SURVIVING EVEREST FOR CLIMBERS- How to

Other very important must reads!

• EATING FOR EVEREST

• ALTITUDE MEDICAL KITS AND RESCUE PROCEDURES

• GETTING EXPERIENCE WISE

• TECHNICAL TRAINING

• FITNESS TRAINING

Your best chance of survival on Everest will be through knowledge and awareness of your surroundings and the handling of a situation should things go wrong.  The ”what if factor” a good reason for hooking up with a qualified mountain guide certified in Wilderness Medical care and Mountain Rescue.

All mountains are unpredictable and sometimes terribly unforgiving to negligence. Beware! Take control of your situation on Everest like on any mountain; by being sensible and well prepared. 

  IMMUNIZATION    

1. General Information

Appropriate immunizations are vital for those entering foreign areas. Current recommendations for travelers are issued by the Centers for Disease Control and Prevention (CDC), published annually in Health Information for foreign travel. The publication contains vaccination and certification requirements for malaria and yellow fever on a country- by- country basis. It also includes the U.S. Public Health Service recommendations for difficult immunizations questions, such as immunization of infants and pregnant or lactating women, and specific recommendations for vaccination and prophylaxis for a wide variety of disorders. Travel Vaccinations for Nepal

EVACUATION   

1. General information

The mode of urgency of the evacuation should be appropriate for the problem. Calling for on-site evacuation (e.g., helicopter) versus evacuation a patient to care by foot or on a litter is decided upon in view of multiple factors, including:

• Severity of the illness or injury, including the psychological condition of the victim.

• Rescue and medical skills of the rescuers

• Physical and medical skills of the rescuers

• Availability of equipment and/or aid for the rescue

• Danger/difficulty of extracting the victim(s) by the various means available.

• Tim, a product of distance, terrain, weather (and the possible deterioration of the weather), and multiple other variables.

• Cost and Insurance- please refer to our policy. Mandatory rescue insurance is required to join a Peak Freak Expedition: Helicopter Rescue Insurance

        An evacuation deemed necessarily “urgent” considers the patient’s life or significant morbidity to be at immediate risk. These guidelines indicate “nonurgent” evacuation in cases where the patient requires further evaluation and treatment but is not at immediate risk for significant morbidity or death.

  Many insurance companies require permission prior to a helicopter rescue. Please discuss this with your insurer and make sure you leave the policy number and contact numbers with whom will be communicating on your behalf should an accident arise.

  AIRCRAFT LIMITATIONS:  Mt. Everest helicopter rescues

  Helicopters have various configurations, with different capabilities and different crew skill levels. All helicopters are adversely affected by increased altitude, high environmental temperatures, high wind, and heavy payload. The aircraft pilot makes the ultimate decision concerning flight operations. A helicopter must not fly into known icing conditions or into even moderate storm conditions. Winds more than 45 mph, night flights into mountains, and landing in high winds are extremely hazardous. Not all helicopters or pilots are capable of flying by instruments into cloudy or foggy conditions. More over, instrument flight rules (IFR) are generally used only for airport-to-airport transport, not flights to mountainous or wilderness destinations, and most EMS helicopters are not equipped for IFR. The expedition leader and ground crew must keep the helicopter crew updated on weather and other related conditions at the scene. Conditions are much different from the elevations they had started flight from.

  Any on-site personnel handling the patients must have some familiarity with helicopter operations. Helicopter landing zones are dangerous places. It is imperative to keep all nonessential personnel away from the area. If possible someone should be assigned to prevent people from approaching the aircraft. 

MYOCARDIAL INFARCTION, ACUTE CORONARY SYNDROMES, and CPR

  A.   Recognition of acute coronary syndromes

SYMPTOMS

1. Chest pain with or without radiation to the arm or jaw. Unstable angina pain will was and wane and may be relieved by nitroglycerin. Pain radiating to the back or stomach suggest inferior myocardial infarction (MI). MI pain will not be completely relieved by nitrates.

2. Nausea with both anterior and inferior MI. When associated with diarrhea is usually assign of impending shock with inferior MI and              represents vagal shock.

3. Shortness of breath usually represents acute anterior MI or acute lateral MI with acute mitral regurgitation.

4. Diaphoreses, which is present with both anterior and inferior infarctions.

Cardiovascular problems are risky business at altitude. One should speak to your doctor and make sure have all the information you need to help avoid and survive stroke or heart attack. The effects of altitude and thickening of your blood is extremely hard on the human heart and circulation, we recommend an aspirin a day to keep things flowing properly.  After that the best you can do is be in tune with your body and listen to it and communicate to your guide your feelings “often”.

