Over the past decade, Global Rescue has been very active in the Himalaya, advising and evacuating hundreds of our members who have faced severe illness and injury while climbing Everest and other peaks.
Recently, however, in addition to the perilous nature of the climbs themselves, climbers and trekkers have faced another danger: the threat of forced or coerced evacuations in non-emergencies as part of fraudulent practices by some in the Nepalese helicopter industry.
We posted about this issue first in June 2013 and again in December 2013, with advice on how to avoid being victimized by this corruption.
For several years, Alpine Rescue Service has been working diligently to put an end to this fraudulence. Climbers and trekkers will be pleased to know that progress is being made. ARS wrote in its June newsletter that its effort to suppress fraudulence “is gaining rapid momentum through collaborative efforts of our insurance partners.” These insurance partners have been investigating questionable cases that resulted in evacuations and visiting the offices of the service providers who initiated these evacuations. ARS writes that it is “hopeful that this initiative will ensure that fraudulence is minimized significantly and emergency medical assistance for travelers to Nepal will ultimately foster with genuine cases demanding the same.”
Global Rescue travelers surely have learned many useful skills during their adventures. Appreciating cream and sugar yet being able to drink coffee black comes to mind, along with knowing how to sew a button or mend a pair of pants, or possessing a working knowledge of the half-life of a pair of Smartwool socks. Despite the obvious utility of those skills, another thing that is equally important is knowing what to pack in an everyday, travel-friendly first-aid kit.
All destinations have inherent differences from one another just as each individual traveler has his or her own unique differences. Evaluate your own personal needs and the parameters of your travel to find the items or kit that best suits you. An easy option is to look for a commercial off-the-shelf product. There are several high-quality kits out there that cover trips of different duration and are designed for the needs of the solo traveler up through the expedition group.
The alternative to a commercial product is to build your own. Global Rescue has tailored its own list of must-have items over the years, always including commonly needed items plus a few medicines. When possible, it’s best to try to use only items that serve more than one purpose, including medications. While it is impractical to pack for every single contingency, one can create a small, packable kit full of highly useful items that takes up very little space in your backpack. Most travel emergencies do not require a combat medic-style kit; quite the opposite. Blisters, minor soft tissue injuries (scrapes and cuts), orthopedic injuries (ankle sprains), and stomach ailments are some of the more frequently encountered issues.
The following is a list of items we recommend for every trip, whether you’re going to Switzerland or Nigeria. This is designed as a personal kit for individual use and the majority of the items can be carried in a small zippered pouch.
- Tweezers, fine point (hard to find a reason NOT to have tweezers)
- Tick remover (yes, a single-use item but very handy if needed and it’s nearly paper thin)
- Alcohol pads (eight is a good amount)
- Band-Aids (about a dozen)
- Blister pads (prefer the Band-Aid Advanced Healing, which work great and stay in place; carry a few of the regular and finger/toe variety)
- Gauze pads (a few small 2”x3” pads)
- Super glue (from minor skin tears, not ideal but works in a pinch, to getting a few more miles out of your shoes)
- Cravats (Carry two standard size triangular bandages. There is very little you can’t splint or bandage with two well-placed cravats. Too many other uses to list.)
- Ibuprofen 400mg (pain reliever, inflammation, minor fever reducer)
- Ondansetron 8mg ODT (anti-emetic; these dissolve on your tongue; great for nausea and vomiting)
- Cipro 500mg (gold standard for traveler’s diarrhea, unless you’re in Southeast Asia)
- Doxycycline 100mg (malaria prophylaxis, tick-borne disease, skin infections; a good multipurpose antibiotic)
- Pepto Bismol (chewable tablets; many indications)
- Antihistamine (a non-drowsy type like Zyrtec or Claritin; used for hives, itching, watery eyes, rash, runny nose, and sneezing due to allergies or the common cold. Secondary uses for motion sickness, anxiety, or as a sleep aid)
- Sewing kit (TSA approved for carry-on if needles and scissors are under four inches)
- Chapstick, with SPF (sunscreen for your lips, nose, ears; also useful on zippers or even hot spots)
- Iodine tabs (clean, treated water is a must)
- Small, emergency headlamp
- Duct tape (wrap about a meter around the outside of the kit)
- Consider an Epi-Pen if you or a member of your group have potentially life-threatening allergies
For trips that will take place in a more remote setting, you might augment this kit with other items, namely more medications and bandaging materials.
