Food and Water Defense – Insights from the Russia-Ukraine War for (Highly) Mobile Food and Drinking Water Testing

Nicole Meier^a, Bernd Klaubert^a

^a Central Institute of the Bundeswehr Medical Service Munich

Abstract

The Russian invasion of Ukraine is currently one of the most severe conflicts in Europe, with far-reaching consequences for nature and the environment. Troop movements, extensive artillery use, infrastructure destruction, and abandoned military equipment all contribute to the release of significant amounts of environmental contaminants. Additionally, the physical, chemical, and biological properties of the soil are impaired with considerable consequences for agriculture and food quality. There is also the risk of radioactive emissions from nuclear power plants. Adverse effects (contamination) and their health impacts can be identified through the food chemical A/C protection. For this purpose, highly mobile analytical capabilities are available with the food and eco-chemical field laboratory. This review aims to identify and summarize the current literature on the release of environmental contaminants through military activities during the Russia-Ukraine War. Based on current data on water contamination levels and pollutant inputs from Ukrainian food, specific questions can be derived to expand the performance spectrum of the mobile food and eco-chemical laboratory container. The focus here is on potential challenges in national/alliance defense or comprehensive national defense. The literature review indicates that the Russia-Ukraine War has a significant impact on food and water quality, for example, through attacks on water resources and infrastructure. Water contamination with explosives, heavy metals, and radionuclides poses a real threat. Mobile field laboratories enable rapid assessment of any toxicological effects. Answering whether consumption is safe thus makes an essential contribution to preventive health protection.

Keywords: Food and water safety, food chemical A/C protection, preventive health protection, mobile analytics, Literature review

Introduction and Background

In light of insights from the war in Ukraine, it must be assumed that chemical and radiological threats significantly jeopardize food and drinking water safety. Among the most endangered areas are drinking water and the associated water infrastructure. The literature reports on both the role of water as a driving force in conflicts and the impacts of armed conflicts on water and water systems. The open-source database “Water Conflict Chronology” by the Pacific Institute currently includes over 1600 entries in three categories (Figure 1):

(1) Water as a “trigger” (control over access to water),

(2) Water as a “weapon” (water is used as a weapon),

(3) Water as a “casualty” (direct attack on water systems).

Since the start of the Ukraine-Russia War, 64 entries have already been recorded in the categories of water as a “weapon” (10 times) and as a “casualty”(54 times) (see Figure 1) [9]. Additionally, water resources are often threatened by so-called collateral damage, such as pollution from military operations. In the first three months of the war alone, reports were registered of damage to dams, flooded mines, mined areas, interruptions to water supply, water transport, wastewater treatment, surface water pollution, bacterial contamination, and the risk of radioactive contamination [13]. Impairment or contamination of drinking water and food, as well as the resulting health consequences for soldiers, can have significant impacts. Through food chemical A/C protection, such risks can be identified and assessed. For this purpose, highly mobile analytical capabilities are available with the food and eco-chemical field laboratory. The objective of this review was to identify and summarize current literature on the release of environmental contaminants due to military activities in the Russia-Ukraine War.

Method

In April 2024, a comprehensive search was conducted in relevant scientific databases for this literature review to identify and summarize existing data and publications on environmental contamination in the context of the Russia-Ukraine War. The databases used included PubMed and Google Scholar to ensure broad coverage of the relevant literature. Both original publications and review articles were considered. Additionally, publicly accessible data from Ukraine was incorporated into the discussion. Through the analysis of current literature and data from Ukraine, specific questions can be derived to expand the performance spectrum of the food and eco-chemical laboratory container. The focus is on potential challenges in national/alliance defense or comprehensive national defense.

