med Biol. 27:107–116, 2026. Background: Helicopter mountain rescue is highly effective. However, air rescue operations at very high altitude (VHA), above 3500 m, are inherently hazardous because of challenging topography, dynamic weather, and hypobaric hypoxic environment. Currently, no established international guidelines exist for helicopter rescues at VHA. Methods: We conducted a narrative review of existing literature, supplemented by expert opinions from helicopter pilots, physicians, and rescuers actively engaged in VHA rescues. These recommendations were approved by the International Commission of Alpine Rescue (ICAR) Medical Commission and endorsed by the ICAR Air Rescue Commission. Discussion: We identified 19 key factors to consider, including operational parameters, ground site management, pilot and rescuer safety protocols, and psychological factors to assist air rescue programs in developing pre-mission, mission, and post-mission plans for helicopter rescue missions at VHA. Conclusions: By implementing the recommendations outlined in this article, helicopter rescue teams operating at VHA can improve response capabilities and minimize risks.

Avalanches claim the lives of around 160 winter recreationists and workers in hazardous snow-covered mountain regions worldwide. These fatalities result from asphyxia, trauma, and hypothermia. Survival for critically buried subjects relies on the speed of extrication, absence of trauma, presence of a patent airway and air pocket, immediate field treatment, and rapid transport to the most appropriate hospital by organized search and rescue (SAR) and emergency medical services (EMS). Survival may be improved with helicopter EMS, advancements in safety and rescue equipment technology, early deployment of professional SAR teams with checklists and standard operating procedures (SOPs), and the use of drones. Prehospital and in-hospital care of an avalanche accident requires medical, technical, logistical, and organizational competencies.This narrative review of historic and updated survival curves, professional society guidelines, and snow burial studies, discusses the best practices for prehospital care, triage, transport, and in-hospital management of avalanche patients.

27:117-122, 2026.Rescue from altitude has additional risks that require specialist knowledge, skills, and ability. Currently, rescue at extreme altitude (>5,500 m) is provided largely by ad-hoc teams responding to a need. The ethics of performing such rescues is controversial, and media coverage rarely considers the complexity of the environment. Organized mountain rescue teams have established processes to manage risk and their conduct to provide a professional service that changes the language of ethical decision-making into a practical, nuanced risk and crew resource management format. The International Commission for Alpine Rescue, along with the International Society of Mountain Medicine, has produced scientific papers on rescue at very high altitude and a position paper on the ethics of extreme altitude rescue. The aim is to improve the safety and outcomes of all rescues at altitude. The position paper, presented here, is targeted principally at those involved in extreme altitude rescue. Organized mountain rescue developed from ad-hoc rescue in response to a need; the same is likely to occur for extreme altitude rescue. Altitude is only one of the risk factors, and the knowledge of modern mountain rescue processes could aid in the advancement of extreme altitude rescue.

Telehealth, Calgary Healthlink, Peter Lougheed Centre, Calgary, Canmore General Hospital, Alberta, Canada Financial Disclosure The author has no potential conflicts of interest to disclose.

Background Periodontal disease is a multifactorial inflammatory condition influenced not only by microbial plaque but also by systemic, environmental, behavioral, and psychological factors. Psychological conditions, such as stress, anxiety, and depression, may contribute to periodontal disease progression through altered immune responses, increased inflammatory mediators, poor oral hygiene practices, smoking, and decreased compliance with dental treatment. General dental practitioners (GDPs) are often the first healthcare professionals to identify oral manifestations associated with psychological distress. Therefore, adequate knowledge and awareness regarding the relationship between psychological factors and periodontal health are essential for comprehensive patient management. However, limited data are available regarding the awareness and attitudes of GDPs toward the psychosocial aspects of periodontal disease. Aim The present study aimed to evaluate the knowledge, attitudes, and clinical practices of GDPs regarding the impact of psychological factors on periodontal health. Materials and methods A descriptive cross-sectional questionnaire-based survey was conducted among GDPs. A structured self-administered questionnaire consisting of demographic details, knowledge-based questions, attitude assessment, and clinical practice-related questions was developed after reviewing relevant literature. The questionnaire was validated by subject experts and pilot-tested prior to circulation. The final questionnaire was distributed electronically using Google Forms. Responses obtained were compiled and analyzed using descriptive statistical methods. Frequencies and percentages were calculated for categorical variables. Results Most participants demonstrated awareness regarding the influence of psychological factors on periodontal health. Stress and anxiety were the most commonly identified by practitioners as being linked to periodontal disease progression. A majority of respondents agreed that psychological evaluation should be incorporated into routine dental examinations; however, fewer practitioners reported routinely discussing psychological well-being with patients. Participants showed moderate understanding regarding mechanisms linking psychological stress and periodontal disease, including altered immune response, behavioral changes, and reduced treatment compliance. Limited confidence in managing stress-related periodontal conditions and a lack of formal training were identified as common barriers among practitioners. Conclusion GDPs demonstrated a positive attitude and moderate level of awareness regarding the influence of psychological factors on periodontal health. However, gaps remain in practical implementation and confidence in addressing psychosocial concerns during routine periodontal care. Incorporating behavioral sciences and psychosocial assessment training into undergraduate dental education and continuing professional development programs may improve holistic patient management and periodontal treatment outcomes.