PEOPLEHermann Brugger

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Hermann Brugger

Former Head of Institute
Institute of Mountain Emergency Medicine

T +39 0471 055 540

hermann.brugger@eurac.edu

https://orcid.org/0000-0003-2752-6929

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About

Hermann Brugger ha fondato l'Istituto di Medicina d'Emergenza in Montagna nel 2009 e lo ha diretto fino al 2022. È stato anche l'inventore del simulatore di clima estremo terraXcube, sviluppato presso Eurac Research a Bolzano, Italia.

Hermann Brugger era un medico di medicina generale per il Servizio Sanitario Nazionale in Alto Adige, Italia, e professore associato presso l'Università Medica di Innsbruck, Austria. Come medico d'emergenza, ha effettuato oltre 2.500 interventi di soccorso per i servizi d'emergenza e le squadre di soccorso alpino nelle Dolomiti. La sua ricerca si è concentrata su vari aspetti della medicina d'emergenza in ambienti montani e remoti, in particolare sulla medicina e fisiologia ad alta quota.

Ha curato numerosi libri e capitoli di libri, pubblicato oltre 350 articoli scientifici sulla medicina d'emergenza e sulla medicina ad alta quota ed è stato invitato come key note speaker a conferenze ed eventi internazionali. Brugger ha inoltre ricoperto il ruolo di presidente sia della Commissione Internazionale per la Medicina d'Emergenza in Montagna (ICAR MedCom) che della Società Internazionale di Medicina Montanara (ISMM). Appassionato alpinista e sciatore, ha scalato numerose vette in Europa, nelle Americhe e in Asia.

Scientific Publications

Journal article2026

Cold stress impacts cognitive performance in healthy volunteers: results from a randomized, controlled, cross-over study

Falla M, Masè M, Cappello TD, Micarelli A, van Veelen MJ, Roveri G, Brugger H, Hüfner K,

Marika Falla, Giacomo Strapazzon, Hermann Brugger, Giulia Roveri

Humans exposed to cold environments for leisure or occupational activities may experience cold stress. Cold-related physical and mental stress can negatively affect cognitive performance. A recent literature review has pointed out that a single acute exposure to cold under controlled laboratory conditions (e.g., cold air or cold water) induces cognitive impairment with attention, processing speed, memory, and executive function being the most affected cognitive domains. Males and females seem to respond differently to short-term cold exposure, although results are not consistent. The aim of the study was to investigate the effect of acute and brief (15 min) exposure to low ambient temperatures of -10 °C compared with 5 °C and 20 °C on selected cognitive performance (reaction time, processing speed, and risky decision-making). We hypothesized that cognitive performance decreases at low temperatures with a sex difference, before core temperature changes. This randomized, controlled, crossover study was conducted in an environmental chamber (terraXcube) under controlled, replicable, and safe conditions in twenty-four healthy volunteers, females and males, aged between 18 and 60 years. Measurements included Psychomotor Vigilance Test (PVT), Balloon Analogue Risk Task (BART), and Digit Symbol Substitution Test (DSST). Cognitive performance, stress, and cold were subjectively rated with a visual analogue scale (VAS). Physiological data (including core and skin temperatures) were continuously recorded with a physiological monitoring system. Data were analysed using repeated measures analysis of variance (ANOVA), Friedman test, Generalised Estimating Equations (GEE), and correlation analysis. We identified transient impairments in cognitive performance in individuals wearing appropriate clothing. Cold exposure (-10 °C) affected attention by slowing response times and increasing the lapses, and decision-making by reducing risky behaviour. Heart rate, cold sensation, and stress, as well as thermal sensation and comfort, but not core temperature were different in the three experimental temperature exposures. No differences were found between male and female subjects in their cognitive performance. Our data support the distraction theory in the decline of cognitive performance even during a short exposure to cold temperatures. Such impairment should be carefully considered in people performing different activities in cold environments, even for a short time.