Results

Overview of Risks Leading to Water Pollution

The impairment of the physical, chemical, and biological properties of the soil due to military activities leads to significant consequences for agriculture and the quality of cultivated food. Physical/chemical contamination of water and food can be attributed to the following causes:

• Large-scale fires
• Destruction of critical infrastructure (e.g., energy and fuel supply, water supply and wastewater treatment facilities, waste disposal systems)
• Damage to the chemical industry and nuclear power plants (release of „toxic industrial chemicals“ [TIC] or radioactive radiation)
• Remnants of bombs, rockets, and ammunition debris, or abandoned/sunken military vehicles and equipment
• Flooding of mines and tailings storage facilities (TSF)
• Contamination with chemical warfare agents or sabotage toxins (e.g., via „unmanned armed vehicles“ [UAV])

Overall, military actions can lead to unintentional contamination and associated health hazards. This differs from deliberate contamination of water and food with chemical warfare agents (CWA) or suitable sabotage toxins.

Fig. 1: Water-related events during the Ukraine-Russia War by year and type. (Data from <https://www.worldwater.org> [9])

Decommissioned Mines and TSF

A particular example of the endangerment of Ukraine‘s water resources is decommissioned mines and tailings storage facilities (TSF), which are facilities for storing liquid waste from various industries (465 TSF in 2019 [8]). In the Donetsk and Luhansk regions alone, there are 200 TSF storing 939 million tons of industrial waste [1][8]. A pump failure or intentional destruction of the TSF systems can lead to mine flooding, resulting in the release of toxic mine water. The toxins can seep into the groundwater, affecting entire areas [11]. A particular danger exists if the Oleksandr-Zakhid mine in Horlivka, where chlorobenzene and other carcinogenic toxins have been stored since 1989, or the Yunyi-Komunar mine, where the Soviet Union detonated a 0.3-kiloton nuclear bomb in 1979, are flooded [4][6].

Pesticides

Another serious problem for Ukrainian waters is small illegal landfills with expired pesticides in the soil from the Soviet era (“pesticide burials”). Ukraine is currently one of the world‘s largest consumers of pesticides (approximately 100,000 tons per year). In 2020, an estimated 8,230 tons of expired pesticides were stored in 650 depots nationwide. Explosions caused by bombing and the intentional flooding of agricultural land through dam explosions contribute to the release of stored pesticides into the groundwater [6].

Nuclear Power Plants (NPP)

During the Ukraine-Russia War, combat actions and artillery attacks have already occurred in areas surrounding the Chernobyl (NPP Chernobyl) and Enerhodar (NPP Zaporizhzhia) nuclear power plants. Both NPPs are located near rivers and large water reservoirs. Such a location carries the risk of radionuclide emissions into the environment and their rapid transmission to surrounding ecosystems [6].

Summary of Water Monitoring Data

Despite military activities, the state agency for water resources conducts monitoring of surface waters used for drinking and household purposes at designated monitoring points, where the military situation permits. Elevated concentrations of heavy metals mercury, copper, tin, manganese, and lithium were detected. Up to an 8.5-fold exceedance of mineral oil and mercury content was also detected at locations where they were not previously detected before the invasion [1]. In the Uda River, for example, a 20- to 58-fold increase in the insecticide cypermethrin and a 1.5- to 1.7-fold increase in levels of polycyclic aromatic hydrocarbons were measured. At the surface drinking water intake points in Kharkiv, the phosphate content increased 2.4 times, and the nitrite content increased 4 times. Due to inefficient operation of wastewater treatment plants following hostilities in the region (damage, power outages, etc.), at the surface drinking water intake points in Donetsk, ammonium levels increased 2.4-fold and nitrite levels increased 2.8-fold.

Additionally, limits for pesticides, polycyclic aromatic hydrocarbons, volatile organic compounds, and heavy metals were exceeded [16]. After rocket debris damaged fertilizer tanks, ammonia and nitrate concentrations were found in river water samples east of Lviv that were 163 and 50 times above standard limits, respectively [11]. As another example, data from Strokal et al. (2023) show that, due to damaged sewer lines and wastewater treatment plants, the inputs of painkillers, antibacterial agents, and microplastics into the Dnipro River increased by 2 to 34% in 2022 [15]. Due to the military situation, state monitoring, however, does not have continuous access to all relevant sampling sites. This creates the need to close the gap with military field laboratories, including associated (highly) mobile sampling teams.

