Climbing season is fast approaching. With years of practice in high-altitude medicine, Dr. Eric Johnson, an associate medical director with Global Rescue, is a globally recognized expert who has seen it all. He offers the following “rules of engagement” for Global Rescue members taking on challenges such as Everest, Island Peak, or Manaslu:
Rules of Engagement:
1.) Do Research
Especially if you are going above 8,000-10,000 feet, know the basics of your trip itinerary and ascent profile, and be prepared to prevent and manage potential challenges such as altitude sickness. Many websites provide valuable information, and Global Rescue has an earlier post from Dr. Johnson available here: “The facts of altitude sickness.”
2.) Never Ascend with Signs of Acute Mountain Sickness (AMS)
This is the most important rule! AMS is the most common type of altitude sickness and mimics hangovers and dehydration in symptoms. These symptoms include:
b. Feeling tired
c. Feeling lightheaded
d. Having no appetite
e. Trouble sleeping
f. Nausea and sometimes vomiting
When addressed, acute mountain sickness is not a life-threatening condition. Allow yourself to recover, either by stopping or descending somewhat until symptoms resolve. Dr. Johnson has never encountered a case in which acute mountain sickness prevented someone from completing his or her journey if prevention and treatment guidelines were followed. As long as those with symptoms are given time to recover, they can continue to ascend.
NOTE: Someone with AMS symptoms should NEVER be left alone to recover. If the group is moving on without an affected member, be sure there is a second person waiting with the member with AMS.
3.) Don’t Rush Your Trip
Many adventurers encounter problems only when they try to ascend too quickly. It is always worth the few extra days on the trail to ensure that your ascent goes safely – and more importantly, to prevent your illness from escalating to the point of requiring evacuation.
4.) It’s OK to get AMS; it’s just NOT OK to die from it.
Many people encounter problems because they do not accept that they may be suffering from acute mountain sickness. It is critical to understand, Dr. Johnson emphasizes, that “altitude has no respect for fitness” and that AMS can strike anyone. When it comes to AMS, physical condition is not a factor, and you cannot predict how your body will react to altitude. A Golden Rule of the Himalayan Rescue Association, Dr. Johnson shared, is that any illness “like the flu” that occurs is acute mountain sickness until proven otherwise.
NOTE: It is important to be aware of two more severe forms of altitude sickness, High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). HAPE and HACE are less common, but are more dangerous.
· HAPE symptoms: cough, difficulty breathing, shortness of breath, and signs of pneumonia are all symptoms of HAPE.
· HACE symptoms: stumbling or clumsiness, lethargy, and altered mental status, are all symptoms of HACE. As with the rule above, anyone who exhibits these signs or trouble walking should be treated as having HAPE or HACE until proven otherwise.
5.) Carry Medication
Diamox (Acetazolamide) can be used for the prevention or treatment of acute mountain sickness. Recently ibuprofen has also been proven to help treat AMS, and not simply the headache symptoms.
6.) Don’t Consume Alcohol
Because the symptoms of acute mountain sickness resemble alcohol hangovers, it is crucial to refrain from alcohol consumption in order to better recognize and attend to any AMS that may occur. In general, always aim to be in prime physical condition when ascending in any form, trek or climb.
7.) Have Evacuation Services
Dr. Johnson remarked that it should be mandatory, when participating in a trek or climb, to have a contracted evacuation service. Those who follow him up the mountain are, in fact, required to show proof of coverage should an emergency occur. While some trekking and/or climbing companies do not require this service, adventurers should be cautious of those that do not at least recommend the investment. Those companies may be one of the more than 2,000 companies in Katmandu alone that are attempting to take advantage of their customers, regardless of the health consequences.
It is critical to fully understand how to access your evacuation provider, and to have communication capability yourself, not relying on your guide. A satellite phone and your evacuation provider’s contact information should be on your person at all times.
Be cautious with the trekking company you use and don’t forget to get evacuation coverage!
Additional information about Global Rescue for climbers and trekkers can be found here.
