Acute Mountain Sickness
This triple trek odyssey that we have been enjoying for the last 16 days has been perfectly sculpted to give our little team perfect acclimatisation to altitude. It would have been easy to have taken the same three treks and shuffled them in order to create acclimatisation chaos.
Our first mini trek into the Tamang area was dubbed the ‘boot camp’ as up and down it went topping out at just over 3,000m. Each night we slept lower than the maximum height attained during the day.
Mini trek two took us up the Langtang Valley with a perfectly placed acclimatisation day at 3,600 before spending a night at 4,000. Folk then had the opportunity to scamper to 5,000m if they felt suitably acclimatised.
Mini trek three would have been a nightmare had we not have been pre-acclimatised and we came across three groups that had got it wrong. The trail climbed inexorably from 1,700m to 4,600m with nights spent at 2,700m and 4,300m. Despite the steep and rapid ascent our little team suffered no AMS symptoms.
A solo trekker a day ahead of us had an uninsured helicopter evacuation from 4,300m. He had pushed on up with a worsening headache and then become confused and collapsed. He didn’t have a guide or a companion so others summonsed the helicopter using their satellite communications thus taking the decision out of his hands. They probably saved his life and cost him a fortune!
A German trekker and his guide became unnerved by the helicopter event and made a dash for the valley the next morning as he had some AMS symptoms through the night.
On the other side of the pass we met another solo trekker with only the haziest notion of the route, the altitude profile and her ability to acclimatise. Wisely she turned around her trekking plans having come to naught.
The difference between a trekker’s delight and a trekker’s disaster is easy to predict but appears, so often, to be overlooked.
It frustrating that these simple lessons have not yet been learned. Twenty seven years ago MEDEX was formed after witnessing a trekking tragedy. A French commercial group ignored medical advice and did not evacuate a deteriorating member but, instead, allowed him to die in the night.
Every time we have been back in Nepal since then we have witnessed altitude related disaster that could, and should, have been avoidable.
In the Himalaya a German Expedition using a lowland cook provided no facilities to evacuate him when he was overcome by pulmonary oedema.
On the Mera La a Japanese climber, abandoned by her team and guide, ignored strident requests from others to retreat and died quietly in the night.
We have encountered countless other teams and individuals requesting medical assistance without so much as a please or a thank you.
Since 1992 we have published umpteen papers, setup the Diploma in Mountain Medicine, written and distributed thousands of copies of our booklet, ‘Travel at High Altitude’, and published it in 14 languages.
Despite all of this, in the last two weeks, we have seen examples of ignorance and stubbornness and seen the impact of this on others. Our trek staff had to assist in the evacuation of a stricken, unsupported trekker. These altitude related events remain common.
What has changed is the knowledge base and experience of the various Sherpa Guide teams who are well accustomed to detecting AMS in their clients and know that DOWN is the only answer. It is a shame that their advice so often gets ignored.
To complicate things further the last decade or more has seen an epidemic of helicopter fraud in Nepal. Corrupt Lodge owners, trekking guides and even hospitals have colluded with helicopter companies to summon unnecessary evacuation.
Some scammers have even taken this further by deliberately creating illness within their groups in order to summons a helicopter and receive the backhander.
No doubt individual trekkers have used insured helicopter evacuation as a taxi service to escape the privations of a hard trek.
It seems to me that that the solo, unsupported trekker is most at risk from altitude in that they may have arranged their trek permit in Kathmandu without considering the profile of the trek and matching it against the time they have available. They will not have a Guide to act as their guardian angel and will need to rely on the charity of strangers to get them out of a hole should they succumb to AMS or worse. If the scams continue they will be more at risk than others from unscrupulous lodge owners and they could end up paying huge helicopter costs for which they may well not be insured.
Maybe MEDEX should set its sights on the solo, unsupported trekker as a particularly vulnerable group?