Fig. 2: The Kakhovka Hydroelectric Power Plant and its associated dam on the Dnipro River were destroyed by an explosion early on June 6, 2023. Downstream, four cities and several dozen villages were largely flooded, resulting in numerous fatalities, and industrial and urban infrastructure was destroyed or damaged. Bacterial and chemical pollution, including mineral oil residues, heavy metals, and polychlorinated biphenyls, was detected in both the downstream area and the northwestern part of the Black Sea. The water supply to extensive agricultural areas, several large cities, and towns, as well as essential energy facilities, including the Zaporizhzhia Nuclear Power Plant, was interrupted [17]. Satellite images of the lower Dnipro River, taken by the Landsat-9 satellite on (a) June 1, 2023, and (b) June 9, 2023. (Source: https://earthexplorer.usgs.gov/)

Health-Relevant Parameters for the Food and Eco-Chemical Laboratory Container

Numerous reports exist on the contamination of water with various chemical compounds. The following list provides an overview of the relevant physical and chemical parameters. References/sources are given in square brackets.

• Ammonium [3][4][7][11][13][15]
• Pharmaceuticals (e.g., Diclofenac) [15]
• Chemical Warfare Agents (CWA) [4][14]
• Chlorobenzothiophen [10]
• Dioxins [7][10]
• Volatile organic compounds (e.g., chloroform) [7]
• Macro-/Microplastics [15]
• Mycotoxins [5]
• Nitrate [3][7][11][15]
• Nitrite [4][7][13][15]
• Oil/fuel residues [1][7][11][13][14][17]
• Perchlorate [10][11]
• Per- and polyfluorinated alkyl substances (PFAS)
• Pesticides (e.g., Triclosan) [6][7][13][15]
• Phosphate [15]
• Polycyclic aromatic hydrocarbons (PAH) [4][7][10][13]
• Polychlorinated biphenyls (PCB) [10][17]
• (Poly)chlorinated naphthalenes [10]
• Radioactive compounds [1][3][6][10][14]
• Heavy metals [1–5][7][10][11][13][14][17]
• Explosives (nitroaromatics, e.g., TNT) [1][3][4][6][10][11][14]
• Sulfate [7][13]
• Toxic industry chemicals (TIC) [6][7][11]

Relevance of the Food and Eco-Chemical Laboratory Container

The current literature indicates that the Russia-Ukraine War has a significant impact on food and water quality, for example, through targeted attacks on water resources and infrastructure, or unintentional contamination resulting from military activities. The benefit of the food and eco-chemical laboratory container lies in the rapid assessment of potential acute toxicological effects from consuming water and food. The highly mobile sampling teams can also operate armed and close the gaps in civilian official surveillance. Due to high mobility and rapid deployability, statements about edibility or potential health hazards can be made directly on site. For the food and eco-chemical laboratory container, parameters not typically covered by civilian surveillance, such as explosive residues or CWA, are of particular interest. Based on the obtained information, the performance spectrum should be adapted to include the determination of TIC or pesticide residues. Additionally, data from satellite images („remote sensing data“) [12][14] or open-source tools can be utilized (Figure 3) to identify potential hazards and derive parameters for analysis.

Conclusion

The review offers insights into the contamination situation of water, food, and the environment in Ukraine, as well as its health impacts on daily life. Furthermore, the summary forms a basis for further developing the performance spectrum of the (highly) mobile food and eco-chemical laboratory container for future deployments within the framework of a national and alliance defense scenario or comprehensive national defense. The highly mobile field laboratories thus make an essential contribution to the preventive health protection of soldiers and ensure a health-safe supply for the troops.

