Lack of knowledge about altitude-related health problems in high-altitude travelers is a significant risk factor for altitude sickness. A recently published international consensus on what high-altitude travelers need to know makes it possible to evaluate current knowledge using a questionnaire.(Berendsen et al., 2022) Our project (STAK@Home and STAK@Alps) aims to survey current knowledge about high-altitude medicine among mountaineers.

The project is divided into two parts: an online questionnaire for alpinists from Alpine associations in Europe and an on-site questionnaire at the Gnifetti hut in the Italian Alps and Pheriche in the Himalayas.

We hypothesize that there is a lack of knowledge among high-altitude travelers about the hazards of high-altitude exposure, with a potential impact on the prevalence of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). In STAK@Alps we expect that less than half of the alpinists staying overnight in the huts of the Monte Rosa massif (>3.000m) have adequate knowledge (a sufficient score on the questionnaire). In STAK@Home we expect the knowledge about to be the same. The project's main objective is to establish a baseline inventory of the state of knowledge about altitude-related illnesses among high-altitude travelers (laypersons) using the international STrengthening Altitude Knowledge (STAK) consensus as the yardstick. This will provide the basis for developing strategies to improve knowledge.

The pilot of this observational cohort study is in the Monte Rosa massif. Anyone staying overnight at altitudes above 3.000m should be knowledgeable about altitude-related health problems and their management. Therefore, we will introduce a questionnaire to determine the level of knowledge among alpinists at altitude.

The main exclusion criterion is the inability to read and understand the questionnaire in one of the languages offered (German, French, English, Italian, Spanish, Nepali, and Dutch). All questions are accompanied by a Likert scale asking the degree of certainty for the response. The questionnaire will be offered to all mountaineers/travelers older than 16 years and willing to participate. The questionnaire will be available online with a smartphone or a tablet. The final dataset will be analyzed by looking at overall and individual item performance. Question quality will be assessed by correlating every question to overall performance and the personal score will be based on an absolute caesura.

Additional information to the questions:

• BORG scale
• LLSRS

STAK is dedicated to equipping altitude travelers and mountaineers with critical medical knowledge to significantly reduce the risks of altitude-related illnesses and enhance their safety and well-being in high-altitude environments.