Prior to any trip, it is recommended that you consult with your physician to determine which medications are right for you. This can be done in conjunction with a visit to a travel clinic for vaccines and other destination specific advice. Despite the fact that many countries require medicines to be transported in their original packaging, several travelers take it upon themselves to repack the items to better fit in their luggage. Many of us are guilty of this but keep in mind that medicine not in the original packaging, especially prescription medications, run a greater risk of being confiscated.
It should be noted that a first-aid kit is not a substitute for proper first-aid training. Everyone has the potential to benefit from some type of first-aid training. Wilderness First-Aid (WFA) or the more in-depth Wilderness First Responder (WFR – pronounced woofer) are excellent options for travelers. These courses focus on providing care in austere locations with little support and finite resources. Improvising and using common on-hand items is highly stressed all the while adhering to sound medical principles. Check local outfitters and clubs for a course offering near you.
Mount Himlung (Courtesy Suman Gurung Mountain Guide blog)
May 20, 2014 0855
Global Rescue, a crisis response firm providing medical and security evacuation services to corporations, governments and individuals, has successfully rescued John All, who fell into a crevasse yesterday while conducting climate research on Mt. Himlung in the Himalayas. All, a member of the American Alpine Club, estimated he fell approximately 70 feet. Global Rescue was alerted to All’s situation via satellite text message relayed over the internet.
The Global Rescue operation was conducted by contracted rotary wing aircraft at an altitude of 19,700 feet (6,000 meters). Global Rescue led the operation from its operations centers in Massachusetts, New Hampshire and Thailand.
Upon landing in Kathmandu, All was immediately transferred to a hospital in Kathmandu capable of addressing traumatic injuries consistent with a fall from great height and continued exposure to the elements. Updates regarding his condition can be viewed at the American Climber Science Program's Facebook page.
All moved his expedition to Mount Himlung after the deadly April avalanche shut down the 2014 Mount Everest climbing season.
In today’s fast-paced world, cellular phones have become a primary means of communication. The technology has advanced rapidly and now people carry sleek smartphones full of apps you did not even know you needed. Cell phones operate off of cellular towers, with your cell phone bouncing its signal to the closest tower, which then relays that signal onward. As you travel farther from urban areas or travel into terrain that is hilly or mountainous, that cellular signal disappears as you are able to connect with fewer and fewer towers. How do you communicate when you are in an area with no cellular towers or where the terrain inhibits your connection to these towers? Satellite phones.
Satellite phones, or sat phones, are mobile two-way communication devices that use satellites orbiting the Earth to receive and transmit data. Sat phones rely on line-of-sight with their satellites to establish a connection. Since they rely on line-of-sight, they work best in open areas with a clear view of the sky. Using them indoors, in vehicles, and even in a city surrounded by tall building and wires will hinder your signal. Satellite constellations are either configured as geosynchronous or low Earth orbit.
Geosynchronous satellites, also called high earth orbit or GEO, are very large satellites that maintain a high altitude (around 22,000 miles) orbit and follow the Earth as it spins. This means that they are always centered along the Equator and generally remain in a constant location in the sky. A constellation of perhaps four satellites will be able to provide coverage for nearly the whole globe. Because of their size, these satellites are able to handle large volumes of data. However, because of their height, they have significant delays in transmission, resulting in momentary pauses for the person on the other end of the line. Since sat phones rely on line-of-sight, polar coverage is hindered and it may be difficult or impossible to get a signal if you are in a canyon or a mountainous area.
Low Earth orbit, or LEO, satellites offer a significantly lower orbit, around 900 miles. They are much smaller and lighter when compared to their GEO counterparts, and there are more of them in orbit. A typical LEO constellation consists of up to 60 satellites orbiting the earth at high speeds. This means that at any one time you will have line-of-sight to at least two or three satellites, giving you more reliable coverage if you are in a polar or mountainous region. Since LEO satellites are much smaller, they are more suited to voice transmission or short text/SMS messaging.
