The goal of this observational study is to learn whether intravenous iloprost treatment for severe frostbite (grades 3-4) is feasible and safe when delivered in pre-hospital, remote high-altitude settings. The main questions it aims to answer are: * Is it feasible to initiate and deliver guideline-based intravenous iloprost for grade 3-4 frostbite at high altitude and what logistical barriers arise? * Does field-based initiation of iloprost increase tissue preservation and reduce amputations (compared to historical cases from similar settings)? Participants receiving Iloprost as part of a frostbite treatment will be followed up after discharge as well as 6, 12 and 18 months to assess tissue preservation and long-term sequelae from the initial frostbite injury.
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Proportion of frostbite presentations with severe frostbite (Grade 3-4) at Everest ER
Timeframe: from enrolment to the end of treatment at 1 week
Proportion of eligible severe frostbite patients who complete ≥1 field iloprost treatment round
Timeframe: From enrolment to 1 week after beginning of treatment
Time from thawing to initiation of iloprost treatment under field conditions
Timeframe: From enrolment to the end of treatment at day 1
Proportion of iloprost-treated patients with mild adverse effects during/after ≥1 treatment round in the field setting
Timeframe: From enrollment to the end of treatment at 1 week
Proportion of iloprost-treated patients with severe adverse effects during/after ≥1 treatment round in the field
Timeframe: From enrolment to the end of treatment at 1 week
Proportion of patients discontinuing field iloprost treatment (overall) and documented reasons for discontinuation
Timeframe: From enrolment to end of treatment at 1 week
Proportion of iloprost treatment discontinuations attributable to adverse effects in the field
Timeframe: From enrolment to end of treatment at 1 week
Qualitative description of logistical constraints and solutions from field notes and staff reports
Timeframe: From enrolment to end of treatment at 1 week
Frequency of logistical challenges during field iloprost implementation
Timeframe: from enrolment to end of treatment at 1 week
Proportion of logistical challenges resolved during the study period
Timeframe: from enrolment to end of treatment at week 1
Mean (SD) time from thawing to first iloprost administration (clinical charts/notes), stratified by logistical challenge status (none vs occurred), resolution status (resolved vs unresolved), and challenge category
Timeframe: From enrolment to end of treatment at 1 week