If you’re headed to Sochi, it’s important to note new regulations that require non-Russian visitors to register with the Russian government all satellite phone SIMs.
According to a recent article, if you are a visitor to Russia, your satellite phone or terminal must be registered through iridium-russia.com as a visiting SIM card. Once registered, the SIM card may be used in Russian territory for a period of 6 months. If you expect to return a second time during that 6 month period, you do not need to re-register. If you return again after the 6 month period has expired, you must re-register for another 6 month period. The article notes that registering “can be thought of as getting a ‘VISA’ for your satellite phone.”
"Iridium satellite phones are International Telecommunication Union (ITU) approved, and Russia is an ITU member country. However they still require registration to be used in Russia," noted Andy Cool of Explorer Satellite Communications, Inc.
To register your SAT phone SIM, go to https://www.iridium-russia.com/.
Ski Racing Magazine highlighted our recent Q&A with Nolan Kasper in its January 13th issue. Enjoy!
Global Rescue, which will support the U.S. Ski Team at the Sochi 2014 Winter Games, recently caught up with Nolan Kasper about coming back from his knee injury, his goals, and how he manages to hit the books when he’s not hitting the slopes.
How are you feeling after last season’s knee injury?
Right now, everything is feeling great. After a few summer/fall camps, I’m fully confident with my knee and solely focusing on my skiing.
Can you tell us about your training regimen as Sochi nears? Are you training any differently post-injury?
The only thing that’s different about my training post injury is that I had to take things a lot slower before getting into gates. Other than that, I am on the same program as the rest of the team.
Do you have any injury prevention advice for up-and-coming ski racers?
No injuries are completely preventable, but being strong and in great shape going into the season is a good way to minimize the risk.
2011 was a breakout season for you. Did you see that coming?
During the season, I knew that I was skiing well and just needed to be more consistent. Once I took a step back and started finishing, I had great results and eventually landed on the podium in Kranjska Gora.
What are your goals for this season?
My goals for the season are to compete without pain, finish the whole year without injury, and continue to improve throughout the season.
How do you think the Sochi games will compare to the 2010 Games?
I’m not sure how the Sochi games will compare to Vancouver because I haven’t been up to Sochi yet. Hopefully I’ll find out in February.
You’re currently enrolled at Dartmouth. How are you finding the ski/school balance?
Taking courses at Dartmouth in the spring is a great way to shift gears after the season and unwind for a few months. It allows me to focus on something else so that once summer training comes around, I’m ready to go.
We would like to share a selection of recent Global Rescue media coverage highlighting the work we are doing to support the U.S. Ski and Snowboard teams at the Olympic Games in Sochi, Russia.
For the last eight years, the U.S. Ski and Snowboard Association (USSA) has relied on Global Rescue to provide life-saving medical advisory, evacuation, security and other critical emergency services to skiers, their families and elite athletes. We will continue to provide these essential services during the Olympics.
If you have plans to travel to the Sochi Games or other locations where our services might be needed, please don’t hesitate to contact us.
Global Rescue Team
USA Today, January 8, 2014
“Sochi Crisis Team Ready”
ABC World News with Diane Sawyer, January 9, 2014
CBS This Morning, January 10, 2014
“Olympic Terror Fears”
Photos courtesy of Martin Kosich
An experienced skier who has skied in Switzerland for several weeks every year for decades, Global Rescue member Dr. Martin Kosich never imagined he would need to be evacuated from that country in early 2013 due to a freak skiing accident.
“I’ve been skiing for 30 to 40 years, and then this happened. I’ve had no incidents at all until this one,” said Martin. “My wife and I both bought Global Rescue memberships at the Safari Club International convention a few years ago, never thinking that we’d really need it. We travel to Africa frequently and decided that it was about time. As we get older, the law of averages will catch up with us. The price seemed reasonable, especially the cost for membership including security rescues. We do travel quite frequently to so-called ‘dangerous places’ that are politically unstable, so I had no real objection to spending money for something that appeared so comprehensive. Little did I know just how comprehensive a Global Rescue membership is.”