References

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2. Gleick P, Vyshnevskyi V, Shevchuk S: Rivers and water systems as weapons and casualties of the Russia‐Ukraine war. Earth's Future. 2023; 11(10): e2023EF003910. mehr lesen
3. Harada KH, Soleman SR, Ang JSM, et al.: Conflict-related environmental damages on health: lessons learned from the past wars and ongoing Russian invasion of Ukraine. Environ health prev med. 2022; 27: 35. mehr lesen
4. Hryhorczuk D, Levy BS, Prodanchuk M, et al.: The environmental health impacts of Russia’s war on Ukraine. J Occup Med Toxicol. 2024; 19: 1. mehr lesen
5. Jagtap S, Trollman H, Trollman F, et al.: The Russia-Ukraine conflict: Its implications for the global food supply chains. Foods. 2022;11(14):2098. mehr lesen
6. Kitowski I, Sujak A, Drygaś M: The water dimensions of Russian–Ukrainian conflict. Ecohydrol Hydrobiol. 2023; 23(3): 335-345. mehr lesen
7. Matviichuk O, Yeromenko R, Lytvynova O, et al.: Hygienic assessment of potential health risks for the population of Ukraine and the Kharkiv region as a result of the deterioration of drinking water supply in the conditions of war. Med Sci. 2023; 5(56): 16-24. mehr lesen
8. Nikolaieva I, Lenko H, Lobodzinskyi O. Donbas Tailing Storage Facilities. Organization for Security and Co-operation in Europe; 2020. mehr lesen
9. Pacific Institute: Water Conflict Chronology. , letzter Aufruf 25. Juli 2024. mehr lesen
10. Pereira P, Bašić F, Bogunovic I, et al.: Russian-Ukrainian war impacts the total environment. Sci Total Environ. 2022; 837:155865. mehr lesen
11. Rawtani D, Gupta G, Khatri N, et al.: Environmental damages due to war in Ukraine: A perspective. Sci Total Environ. 2022; 850: 157932. mehr lesen
12. Serhii AS, Vyshnevskyi VI, Olena PB: The use of remote sensing data for investigation of environmental consequences of Russia-Ukraine war. J Landsc Ecol. 2022; 15(3): 36-53. mehr lesen
13. Shumilova O, Tockner K, Sukhodolov A, et al.: Impact of the Russia–Ukraine armed conflict on water resources and water infrastructure. Nat Sustain. 2023; 6(5): 578-586. mehr lesen
14. Solokha M, Pereira P, Symochko L, et al.: Russian-Ukrainian war impacts on the environment. Evidence from the field on soil properties and remote sensing. Sci Total Environ. 2023; 902: 166122. mehr lesen
15. Strokal V, Kurovska A, Strokal M: More river pollution from untreated urban waste due to the Russian-Ukrainian war: a perspective view. J Integr Environ Sci. 2023; 20(1): 2281920. mehr lesen
16. Ukraine SAfWd: ÜBERWACHUNG UND UMWELTVERTRÄGLICHKEITSPRÜFUNG DER WASSERRESSOURCEN DER UKRAINE. , letzter Aufruf 25. July 2024. mehr lesen
17. Vyshnevskyi V, Shevchuk S, Komorin V, et al.: The destruction of the Kakhovka dam and its consequences. Water Int. 2023; 48(5): 631-647. mehr lesen

Manuscript Data

Citation

Meier N, Klaubert B: Food and Water Defense – Insights from the Russia-Ukraine War for (Highly) Mobile Food and Drinking Water Testing. WMM 2025; 69(10-11E): 7.