DOI

DOI: 10.1038/s41598-026-38048-y

Journal article2026

Defibrillation in patients with accidental hypothermia and core temperatures ≤30°C – a retrospective observational study

Cools E, Blasco R, Paal P, Courvoisier DS, Zafren K, Brugger H, Rauch S, Walpoth B

Simon Rauch, Hermann Brugger

DOI

DOI: 10.1016/j.resuscitation.2026.110971

Journal article2026

Helicopter Rescue at Very High Altitude: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom) 2025

McLaughlin K, Shimanski C, Zafren K, Jackson I, Biner G, Folini M, Hermansky A, Ridington E,

Marika Falla, Giacomo Strapazzon, Hermann Brugger

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.

DOI

DOI: 10.1177/15578682251375408

Edited book2026

Mountain and High-Altitude Medicine

Berger MM, Berghold F, Brugger H, Burtscher M, Fischer R, Paal P, Schobersberger W, Sumann G

Hermann Brugger

ISBN: 978-3-662-73021-8

The standard reference work on Mountain and High-Altitude Medicine

Renowned mountain and high-altitude medicine experts from the German-speaking area and beyond provide a comprehensive overview of mountain sports, emergency medicine in the mountains and high-altitude medicine with this specialised book. The book covers all content for the 'International Diploma in Mountain Medicine' (DIMM) of the World Federation of Alpine Associations (UIAA), the International Commission for Alpine Rescue (ICAR), and the International Society for Mountain Medicine (ISMM), and is recommended by the Austrian Society for Alpine and High-Altitude Medicine (ÖGAHM) as well as the German Society for Mountain and Expedition Medicine (BExMed).

The book is a translation of the German third edition “Alpin- und Höhenmedizin”, which hast been extensively updated: new chapters have been added on pulse oximetry at high-altitude, neurological and psychiatric emergencies in the mountains, multiple trauma in the mountains, suspension syndrome, an new search and rescue technology in the mountains. Numerous other chapters have been updated and thoroughly revised.

The book is aimed at mountain physicians, sports medicine specialists, travel medicine physicians, medical personnel and physicians involved in emergency medicine and mountain rescue, and all physicians and professional groups interested in mountain and high-altitude medicine.

DOI Fonte

DOI: 10.1007/978-3-662-73022-5

Journal article2026

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

McLaughlin K, Roy S, Falla M, Strapazzon G, Luks AM, Zafren K, Brugger H, Musi M,

Hermann Brugger, Marika Falla, Giacomo Strapazzon

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. 00:00-00, 2025. 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.

DOI

DOI: 10.1177/15578682251365931

Journal article2025

A new approach to haemoglobin oxygen affinity research at high altitude: Determination of haemoglobin oxygen dissociation curves and 2,3-bisphosphoglycerate in an experimental human crossover hypoxic chamber study

Woyke S, Oberacher H, Plunser D, Siebenmann C, Turner R, Regli IB, Schlittler M, Strapazzon G,

Rachel Turner, Giacomo Strapazzon, Christoph Siebenmann, Hermann Brugger, Hannes Gatterer

Purpose: During rapid exposure to hypobaric hypoxia (HH), arterial oxygen tension and haemoglobin oxygen saturation decrease. The oxygen dissociation curve (ODC) describes the relationship of oxygen tension and haemoglobin oxygen saturation. Previous methods for ODC determination are mostly limited to standard conditions (40 mmHg PCO₂, 37 °C), and measurements of 2,3-bisphosphoglycerate (2,3-BPG) and adenosine triphosphate (ATP) are omitted. This study aimed to investigate hypoxia-induced changes on the ODC in a strictly controlled hypobaric chamber setting utilising a novel method for ODC determination, incorporating innovative 2,3-BPG and ATP measurements.

Methods: In a randomised crossover design, ten healthy males completed two 4-day sojourns, one in HH (3,500 m) and one in normoxia (NX, 262 m). ODCs were determined from venous blood at 96 h using a highly customisable high-throughput microplate reader method. Haemoglobin half saturation pressure (P50) was measured for a standardised CO₂ tension of 40 mmHg (P50_st) and individual end-tidal CO₂ tensions (P_etCO₂) (P50_act). 2,3-BPG and ATP were determined by liquid chromatography-tandem mass spectrometry.