The accident occurred in Zermatt, Switzerland, when the edge of Martin’s ski inadvertently caught on ice. His binding did not release and Martin went down on the ice, hitting his left hip and sustaining a comminuted fracture, with bone crushed in multiple places. He was in a great deal pain, more than he had ever experienced in his 73 years. As a retired surgeon, he understood that with a fracture so serious in nature, he could “bleed out” into the hip. His leg was swelling quickly.
“My wife got out her Global Rescue card and immediately called the number on the back. Without one bit of hesitation, Global Rescue said, ‘Ok, we’ll send a team to help! We’ll be there.’ It was like magic. A helicopter arrived and before I knew it, I was landing on the roof of a hospital in the Swiss town of Visp. It was 25 minutes from the accident site, which occurred at 12,000 feet and was a 2 ½ hour non-stop ski run to the nearest town.
“I would not have been able to make that trip in a rescue sled, bumping along down to town then riding a couple of hours to the nearest hospital. I would have ‘bled out’ by that time and would not be here to tell the story. There are no words to express the angst that was taken off my mind and body by Global Rescue’s performance. I was in a strange country thousands of miles from home, unable to communicate and not knowing where to go or what to do.”
Martin’s fall happened mid-morning and within hours he was in the operating room, where doctors performed surgery. Global Rescue deployed two critical care paramedics to Martin’s hospital bedside.
“It was a great thing. These able-bodied and knowledgeable Global Rescue paramedics came immediately to my room. They introduced themselves, briefly examined me mentally and physically, and went right to work collecting all of the accumulated medical records. They met with the medical staff and reported it all back to me and to Global Rescue’s team of doctors for their assessment and development of a plan for my recovery.”
Once Martin had gained enough strength -- he had lost better than three-quarters of his blood – he was deemed fit to be transported home.
“Because Global Rescue’s paramedics had spent a great deal of time with me in the hospital, they learned from our conversations about my love of German food. On my last night in the hospital, the paramedics really surprised me by bringing a warm lamb dinner, my favorite dish, from a local diner. That really gave me the strength I needed.”
Global Rescue had coordinated Martin’s transportation by ambulance from the hospital to the airport, with Global Rescue’s paramedics accompanying him every step of the way.
“My wife felt enough confidence in Global Rescue’s paramedics to be able to bring herself to leave with our ski group, at my insistence. Global Rescue kept in constant contact with my wife during this whole episode, keeping her informed of our progress and position. When we left Lucerne, they told her they’d call from Heathrow in London. My wife appreciated that.”
Once the flight arrived in New York, the paramedics successfully drove five hours through a blizzard and delivered the member to the Columbia Hospital in New York, where his admission had been pre-arranged.
“We arrived about midnight and the paramedics placed me on a gurney, took me to my room, placed me in bed then said ‘mission complete.’ They shook hands and departed.”
Martin, who is finally walking without a crutch, expressed his appreciation for the Global Rescue paramedics and everyone at Global Rescue’s operations centers who contributed to his successful repatriation.
“It’s all because of Global Rescue. It was well worth the money and way beyond it. Global Rescue’s performance was terrific. I can’t say enough about it. Without Global Rescue, I wouldn’t be here today.”
When a medical emergency strikes far from home, attempting to make the best possible decisions for your own health or a loved one’s health can be challenging, even terrifying. Recently a Global Rescue member wrote to share her appreciation of Global Rescue in a time of need:
This past April, my husband and I needed the services of Global Rescue. Your team was extraordinary.
In April, we met friends in Bangkok for our long-anticipated trip to Bhutan. Unfortunately, my husband, Bob Corbin, had developed a fever and a urine infection while still at home in Los Angeles. Because of a misdiagnosis, we left on the trip, not knowing that the true diagnosis was e-coli.