DOI: https://doi.org/10.48701/opus4-763

For the Authors

Captain (MC Pharm) Dr. Nicole Meier

Central Institute of the Bundeswehr Medical Service Munich

Ingolstädter Landstraße 102, D-85748 Garching

E-Mail: nicole1meier@bundeswehr.org

Descent of 2000 Meters in Five Minutes – Hands-on Training in the Altitude Climate Simulation Facility of the German Air Force

Markus Tannheimer ^a,b, Raimund Lechner ^c,d, Thomas Küpper ^e,f, Andreas Werner ^e,g,h

^a Section of Sports and Rehabilitation Medicine, University of Ulm

^b General and Visceral Surgery, ADK-Hospital Blaubeuren

^c German Society for Mountain and Expedition Medicine

^d Medical Service, Police of Baden-Württemberg

^e Institute for Occupational, Social & Environmental Medicine, RWTH Aachen

^f Faculty of Travel Medicine, Royal College of Physicians and Surgeons, Glasgow (U.K.)

^g Medical Group Occupational Medicine, Medical Support Center Munster

^h Institute for Physiology/Center for Space Medicine and Extreme Environments, Charité Universitätsmedizin Berlin

Abstract

Military operations at high altitudes are of significant importance, as approximately 85 % of all armed conflicts worldwide occur in mountainous regions. Above an altitude of 2,500 meters, the risk of acute mountain sickness (AMS) increases markedly. Soldiers are significantly more affected than civilian mountaineers. The hyperbaric rescue bag provides an effective emergency medical measure under field conditions. By creating an overpressure in an airtight chamber, a physiological descent of approximately 2,000 meters can be simulated, often leading to rapid clinical improvement.

Practical training is required for safe application. The Altitude Climate Simulation Facility at the German Air Force’s Center for Aerospace Medicine offers optimal conditions for this. It enables a realistic depiction of high altitudes (15,000 feet, equivalent to 4,572 meters) in a controlled and safe environment.

During a training course, the effect of the hyperbaric rescue bag is impressively demonstrated. The simulated descent and the associated rapid improvement of physiological parameters, such as oxygen saturation and heart rate, are immediately tangible to the participants. This hands-on training enhances understanding of the pathophysiology of altitude sickness and the handling of available emergency measures during military operations at altitude.

Keywords: Military operations at high altitudes, acute mountain sickness (AMS), hyperbaric rescue bag, Altitude Climate Simulation Facility, emergency medical training, physiological parameters

The Altitude Climate Simulation Facility of the German Air Force

The Altitude Climate Simulation Facility (ACSF) in Königsbrück, now operated by the Center for Aerospace Medicine of the German Air Force, has a long history in the training and research of flight physiology [18][19], dating back to its use by the National People’s Army of the former German Democratic Republique [17]. Since its commissioning in 1987, it has been used to specifically prepare flying personnel for the effects of oxygen deficiency (hypoxia) and altitude conditions (low pressure). These measures are an essential component of flight safety [4]. Over the years, the chamber has undergone several modernizations to meet the latest technological standards [5]. The chamber is equipped with comprehensive safety measures to respond in an emergency quickly. Trained personnel can immediately intervene if complications occur during training. The HKS is a unique facility in Europe. It is not only used for military purposes but can also be utilized for scientific cooperation and research in the civilian sector.

Performance Data and Functions

The ACSF is a technical facility that enables the realistic simulation of the physiological effects of low pressure (altitude simulation) and, to some extent, climatic conditions (air temperature and humidity) on the human body. With a length of 6.60 meters, a width of 3.70 meters, and a height of 2.20 meters, the chamber is large enough to train six people simultaneously. Depending on the profile, longer simulations (up to 21 days) can also be conducted [10]. For safety reasons, an interior companion is generally present during ascents in the chamber, who is permanently supplied with 100 % oxygen as a paramedic or emergency medical technician and can intervene appropriately in case of complications until the pressure in the chamber has returned to ground level and further medical measures can be initiated. Additionally, a smaller chamber (with two seats) is attached to the main chamber to simulate rapid decompression.