  SPECIFIC SITUATIONS AND THE IMPLEMENTATION OF CPR

  A.    Hypothermia

2. Avalanche victims- breathless and pulse less victims of avalanches are usually dead from suffocation and/or blunt trauma. Hypothermia is often a compounding factor. Clear the airway, protect the cervical spine, and initiate rescue breathing and chest compressions (CPR) immediately.

1. If there is no pulse and core temperature is 32 Celsius or above, or burial is less than thirty minutes, continue CPR for twenty minutes. If successful with CPR, transfer to a hospital with an intensive care unit. If unsuccessful, stop CPR.
2. If the core temperature is below 32 Celsius and burial is longer than thirty minutes, treatment depends upon the presence of an air pocket (any space around the nose or mouth, no matter how small).

TRAUMATIC BRAIN INJURY

1. General Information

      Anyone with a blow to the head or face, whether blunt or penetrating, risks developing increased intracranial pressure (ICP) or intracranial hemorrhage (ICH). Because definitive management of increasing ICP or ICH is not possible in the wilderness, prevention of head injuries should rank high amount priorities. Prevention involves attention to safety and includes wearing an adequate helmet, approved for the specific activity being undertaken. It must fit the user and be held in place with a nonstretching chinstrap. The use of even a properly fitted helmet does not preclude the possibility of serious head injury, but it does reduce the risks. Chinstraps should not obstruct venous blood flow as the may cause increased ICP.

HIGH- ALTITUDE ILLNESS or AMS ACUTE MOUNTAIN SICKNESS   

1. General Information

      In unacclimatized persons ascending to high altitude, failure of the body to adapt to the stress of hypo baric hypoxia may lead to the cerebral and pulmonary syndromes of high-altitude illness. Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) refer to the cerebral disorders, and high-altitude illness affect large numbers of wilderness travelers and result in occasional deaths. Proper management requires early diagnosis and prompt intervention. Most importantly, preventative measures such as gradual ascent will allow time for acclimatization and prevent high-altitude illness. For more information on: Symptoms, treatment and prevention refer to: Acute Mountain Sickness

   HYPOTHERMIA

1. General Information

Hypothermia occurs when the body's ability to generate a conserve heat is overcome by heat loss. Acute hypothermia presents with a sudden drop in the body core temperature within a few house. This is usually caused by immersion in cold water or a sudden drop in ambient temperature combined with wind and precipitation. Chronic hypothermia is the result of a gradual drop in body core temperature over several hours. Most chronic hypothermia deaths occur when the ambient temperature ranges from 30 to 50F (-1 to 10C). Hypothermia is almost always preventable by minimizing heat loss via conduction, convection, radiation, and evaporation. Prevention includes:

•  Proper choice and use of clothing and shelter

• Avoidance of overexertion

• Staying dry (a combination of proper clothing and avoidance of overexertion)

• Staying well hydrated

• Maintenance of adequate nutrition

  FROSTBITE/IMMERSION FOOT

1. General Information

Frostbite is localized injury or death of tissue from exposure to subfreezing cold of the Himalayas and climbing Everest. The chance of damage is increased by:

Temperatures 24F (-4.5C) or below

• High winds

• High altitude

• Use of tobacco, alcohol, or other drugs

• Contact with heat-conductive materials, such a metal, water, or gasoline

• Overexertion, which produces frostbite include:

• Previous frostbite injury 

          Measures to help prevent frostbite include:

• Avoiding tight boots or too many pairs of socks in larger boots

• Preserving heat by keeping head, neck and face covered

• Wearing mittens instead of gloves

• Staying well hydrated

• Maintaining metabolic heat production with adequate caloric intake

• Keeping dry

• Avoiding direct skin-metal or skin-fluid contact

           Immersion foot (trench foot) is a cold weather, nonfreezing injury resulting from vasoconstriction of the arterioles with subsequent loss of heat and oxygen   supply to surface tissues. Prevention includes: 

• Avoidance of tightly fitting footwear

• Changing into dry sock regularly (at least once a day)

• Periodic (every four hours in extreme wet and cold conditions) air-drying, elevation, and massaging of feet to promote circulation.