Bob received a telephone call at 3 AM from his internist in Los Angeles, informing him that he had an e-coli infection in his bladder and kidneys and needed to get to a hospital immediately. We called Global Rescue, which directed us to the Bumrungrad International Hospital. Throughout the ordeal, your staff was professional, informative, and available to assist us through a difficult and frightening situation in a foreign country. Global Rescue’s Operations team helped us navigate the hospital and obtain the medical records that we needed for reimbursement, and worked with our Geographic Expeditions (GeoEx) advisor to reschedule various airplane trips to finally get us back to Los Angeles.
We returned home in time for Bob to recover fully, so that he could walk our daughter down the aisle for her May 5th wedding.
Although it has taken me a while to write this note, the time has not lessened my appreciation for all that Global Rescue did for my family.
If you're planning to travel internationally this holiday season, you can help reduce the medical risks associated with traveling abroad. Simply follow these travel tips below. Safe and healthy travels!
- Have the ability to call for help, know how to call for help, and know where you would want to go for help. Outside of the U.S., dialing “911” does not work. Have a way to call for help: a local cell phone or SAT phone. Know how to dial that number based on international calling configurations, and what number to call for emergency medical services.
- Complete a pre-travel physical. Make sure any chronic medical conditions are stable. Avoid traveling too soon after surgery since complications may surface three to six months after some surgical procedures. Make sure your vaccinations are up to date. Some countries you will need to provide proof of vaccination to enter the country. Be sure your travel medical provider prescribes any necessary travel medications in adequate supply.
- Know your health insurance policy and service coverage. Know in advance whether your plan covers medical bills if you are hospitalized while traveling internationally. Do you have medical evacuation coverage for emergency medical transportation, and trip cancellation insurance in case you miss your flight due to a medical emergency?
- Have a backup plan to pay for emergency care if needed. There is a chance some international medical facilities will not work with your health insurance provider. Travel with a credit card or have another way to access funds quickly. Some facilities will turn you away at the door regardless of the nature of the medical emergency if you cannot provide a guarantee of payment or some type of financial deposit for services rendered.
- Bring your own pharmacy. There is no guarantee that you’ll find a pharmacy around the corner. Travel with basic over-the-counter medications and a small first aid kit. Pain relievers, medications to control a fever, antacids, stool softeners, allergy medicine, antibiotic ointment, eye drops, decongestants, cold medicine, band aids, yeast infection treatments and sunscreen are just a few items we take for granted that can be obtained easily at drug stores at home. Bring any necessary travel medications with you, such as malaria prophylaxis and traveler’s diarrhea treatment. Do not assume you will be able to source these medications in other countries. Any medications purchased abroad may not be subject to the same manufacturing standards and quality control you expect at home.
- Bring 2x the amount of daily medication needed. Travel plans can be delayed, flights cancelled, and pill bottles can spill. Refilling a prescription while traveling internationally can be challenging and having the flexibility to accommodate a few extra days of travel reduces the risk of this happening. If you have a prescribed medication you use “as needed,” be sure to bring it.
- Research local hospitals or travel clinics before you travel. Know the best facilities available to you in a specific area. If you are a U.S. Citizen, the U.S. Embassy based in your country of travel is a useful resource in providing this information. You can also register your dates of travel with the embassy, which can further help in an emergency.
- Be familiar with health concerns relevant to the location. There are general health advisories, health risk assessments and food and water safety precautions specific to different regions. Your travel medical provider should be able to review any individual health concerns specific to you and your medical history and your itinerary. Be sure you have the necessary information to prevent health risks associated with your particular travel itinerary.
- Follow the same safety practices you would use if you were at home. Wear your seat belt, if it is available. Use a helmet when riding a bicycle, moped, scooter, or motorcycle, or if skiing or snowboarding. Be sure to drink plenty of (safe) water. Be mindful of your body’s needs in extremes of temperature: have adequate clothing and gear in the cold and seek shade and cooling opportunities in the heat.