Key Data of the ACSF

1. Altitude Simulation: In the ACSF, low pressure can be generated, equivalent to an altitude of up to 82,000 feet (≈ 25 km). This is well above the maximum flight altitudes of military aircraft (≈ 55,000 feet).
2. Climatic Ranges: Temperatures between 15 and 50°C and humidity between 30 and 80 % relative humidity can be generated in the chamber, which is of great importance for testing equipment and technical devices. In the small chamber, temperatures as low as -45°C can be generated, although this involves dehydrated air.
3. Hypoxia Training: One of the primary training objectives in the HKS is the simulation of oxygen deficiency (hypoxia), which becomes increasingly prevalent at altitude due to the reduction in O₂ partial pressure. Flying personnel can recognize their individual symptoms of oxygen deficiency here in a safe environment and learn how the symptoms change with the use of oxygen masks.

Importance and Use

The ACSF in Königsbrück is one of the central facilities for training flying personnel of the Bundeswehr. Its main tasks include:

1. Pilot Training: Pilots are prepared in the chamber for the physiological challenges associated with high-altitude flights. In particular, they learn how to recognize the symptoms of hypoxia early and take countermeasures.
2. Aeromedical Research: The ACSF is used for scientific investigations into the effects of low pressure, temperature, and humidity on the human body. This also includes studies on altitude sickness, acclimatization, and the limits of human performance in this extreme environment.
3. Testing of Survival and Protective Equipment: Equipment for emergencies, especially breathing masks and oxygen systems used in the event of a sudden drop in pressure at high altitude, is tested in the ACSF. Real conditions can be simulated here to ensure that the equipment functions reliably under extreme conditions.
4. Emergency Scenario Training: The ACSF also allows training for emergencies, such as a sudden drop in pressure or failure of the oxygen system in an aircraft.
5. Altitude Medicine Training for Medical Personnel: This course was initiated at the request of foreign deployments by the Surgeon General of the German Medical Service, Lieutenant General Bernhard Nakath, MD, and by the Surgeon General of the German Air Force, Brigadier General (ret) Erich Roedig, MD, and took place almost annually until 2022.

Basics of Altitude Sickness and Hyperbaric Oxygen Therapy

Military operations at high altitudes are of great importance, as approximately 85 % of all armed conflicts worldwide occur in mountainous regions. Acute mountain sickness (AMS) occurs when the body is not given sufficient time to adapt to the lower oxygen partial pressure at high altitudes [13]. This can lead to headaches, nausea, fatigue, and in more severe cases, pulmonary or cerebral edema [7][14]. The susceptibility of soldiers to altitude sickness is about twice as high as that of civilian mountaineers [16]. In such symptoms, especially in severe forms, the best therapy is immediate descent [6]. However, this often cannot be carried out due to the patient‘s condition, adverse weather conditions, poor lighting and visibility, challenging terrain, or lower camps that have already been dismantled, thus lacking necessary infrastructure [3][9]. In the military context, mission fulfillment and the military threat often do not allow for descent [8].

The hyperbaric rescue bag offers a mobile option for an initial and temporally limited treatment option [2], enabling an artificially created overpressure environment to increase oxygen availability in the breathing air. Although the patient remains at the exact location and terrestrial height, they are „transported“ to a lower altitude level, which physiologically corresponds to a descent.

Functionality of the Hyperbaric Rescue Bag

A hyperbaric rescue bag operates on a simple principle: the patient is placed in an airtight bag, which is then pressurized using a pump. This significantly reduces the simulated altitude inside the bag by about 1,500 to 2,500 meters, increasing oxygen availability for the patient. This provides quick relief from altitude sickness symptoms, especially life-threatening forms such as high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE) [9][15].

