High Altitude Mountain Rescue 101 - Gamow bag - rope rescue

GAMOW BAG -made in the USA and the PAC (personal altitude chamber) made in Australia:

Altitude chambers are used to treat severe Acute mountain Sickness, and works especially well for the severe persistent headache at altitude. It is especially useful for the treatment of Cerebral Edema. The treatment of choice for pulmonary edema is oxygen and decent, but if this is immediately impractical then the gamow bag can be used to buy time.

The pressure chamber concept has been around for 20 years or more, yet the majority of independent mountaineers going to high altitudes do so without this essential piece of safety equipment. The PAC and Gamow bags are kept at the HRA (Himalayan Rescue Associations locations and Peak Freaks keeps one in our expedition kit at base camp.

The bags/chambers are an answer to the need for an effective, simple, durable, lightweight and affordable pressure chamber for the treatment of AMS.

Effective
The technology has been shown to be highly effective in the reversal of symptoms of AMS. Depending on the starting altitude, simulated descents of about 2000 meters (6000 feet) are achieved at the operating pressure of 2 PSI above ambient pressure.

The individual should be pressurized in the bag for one to two hours and then reassessed some 12 hours later for father treatment. Consult the manual for details about use. individuals going into the bag should also receive appropriate medication. For example, if the climber is vomiting or nauseous, then they should receive appropriate medication. For example, if the climber is vomiting or nauseous, then they should receive intramuscularly gravol before going into the closed confined space of the bag. Close contact would be maintained with the individual as the bag is very claustrophobic.

Acute Mountain Sickness (AMS)
As we ascend above 2500 metres (8000 feet) our bodies must acclimatize to the decreasing amount of oxygen available. Failure to acclimatize can result in AMS.
The symptoms of AMS may include any of the following: headache, fatigue, loss of appetite, shortness of breath, cough, dizziness, blurred vision, vomiting, etc. The intensity and severity of these symptoms will vary, but can very quickly become extremely serious and even fatal.

The only treatment for AMS is to descend to a lower altitude.

However, there are many situations where immediate descent is difficult if not impossible, due to the hazards of weather, lack of manpower, difficult terrain or geography such as a plateau.

PAC technology buys time and can stabilize or reverse severe symptoms of AMS before (or while) descent is undertaken.

Altitude Specific:

Diamox
Decadron
Adalat

Respiratory:

Ceftin/and or Biaxin
Codine (for severe cough)

Gastro-Intestinal:

Imodium
Cipro
Zantac
Gravol

Eyes:

Atropine
Tetracaine

Anti-inflammatory:

Motrin or Naproxen

Intra-muscular:

Morphine/ Gravol for severe pain
Decadron
Gravol (for severe vomiting)

Cold remedies

Colds often kill a climbers chance to summit. You can't heal at altitude. Climbers MUST bring an antibiotic as precaution.

AMS- ACUTE MOUNTAIN SICKNESS- Prevention and Treatment

ALTITUDE SICKNESS
Altitude Sickness, often known as Acute Mountain Sickness (AMS) is particularly an important consideration while trekking in Nepal. Altitude Sickness means the effect of altitude on those who ascend too rapidly to elevations 3000m. The initial symptoms of AMS are as follows:

Nausea, vomiting
Loss of appetite
Insomnia / sleeplessness
Persistent headache
Dizziness, light headache ness, confusion
Disorientation, drunken gait
Weakness, fatigue, lassitude, heavy legs
Slight swelling of hands and face
Breathlessness and breathing irregularly
Reduced urine output

These symptoms are to be taken very seriously. In case of appearance of any of the above symptoms any further ascend should be reconsidered; otherwise more serious problems may occur which can even cause death sometimes within a few hours. The only cure for the Altitude Sickness is to descend to a lower elevation immediately. Acclimatization by ascending to no more than 300 to 500 meters per day above 3000 meters and the proper amount of rest are the best methods for preventions of AMS.

CAUSE / FACTOR OF ALTITUDE SICKNESS

Less Oxygen
Low pressure ir Barometric Pressure
Rapid Ascent
Possible Dehydration
Hypothermia

TYPES OF ALTITUDE SICKNESS

AMS : Acute Mountain Sickness
HAPE: High Altitude Pulmonay Edema
HACE: High Altitude Cerebral Edema

SYMPTOMS
1. ACUTE MOUNTAIN SICKNESS

Mild symptoms feels like a hangover / not feeling well:
Headache
Fatigue / Tiredness
Nausea
Shortness of Breath
Loss of Appetite
Disturbance in Sleep
Dizziness

2. HIGH ALTITUDE PULMONARY EDEMA

Water in Lungs.
Increasing shortness of breath even at rest
Severe cough – Dry / productive
Very tired unusual fatigue while walking
High pulse rate, ie 110
Blueness of face, lip, fingernails – that means the inability of transporting oxygen into the blood.

3. HIGH ALTITUDE CEREBRAL EDEMA

Water in the head :
Severe headache
Vomiting
Walking like an intoxicated (ataxia)
Mental confusion / altered mental status
Irritable – does not want to be bothered by other people
Unconsciousness or coma
Test: tandem walking test, heel to toe step. Fall off from the line.

DECISION MAKING
Find out the mean problem ie at altitude. Assume all problems are altitude sickness unless proven otherwise.

If it is an altitude problem with mild symptoms, stay at the same altitude until the symptoms are completely gone. An example – take an aspirin tablet, try to go up but listen to your body. If symptoms are worsening, please do descend.

PREVENTION

Acclimatization – after a 1000m ascent, stay one more night for acclimatization.
Do not make a rapid ascend, don’t go too fast too high.
No alcohol, sleeping pills and smoking.
Drink more fluid 3-4 liters a day – clean water, boiled and filtered, or treated tea/coffee/soup/juice etc.
Do not carry heavy packs, 10-12 kgs ok.
Climb higher, always sleep lower.
Over 3000m, 300m ascent a day.
Never travel alone.

TREATMENT

Descent is the best remedy; please do not wait for the helicopter

Medicines:
i. Oxygen
ii. Diamox- for AMS – 125mg before dinner for sleeping problem if feeling suffocated. iii. Nafedipine - for HAPE
iv. Steroids/dexmethasone for HACE
v. Hyperbolic bag – Gammow bag

FOUR GOLDEN RULES

Awareness of Altitude Illiness
If you have mild symptoms, do not proceed higher. Take aspirin tablets.
If you have worsening symptoms, go down immediately.
Do not leave your team member behind unattended, either the trekker or the guide or a porter.

THREE IMPORTANT THINGS TO PERFORM

Go up slowly.
Drink plenty of fluids (at least 3 litres per day)
Before your trip, please refresh your knowledge about altitude sickness so that you can help yourself and others as well.