These days almost anyone can benefit from owning a sat phone. Are you a mountain climber or trekker who routinely travels far up in the mountains in small groups? Do you fish in exotic locales, isolated beaches, far down rivers that time forgot, or clear high-mountain lakes? Does the thrill of an African safari stir something deep and primal within you? Even for those who do not typically travel abroad, our own backyards are ripe with places where there is little to no cellular coverage. Anyone who likes to be prepared should know that cellular networks will be the first to crash and/or become overloaded in an emergency or disaster situation while satellite networks will be much more reliable. No matter your pleasure or purpose, satellite phones are a reliable communication alternative.
You can expect to spend in the range of $500-$1500 on a sat phone, depending on your particular needs. Pricing structure for airtime varies with each manufacturer, but a safe estimate is around $2 per minute, plus a monthly service fee. This is significantly lower than roaming charges offered through some cellular networks. Many vendors also rent sat phones for about $75 per week plus airtime.
It is worth noting that, since Global Rescue requires two-way communication with our members, a sat phone is just one method of enabling this.
Satellite phone use is restricted, and in some cases illegal, in a number of countries. Examples include: North Korea, India, Myanmar, Cuba, Iran, Libya, Sudan, Poland, Hungary, and Angola. Please confirm coverage details with your provider prior to purchasing or renting a phone and research possible restrictions imposed by the countries you’ll be visiting.
Should you have questions or wish for further information on sat phones, please post a comment below or feel free to contact Global Rescue at 617-459-4200.
The next featured adventurer in our “Global Rescue Members in Action” series is Josh Aldridge, who was captured in an inspiring moment of teamwork during a climb in an Arkansas cave. Josh, a finalist in Global Rescue’s “In the Spirit of Adventure” photo contest, shares some background on his experience below.
“The photo was taken in Eden Falls Cave in Arkansas' Lost Valley. We were climbing behind the interior falls, searching for a route up to an unexplored, offshoot tunnel. The rich gold light comes from headlamps and flashlights placed in and reflecting from the wet rock.”
Do you have a great story to share about your travels? We want to hear about it! If you (or someone you know) would like to be considered as a “Global Rescue Member in Action,” tell us why in an email to email@example.com.
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.
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.
Photo courtesy of Joe Stock
While climbing in Bolivia earlier this year, Global Rescue member James Kesterson suffered a painful toothache. Kesterson, a frequent traveler on expeditions with Stock Alpine, was concerned with how much worse the pain might get at a higher altitude, not to mention putting his team in jeopardy.
He recounts his experience and shares his thanks with Global Rescue:
“We had been in Bolivia climbing for about 10 days when I developed a toothache. It was the first time in my life that I experienced that much pain. A doctor who was with us prescribed lots of ibuprofen but said that I probably should take an antibiotic. We had some antibiotics with us but he was unsure of which to give me. We called Global Rescue.
“We were at 14,000 feet planning to head up to 21,000 feet. Global Rescue doctors directed me to take neither antibiotic that we had since both were for stomach illness. Instead, Global Rescue directed me to get some penicillin. They assured me that, if I could tolerate the pain with the ibuprofen, I should be fine at a higher altitude. No penicillin could be located where we were so we climbed on, doing well on our trip, although the ibuprofen seemed to make me very tired.
“Upon returning home, my dentist told me that something had upset my root canal and that amoxicillin should take care of it. Of course, that’s basically the same advice that Global Rescue gave me. It seems to have worked. I completed my prescription last week and have no pain now.
“Global Rescue did a great job at the time and in the follow up after I returned home. By the way, one of my climbing friends had a small skiing accident last winter and Global Rescue was very responsive with his sprained wrist.
“I am very pleased with Global Rescue’s service. Thanks for being there.”
With trekking season in full swing, Global Rescue members heading to the peaks should be prepared with the facts about altitude sickness. Global Rescue medical advisor Dr. Eric Johnson, a globally recognized expert on high-altitude medicine who has spent decades practicing high altitude medicine, answers some of the most frequently asked questions about the types of altitude sickness, their symptoms and treatment.
What is altitude sickness?
Traveling to altitude, typically higher than 8,000 feet, can sometimes cause health problems. This group of problems is called “altitude sickness” and there are three main types. The symptoms differ depending on the type of altitude sickness you have.