The most commonly used models are the Gamow Bag^®and the CertecBag^®. Another model, the PAC Bag^®, according to the Australian manufacturer, is not delivered in Europe and has the design disadvantage that patients must be slid in lengthwise, which is extremely difficult if a patient cannot actively cooperate. The following discussion, therefore, focuses on the first-mentioned models:

Gamow Bag^® : This is a widely used, robust hyperbaric bag manufactured by Chinook Medical Gear Inc. (USA), which has been in use for decades. It has proven to be a reliable option for treating AMS, HAPE, and HACE. It can be inflated relatively quickly (in about 2 minutes) and allows the simulated altitude to be reduced by up to 2,000 meters. Due to the numerous crossing straps, it can be challenging to place non-cooperative patients into the bag.

CertecBag^®: This model by the French company Certec is characterized by its lightweight design and ease of handling, making it particularly attractive for mountaineers and expedition teams. The CertecBag^® is also more compact than the Gamow Bag^®, which can be advantageous in extreme ventures where weight and pack size are critical. There are two variants with different internal pressures (180 mbar and 220 mbar), each achieving a greater reduction in simulated altitude compared to the Gamow Bag. During the course in the ACSF, we used the 180 mbar (Trekking) variant. The exemplary calculations (Figures 3 and 4) were performed with the 220 mbar variant (MAM’OUT).

Recommendations of International Professional Societies

Leading professional societies such as the International Society for Mountain Medicine (ISMM), the Union Internationale des Associations d’Alpinisme Medical Commission (UIAA MedCom), and the Wilderness Medical Society (WMS) recommend the use [1][11][12] of a hyperbaric rescue bag in cases where descent is not immediately possible [6]. Typical symptoms for its use include severe headaches, vomiting, signs of pulmonary edema (e.g., shortness of breath and performance decline), or neurological symptoms such as confusion [9][15]. The recommended duration of treatment varies but typically ranges between 1 and 2 hours per session [11]. Repeat sessions may be necessary, especially if circumstances continue to delay descent. Rapid improvement of symptoms is often expected after 30–60 minutes. This should ideally be used to assist with descent with the patient, if possible, or to transport them [3].

Application of the Rescue Bag

To perform the procedure, the patient is placed in the rescue bag, which is then sealed and pressurized using a pump until the integrated pressure valve opens. Pumping must continue to supply the patient with fresh air. Mountaineers have died due to insufficient air supply and CO₂ buildup because the group failed to continue this maintenance pumping. The patient‘s condition should be regularly monitored during treatment. Ideally, a pulse oximeter is attached to the patient, and a barometric altimeter is included in the rescue bag for success control [11]. Additionally, therapy in the bag can be supplemented with oxygen insufflation and medications against altitude illness. Sufficient insulation from the ground should also be ensured. Since significant nausea often exists, a bag for potential vomiting during therapy should be provided to the patient. If available, decongestant nasal drops can be applied beforehand to facilitate pressure equalization. Continuous psychological support of the life-threateningly ill patient and constant monitoring through the viewing window are self-evident. Even though the principle is simple, practice is required for practical application [11], primarily since real-life application situations are often associated with high stress and the patient‘s companions usually also experience altitude symptoms.

This training took place during the course „Altitude Medicine for Medical Personnel.“ The ACSF provided an ideal and safe, as well as a very illustrative and practical, demonstration for this purpose. This will be presented below.

Training and Testing in the HKS

During the “Altitude Medicine Course for Medical Personel”, participants experienced an oxygen deficiency demonstration at 15,000 feet (4,572 meters) in the HKS. In addition to tests for color vision and concentration ability, a hyperbaric rescue bag (CertecBag^®) was tested in practice. The handling was trained the day before. A course participant, equipped with a pulse oximeter and a barometric altimeter, lay down in the rescue bag. It was sealed and inflated by the other course participants, maintaining the fresh air supply thereafter (Figure 1).

Fig. 1: CertecBag (R hochgestellt), trekking version with 180mbar internal pressure (Origin of photo material: Raimund Lechner).