Results: P50_st were increased in HH compared to NX but missed statistical significance (28.3 ± 2.0 mmHg vs. 26.8 ± 1.9 mmHg; p = 0.054), whilst P50_act was similar in HH and NX (26.4 ± 1.6 mmHg vs. 26.1 ± 2.7 mmHg; p = 0.360) despite reduced P_etCO₂ (31.0 ± 2.1 mmHg vs. 38.4 ± 2.5 mmHg; p < 0.001). 2,3-BPG and pH were significantly increased in HH compared to NX (16.8 ± 1.6 µmol/gHb and 20.5 ± 1.1 µmol/gHb, p < 0.001; 7.36 ± 0.01 versus 7.39 ± 0.02, p < 0.001).

Conclusion: The 2,3-BPG increase after 96 h in HH compensates the effect of hypoxia-induced decrease in P_etCO₂/increase in pH on the ODC.

DOI

DOI: 10.1007/s00421-025-05806-1

Inbook2025

Akzidentelle Hypothermie

Rauch S, Paal P, Brugger H

Hermann Brugger, Simon Rauch

ISBN: 978-3-662-69577-7

Im Gebirge ist die Kälteeinwirkung v. a. bei Nässe und Wind allgegenwärtig. Nicht nur beim Lawinen- und Gletscherspaltenunfall, sondern bei allen verletzten und erschöpften Bergsteigern kann im Winter wie im Sommer eine begleitende akzidentelle Hypothermie, d. h. eine ungewollte Körperkerntemperatur (KKT) unter 35 °C, vorliegen. Der Schweregrad kann im Gelände am besten anhand des Bewusstseinszustandes geschätzt werden. Wenn möglich, sollte zusätzlich die KKT gemessen werden, da die klinische Symptomatik sehr variabel sein kann. Die Unterkühlung reduziert den Sauerstoffverbrauch und erhöht damit die Überlebenschancen bei einem Herz-Kreislauf-Stillstand. Daher kann selbst nach längerem Herzstillstand und nach stundenlanger kardiopulmonaler Reanimation (CPR) das Outcome gut sein. Der Tod akzidentell hypothermer Patienten sollte nur dann festgestellt werden, wenn eine mit dem Leben nicht vereinbare Situation vorliegt. Im Allgemeinen gilt: „Niemand ist tot, solange er nicht wiedererwärmt und tot ist.“

DOI Fonte

DOI: 10.1007/978-3-662-69578-4_29

Edited book2025

Alpin- und Höhenmedizin

Berger MM, Berghold F, Brugger H, Burtscher M, Fischer R, Paal P, Schobersberger W, Sumann G

Hermann Brugger

ISBN: 978-3-662-69577-7

Namhafte Alpin- und Höhenmedizinexperten aus dem deutschen Sprachraum und darüber hinaus geben mit diesem Fachbuch einen umfassenden Überblick über die Sport- und Unfallmedizin im Gebirge sowie zur Höhenmedizin. Das Buch deckt dabei alle Inhalte zum „International Diploma in Mountain Medicine“ (DIMM) des Weltverbandes der alpinen Vereine (UIAA), der Internationalen Kommission für Alpine Rettung (ICAR) und der Internationalen Gesellschaft für Bergmedizin (ISMM) ab und wird von der Österreichischen Gesellschaft für Alpin- und Höhenmedizin (ÖGAHM), sowie der Deutschen Gesellschaft für Berg- und Expeditionsmedizin (BExMed) empfohlen.

Die dritte Auflage wurde ausführlich aktualisiert: Neu dazugekommen sind Kapitel zur Pulsoxymetrie in der Höhe, zu neurologischen und psychiatrischen Notfällen im Gebirge, zum alpinen Polytrauma und zum Hängesyndrom. Zahlreiche andere Kapitel wurden aktualisiert und eingehend überarbeitet. Das Buch wendet sich an Alpinärzte, Sportmediziner, Reisemediziner, Ärzte in der alpinen Rettung und alle an der Alpin- und Höhenmedizin interessierten Ärzte und Berufsgruppen.