- Never travel without a Global Rescue membership. Medical problems can threaten your life at the worst possible time, when you’re away from home, far from friends, family and support. Global Rescue medical membership includes medical evacuations from anywhere in the world to your choice of home-country hospital, any time you are more than 160 miles from home and need hospitalization. Global Rescue excels at Field Rescues for medical emergencies requiring hospitalization in the event you are in a remote location and cannot get to a hospital on your own. Membership includes 24/7 medical advice and support from world class physicians at Johns Hopkins Medicine.
We are pleased to announce the winners of the Global Rescue “In the Spirit of Adventure” Photo Contest 2013:
1st place: Casa del Arbol, Ecuador, by Monica Mueller
Story Behind The Picture...
While backpacking in South America after graduating college, I started a social enterprise www.ArtfulVenture.com, which is an entire adventure in itself. We were creating a community mural for our nonprofit partners, and decided to take a break to explore more of the town of Baños, Ecuador with our local friends. After a steep, windy drive to the top of the city, we climbed out of the car and sprinted up the hill to greet a herd of cows and the most magical tree house I had ever seen. Surrounded by misty clouds, with a rickety old staircase and creaky swing, we literally felt like we were swinging in heaven. This shot reflects my quest for adventure because through Artful Venture's online boutique, we aim to change the world.
A Judge’s Perspective:
"This is a well composed and beautifully executed image portraying a tree house, where so many of us begin having our adventures. As children, it is high in the branches of trees we build forts, begin exploration, and imagine overcoming all forces against us. This tree house is a work of art in itself, placed on the left side of the frame, it's balanced with the fog which creates a sort of blank canvas for the rest of the adventurous life to be lived."
2nd place: Polar Power, Repulse Bay, Nunavut, by Joe Bunni
Story Behind The Picture...
A shot of a life time that you cannot miss no matter what. I felt confident with this female and she was in no way aggressive. Actually she came incredibly close, the first time putting a paw on the lens and the second time her nose. She was looking at her reflection in the lens like many mammals do!
A great picture can be taken anywhere, even in one's backyard but when it's a dangerous situation it obviously adds some spice and adrenalin to the moment, something that I'm always looking for whether it's a bear, shark, or elephant.
A Judge’s Perspective:
"A fun shot that shows the bear from a totally different perspective. The angles and lines of the water in front of the bear also make this image 'work.'
N.B. Amazingly, Joe took this shot while swimming in the freezing water, wearing a dry suit!
3rd place: Surfer, Mentawai Islands, Indonesia, by John Maher
Story Behind The Picture...
This shot was taken in a remote region of the Mentawai Islands, 100 miles off the coast of Sumatra, Indonesia. I was in the Mentawais for a month working as a volunteer medic and surf guide for one of the local surf resorts. Most of the waves in the area break over outer reefs which require a boat to access. The isolation makes logistics tough, but allows for beautifully clear water.
This trip occurred while I was transitioning from a professional surfer to a photographer, so with my surfboard, I brought a camera and water housing on the boat everyday with anticipation of capturing unique moments such as this one.
This image is special to me because it was taken at a very fickle wave. In fact, I waited the entire month to finally score favorable winds, tides, and swell direction for it to work. Additionally, lucky timing of a set wave breaking, and a surfer riding just close enough to the wall of the wave to be recognizable as he passed by me, all coinciding within a few minutes of the sunset in a rainforest region, is a very fortunate occurrence.
Having the correct camera settings while shooting underwater in low light without strobes or a flash is tricky, so I held my breath until I was able to get the camera out of the housing later that evening to see if the shot was exposed correctly!
Dodging waves breaking over sharp coral reefs in dark water, while volunteering as a medic at one of the most isolated and wild regions surfers have recently begun exploring - that encompasses my spirit of adventure!
A Judge’s Perspective:
"The colors and light in this shot are great. I also always love an image that shows the world from a totally different perspective. It is never easy to shoot great underwater shots like this."
Thank you to our panel of judges and to all who were inspired to share your spirit of adventure with us!
Enjoy a selection of outstanding "In the Spirit of Adventure" photos here.