Once a relevant pressure had built up in the rescue bag through pumping, the altitude inside the bag dropped noticeably for the course participants, as observed through a viewing window on the barometric altimeter placed inside. With some delay, the subject‘s oxygen saturation increased by about 25 percentage points to nearly 100 %. The pulse rate, increased due to altitude hypoxia, decreased in parallel. Within just 5 minutes, a physiological descent of 2,000 meters was achieved. At the end of the demonstration, the pressure in the rescue bag was slowly released, and the chamber altitude was regained. During this process, the SpO2 dropped again, and the pulse increased (Figure 2).

Fig. 2: Use of the hyperbaric rescue bag (CertecBag^® Trekking) at 15,000 ft (4,572 m): Within 5 minutes, the person inside „descends“ physiologically by 2,000 m. Once a relevant pressure has built up in the bag, the SpO₂ increases by about 25 percentage points.

Discussion

The extent of the achievable physiological descent depends on the starting altitude and the rescue bag used. The higher the starting altitude, the greater the effect (Figure 3). There are also technical differences between the various hyperbaric bags, listed in Table 1, which affect the achievable descent altitude.

Tab. 1: Specifications of Gamow and CertecBag^®

Fig. 3: Comparison of Gamow and CertecBag^® (220 mbar version): The higher the starting altitude, the greater the descent effect; exemplary at 3,000 m: 1,450 m with the Gamow Bag vs. 2,200 m with the CertecBag^® or at 7,000 m: 2,130 m with the Gamow Bag vs. 3,175 m with the CertecBag^®.

Hyperbaric rescue bags are typically used at altitudes between 3,000 meters and 7,000 meters above sea level. Severe forms of altitude sickness are sporadic below 3,000 meters, and above 7,000 meters, the effort required for necessary pumping becomes so great that application is generally no longer possible. Since the internal pressure of the CertecBag^®is higher at 220 mbar than that of the Gamow Bag (138 mbar), a greater descent altitude is achieved with the CertecBag^®. At 3,000 meters, a descent of 1,450 meters is achieved with the Gamow Bag and 2,200 meters with the CertecBag^®. At 7,000 meters, a descent of 2,130 meters is achieved with the Gamow Bag and 3,175 meters with the CertecBag^®.

From a user‘s perspective, this does not play a significant role, as the descent altitude achieved with the Gamow Bag is entirely sufficient. For real descent, a descent of 300–500 meters or to the altitude of the last symptom-free night is recommended [2]. In life-threatening forms such as high-altitude pulmonary edema or high-altitude cerebral edema, a descent of at least 1,000 meters should be undertaken [6]. In the military context, for example, if the altitude relocation occurred through rapid air transport to altitude, even the Gamow Bag still has sufficient safety reserves.

Fig. 4: Inspiratory O₂ partial pessure achieved in the corresponding atitude in the Gamow Bag and CertecBag^® (220 mbar Version) compared to the natural environment.

Conclusion

Hyperbaric rescue bags are a fascinating example of how practically applied physiology can save lives. Although their application is fundamentally simple, user training is still required. For this, the ACSF in Königsbrück offers ideal conditions, as the technical handling of such a rescue bag can be practiced in a safe environment, and the impressive physiological effect can be experienced live. The visualization of increasing oxygen saturation, decreasing pulse, and real physiological descent significantly enhances learning success.

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Manuscript Data

Citation

Tannheimer M, Lechner R, Küpper T, Werner A: [Descent of 2000 Meters in Five Minutes – Hands-on Training in the Altitude Climate Simulation Facility of the German Air Force.] WMM 2025; 69(10-11E): 8.

DOI: https://doi.org/10.48701/opus4-761

For the Authors

Lieutenant Colonel (MC Res.) Prof. Dr. Markus Tannheimer

Department of General Surgery, ADK-Hospital Blaubeuren

Ulmer Str. 26, D-89143 Blaubeuren

E-Mail: m.tannheimer@adk-gmbh.de