DOI

DOI: 10.1007/978-3-662-69578-4

Journal article2025

Effect of cold environments on technical performance and perceived workload and stress during advanced medical procedures: a randomized controlled simulation study

Roveri G, Gamberini L, Borotto E, Eisendle F, Festi L, Brugger H, Strapazzon G, Rauch S,

Giacomo Strapazzon, Hermann Brugger, Giulia Roveri, Simon Rauch

Progetto: PNRR iNEST - Ecosistema interconnesso dell'innovazione del Nord Est

Background: Advanced medical procedures in prehospital settings are often performed in hostile environments, where cold temperatures may impair manual and cognitive performance. Although such procedures are essential in mountain rescue missions, the effects of cold conditions on their execution and associated workload and stress are unknown.

Objective: This randomized controlled simulation study evaluated differences in performance, perceived workload, and stress during the execution of three advanced emergency medical procedures under cold (- 20 °C) versus control (+ 20 °C) ambient temperatures. Additionally, the study examined the influence of operator experience on these outcomes.

Methods: Thirty-six members of the International Medical Commission for Alpine Rescue participated in a crossover study conducted at the terraXcube environmental simulator in Bolzano, Italy. Participants performed orotracheal intubation via videolaryngoscopy (OTI-VLS), mini-thoracostomy, and front-of-neck airway (FONA) procedures under both temperature conditions. Time to procedure completion, number of attempts, and perceived workload and stress (using the NASA Task Load Index and Visual Analogue Scale) were measured. Operators were categorized into high or low experience groups based on self-reported prior procedure frequency.

Results: Time to complete the procedures tended to be longer in cold conditions for all procedures, with the largest difference observed for OTI-VLS (14 s, p = 0.076). Success rates exceeded 90% on the first attempt under both conditions. Perceived workload and stress increased significantly in cold environments across all procedures, especially for less experienced participants. Experienced operators completed OTI-VLS and mini-thoracostomy significantly faster and reported lower stress and workload levels compared to their less experienced counterparts.

Conclusions: While cold environments had low impact on procedural time, they significantly increased perceived workload and stress among rescue personnel. Experience mitigated these effects, emphasizing the importance of tailored training programs to enhance both technical and non-technical skills in challenging conditions. While this study has explored the impact of temperature, it would be valuable to investigate how other environmental factors, such as wind and rain, might affect clinical actions.

DOI

DOI: 10.1186/s13049-025-01373-8

Journal article2025

Influence of esophageal temperature probe tip placement on core temperature measurement accuracy in cold environments: a randomized crossover trial with implications for cardiac arrest management

Roveri G, Dal Cappello T, Hofer A, Breidt F, Kofler O, Popp E, Brugger H, Rauch S

Tomas Dal Cappello, Hermann Brugger, Giulia Roveri, Simon Rauch

Progetto: PNRR iNEST - Ecosistema interconnesso dell'innovazione del Nord Est

Introduction

Accurate core temperature (CT) measurement is critical for staging and management in accidental hypothermia, particularly in cardiac arrest, where it guides extracorporeal rewarming decisions. Esophageal temperature monitoring is considered the reference method in the prehospital setting in patients with a secured airway, provided the probe tip is positioned in the distal third of the esophagus behind the heart. However, the effect of proximal misplacement on measurement accuracy remains unknown. We hypothesized that a probe tip positioned behind the trachea would yield falsely low readings during cold air exposure.

Methods

In this randomized crossover study (May 2024 at Eurac Research, Bolzano, Italy), healthy volunteers underwent nasal esophageal probe placement using a height-based formula. Two probe positions were defined via posteroanterior chest radiographs: correct (behind the heart) and incorrect (5 cm above the tracheal bifurcation). Participants were exposed to –20 °C for 20 min in a climate chamber, once with the probe in the correct and once in the incorrect position, in randomized order, separated by a washout period.