For a parent with a young adult child traveling overseas, stress can sometimes outweigh the pleasure of knowing that your child is experiencing wonderfully different cultures firsthand.
Through a year-long fellowship, a young woman was traveling independently to South Africa, India, Northern Ireland, Chile, Germany and Greece. Her mother, Laura Stanley Duffy, insisted on a Global Rescue medical and security membership for her.
“With Global Rescue, I felt like I was buying peace of mind,” said Duffy.
The joys of travel were instilled in her two daughters from an early age. “We live in a small house so it was easier to give travel than stuff. But it made my daughters unafraid to travel anywhere, which can be stressful for me.”
Her first daughter was enrolled in the Traveling School, a non-profit organization which takes high school girls overseas for a semester. Through the school, she was covered with a Global Rescue membership for her travels to Namibia, South Africa and Botswana.
Duffy’s second daughter, traveling independently for one year, was healthy until she reached India. After three months there, she contracted dysentery and could not shake it. She lost nearly 15 pounds in three weeks.
“She was alone and far from home,” said Duffy. “As a mom, you’re truly relying on your child’s judgment. A child often assumes you’re overreacting. But people get into trouble when they’re dehydrated.”
Global Rescue was contacted for advice on hospitals in India. The company, which conducts extensive research on and has relationships with medical centers of excellence around the world, confirmed that the young woman was going to the right place for care.
“It was calming to me to hear another professional who knew the landscape and could say my daughter was in good hands,” noted Duffy.
After two hospital visits and two rounds of medicine, the young woman was on the mend by the time she was ready to leave India.
“I got paid back all year long,” said Duffy. “If your kids are traveling, you need to know about Global Rescue.”
Global Rescue has been deeply involved in the Himalaya, having advised and evacuated hundreds of members over the years. The close of trekking season in Nepal offers an opportunity to consider the tremendous growth in the region, and what it might portend for the future.
Since 2006, the number of visitors to Everest has doubled. The Himalaya now attract over 100,000 trekkers and climbers each year. Helicopter-based services in Nepal have also increased dramatically. In an emergency, a helicopter evacuation from Everest undoubtedly can save your life. Unfortunately, some tour operators and helicopter companies seek financial gain through kick-backs from arranging non-emergency helicopter evacuations for climbers and trekkers.
In an earlier post this year, we highlighted an article by the British Mountaineering Council on corruption in the Nepalese helicopter rescue industry. The BMC article cited weak regulation and a willingness by some to defraud insurers to make quick money from a rescue.
A new article by the Alpine Rescue Service, one of the medical emergency assistance providers based in Nepal, addresses the same issue: certain guide companies and tour operators requesting helicopter evacuations in non-emergency situations for their own financial benefit. In one scenario, tour operators or trekking guides attempt to persuade inexperienced trekkers that helicopter evacuation is essential, even at the slightest hint of mountain sickness. Fearing for their health and their lives, trekkers feel compelled to take the advice given. They are advised to contact their insurance or travel assistance companies to guarantee payment, often for outrageously inflated prices. In another scenario, operators and guides go so far as to build into the itinerary in advance a helicopter evacuation simply to save time. It is not difficult, with the right contacts, to produce documentation supporting a medically-justified but unnecessary evacuation.
If this trend continues, these inflated costs for fraudulent evacuations will result in the unfortunate consequence of considerably higher fees for medical emergency services for climbers and trekkers in the Himalaya.
What can Global Rescue members planning Himalayan travel do?
· --Know the facts about altitude sickness. In many cases, descent is the first recommended course of action.
· -- Research tour operators and guide companies before you travel. Understand their perspective on helicopter evacuations.
Unnecessary evacuations in Nepal, while orchestrated by a small number of operators, have the potential to damage the climbing and trekking industry. Global Rescue has long-standing partnerships with many of the leading guide companies who have expressed frustration with the situation and who simply want to provide clients with reasonable evacuation options for bona fide medical emergencies.
Please don’t hesitate to contact us for information.