 HEAT RELATED ILLNESSES

On Everest and most glaciers and mountains the temperature can go from -30C to +30C in a matter of minutes with rise and set of the sun. 

1. General Information

Heat-related illnesses comprise several conditions caused by exposure to hot environments, or intense exercise in moderate environments, that range from mild discomfort t life-threatening illness. Hypothermia occurs when heat stress on the body, from internal metabolic heat production and external sources, overcomes the hat dissipating capability of the body. Extreme or untreated hypothermia can rapidly become life-threatening.

Heat illnesses are preventable. Prevention includes:

• Acclimatization: The process by which the body adapts to heat exposure, acclimation is induced by a minimum of sixty to ninety minutes of exercise in the heat each day for one to two weeks. Initial adaptation occurs within a few days. The most significant change is an increase in sweat volume initiated at lower skin temperature. This increases evaporative cooling and result in a lower hear rate and core temperature for a given amount of work in the heat.

• Hydration with adequate fluid quantities. An acclimatized person can lose 1 litre of sweat during exercise. Relieving the thirst alone risks not maintaining full hydration. Start each work period by drinking 500 ml of water. At least 300-500 ml per hour is then likely to be required, and requirements may be higher with extreme exertion or seat loss. In extreme conditions, sweat loss may exceed gastric emptying, and intravenous fluids may be required. 

• Appropriate clothing: Dress appropriately in light-colored, loose-fitting clothing allowing maximum evaporative heat loss.

• Frequent rest: Rest frequently, especially before full acclimatization, preferably in shade during the hottest part of the day. 

• Maximization of evaporative cooling. Periodically dip clothing in water, if possible. 

• Physical fitness: This improves the rate and quality of acclimatization, but it does not provide heat adaptation by itself. The insulation of excess body fat reduces heat loss.

  FIELD WATER DISINFECTIONS

1. General Information

All surface water carries a risk of enteric illness due to ingestion of waterborne pathogens that include bacteria, viruses, protozoan cysts, and some parasitic eggs or larvae. Risk varies with geographic location. In North America, Giardia lamblia is the most common microbial contaminant, but  Campylobacter jejuni, enterotoxigenic E. coli, enteric viruses, and Cryptosporidium have caused outbreaks of illness. In developing countries, surface and tap water must be considered contaminated. In developing countries, surface and tap water must  be consdired contaminated. Potential microorganisms include protozoa (Entamoeba histolytica, Giardia lamblia, Cryptosporidium), bacteria (E. coli, Shigella, Vibrio cholerae, Salmonella, C. jejuni, V. parahaemolyticus), viruses (hepatitis A and other entereci viruses), or helmiths. Potable drinking water on Everest will be disinfected by boiling. 

Other methods used in mountains can be:

• Heat- Pasteurization to about 160F or (70C) kill all enteric pathogens within 30 minutes, and 185F (85C) is effective within a few minutes.

• Filtration

• Clarification

• Halogens

   ORAL FLUID AND ELECTROLYTE REPLACEMENT

1. General Information

Oral dehydration/electrolyte solutions (ORS) are useful in three circumstances when fluids and electrolytes may be lost in significant amounts. Large fluid losses is a problematic for Everest climbers at these extreme altitudes. Peak Freak's recommends supplements like Gatorade crystals to help deal with the problem.

• Heavy, prolonged exercise with high-volume sweat losses.

• Treatment of mild to moderate heat illness

• Illness with diarrhea and/or vomiting

   ANXIETY AND STRESS REACTIONS IN THE MOUNTAINS

1. General Information

Death on Everest!

Accidental injuries in the mountains particularly when severe, are accompanied by significant psychological distress in victims, other party members, and in rescuers. Panic and anxiety reactions are common in stressful situations. Other emotions, such as grief of depression, may also occur. The reactions of victims or witnesses may be so severe that their safety and that of other party members compromised. 

The incidents that generate strong emotions include serious injury or death of a fellow climber or bystander, multiple deaths or serious  injuries, serious injuries or death of a child, and incidents that attract unusual attention by the media. Having a person die in spite of diligent rescue efforts and intensive care is particularly stressful. An immediate stress reaction is normal, not a sign of psychological problems, and may have physical, emotional, cognitive, and behavioral components. 

On Everest there are many spiritual factors that come to play when a sherpa dies. The sherpas feel that a bad omen has been cast on the season and motivation can be hampered affecting all sherpas on the mountain. 

HIMALAYAN HIGH ALTITUDE SPECIALISTS since 1983