Results

Fifteen participants (7 male, 8 female) completed the study. Mean correct insertion depth was 41.1 (2.5) cm for males and 39.3 (1.5) cm for females. At baseline and throughout –20 °C exposure, mean CT was on average 0.6 °C lower when the probe was incorrectly positioned. Temperature fluctuations were also greater with proximal misplacement.

Conclusion

Proximal misplacement of esophageal probes during cold air exposure results in falsely low and more variable CT readings. This may critically affect triage and treatment, particularly in hypothermic cardiac arrest.

DOI

DOI: 10.1016/j.resplu.2025.101087

Inbook2025

Lawinenmedizin

Wallner B, Eisendle F, Strapazzon G, Brugger H, Rauch S, Paal P

Simon Rauch, Giacomo Strapazzon, Hermann Brugger

Schneelawinen entstehen im steilen, schneebedeckten Gelände. Sie stellen eine der bedrohlichsten Naturgefahren im winterlichen Gebirge dar, insbesondere für Wintersportler, welche sich im freien Gelände bewegen. Auch auf gesicherten Skipisten sowie in alpinen Siedlungsgebieten und auf alpinen Verkehrswegen können sich Lawinenverschüttungen ereignen.

DOI Fonte

DOI: 10.1007/978-3-662-69578-4_31

Journal article2025

The Effect of Automated Verbal Commands During Avalanche Transceiver Search on Acute Mental Stress and Arousal-A Mixed-Methods Crossover Field Study

Wallner B, Caramazza F, Woyke S, Winkler M, Regli IB, Mair P, Putzer G, Strapazzon G,

Hermann Brugger, Giacomo Strapazzon

Background: Companion rescue using avalanche transceivers can lead to a disproportionate increase in mental stress and arousal, which can negatively affect performance. The aim of this mixed-methods field study was to assess the effects of automated verbal commands on mental stress and affective responses.

Methods: Participants performed two search trials using avalanche transceivers with either verbal commands (VOICE) or without verbal commands (NO VOICE) in simulated avalanche rescue scenarios. The study assessed perceived mental stress with a visual analogue scale (VAS 1-10 points) and used the Self-Assessment-Manikin with 9-point Likert scales to measure affective response (valence, arousal, and dominance). Semistructured interviews were performed to assess the specific effects of verbal commands.

Results: Participants reported higher levels of mental stress after the trials than before the trials (-1.2 ± 2.3 points; p ≤ 0.001). A smaller increase (59.0 ± 8.2 s vs. larger increase [81.0 ± 11.5 s]) in mental stress, as detected in participants using VOICE navigation, resulted in shorter coarse search times. VOICE (Δ -1.2 ± 3.2 vs. Δ -0.6 ± 2.7 points; p = 0.041) showed a greater reduction in arousal, resulting in faster coarse search. In the qualitative interviews, the majority described VOICE navigation to be helpful. In the individual semistructured interviews, those subjects reporting a stress reduction through VOICE (38.5 ± 4.7 s vs. no stress reduction [107.4 ± 24.3 s]; p = 0.001) had a significantly faster coarse search time, and those who indicated VOICE to be helpful were faster in the coarse search (p = 0.013).

Conclusions: The study demonstrated that even a simulated avalanche rescue scenario results in increased mental stress levels. VOICE navigation may be an interesting option for companion avalanche rescue since it helps to reduce mental stress and arousal, thereby leading to shorter search times. The most significant limitation of the study was the setting of an experimentally created avalanche scenario, which cannot fully replicate all the environmental and psychological factors of a veritable burial situation.

DOI

DOI: 10.1002/brb3.70684

Journal article2025

Effect of cold environments on technical performance and perceived workload and stress during advanced medical procedures: a randomized controlled simulation study

Roveri G, Gamberini L, Borotto E, Eisendle F, Festi L, Brugger H, Strapazzon G, Rauch S,

Giacomo Strapazzon, Hermann Brugger, Giulia Roveri, Simon Rauch

Progetto: PNRR iNEST - Ecosistema interconnesso dell'innovazione del Nord Est

DOI

DOI: 10.1186/s13049-025-01373-8

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