Acute mountain sickness (AMS) -- This is the most common type and causes symptoms similar to those caused by an alcohol hangover, usually within a day or so of arriving at altitude. Acute mountain sickness can happen within a day of traveling or climbing to a very high altitude (typically above 8,000 feet). The symptoms can include:
▪ Feeling tired
▪ Feeling lightheaded
▪ Having no appetite
▪ Trouble sleeping
▪ Nausea, sometimes with vomiting
High altitude cerebral edema (also called “HACE”) – This is less common but more serious than acute mountain sickness. It involves swelling of the brain and usually involves symptoms of AMS but with worsened brain symptoms (commonly an inability to walk in a coordinated fashion).
The symptoms of HACE (swelling of the brain) usually start one to three days at a high altitude. They include:
▪ Extreme tiredness and weakness
▪ Trouble walking normally
▪ Confusion and irritability
▪ Acting drunk
High altitude pulmonary edema (also called “HAPE”) – This is also less common and more serious than acute mountain sickness. It involves fluid build-up in the lungs.
The symptoms of HAPE (fluid in the lungs) usually start two to four days after traveling or climbing to a high altitude. They include:
▪ Feeling breathless, with worsening exercise tolerance
▪ Trouble walking uphill
What should climbers do if they experience symptoms of altitude sickness?
Treatment depends on which type of altitude sickness you have. If you have mild symptoms of acute mountain sickness, rest and stay where you are until you feel better. Do not travel or climb to a higher altitude until you feel better and all symptoms resolve. Moving to a lower altitude can also help if symptoms do not go away in a day or two.
For a headache, you can take medicines such as aspirin, acetaminophen (sample brand name: Tylenol®), or ibuprofen (sample brand names: Advil®, Motrin®).
There are also prescription medicines that should only be used under the guidance of a physician. These medicines can help treat the symptoms of acute mountain sickness. These include:
▪ Acetazolamide (brand name: Diamox®) — This medicine can help prevent and treat acute mountain sickness.
▪ Dexamethasone (brand name: Decadron®) — This medicine can help keep the symptoms of acute mountain sickness from getting worse and it can help prevent swelling of the brain. It is intended for very short-term use (a few days) and if used, descend immediately.
The most important treatment for HACE or HAPE is to descend to a lower altitude immediately. If you have HACE or HAPE and cannot descend to a lower altitude, you might be put inside a special inflatable bag called a portable hyperbaric chamber. Once you are zipped inside this bag, a doctor or nurse will fill it up with air that is similar to the air at lower altitudes. A doctor or nurse might also give you oxygen to breathe.
Should those suffering from altitude sickness see a doctor or nurse?
If you have severe symptoms after traveling or climbing to a high altitude, get medical attention immediately. Waiting for treatment could cause serious health problems, or even death.
Can altitude sickness be prevented?
Yes. The best way to prevent altitude sickness is to avoid moving quickly to a higher altitude. Going slowly gives your body time to adjust.
▪ If you are traveling to a very high altitude, plan to stretch your trip out over several days.
▪ If you are hiking or climbing, don’t do difficult physical activities for the first few days, and avoid alcohol and sleeping pills.
▪ When hiking, go to a higher altitude during the day and then go back down to a slightly lower altitude each night to sleep.
▪ If you have had altitude sickness before, your doctor might give you a medicine to keep you from getting it again.
Call Global Rescue immediately at 617-459-4200 if you are a traveling Global Rescue member and have symptoms or concerns about your health!
Broad Peak, also known as K3, is the twelfth highest mountain on Earth and lies in the Karakoram range in Pakistan on the border with China. For one Global Rescue member, the experience of climbing Broad Peak included a dramatic twist that could have proved tragic.
To acclimatize to the high altitude, the member was making a series of trips from Base Camp to Camp Two and Camp Three. When a piece of ice broke free from his crampon on the descent from Camp Two, the member fell 20 feet onto rocks, bounced, and fell another 100 feet before he was able to stop himself with his ice axe. Had he fallen another 200 feet, he would have dropped off a 4,000 foot cliff. Realizing his leg was broken, the member made his way to a fixed rope several feet away and clipped himself in. His climbing partner, half an hour behind, was rappelling and saw his friend’s predicament. The partner helped secure the member’s leg for the trip back to Camp One and finally Base Camp. Global Rescue was contacted and coordinated the helicopter evacuation.
“Knowing the helicopter was coming was great,” said the member. “Twice due to weather it had to turn back but eventually made it. My partner and I were brought to Paiyu, a post along a glacier. From there we picked up the body of a climber who had perished unfortunately and we went on to Skardu.”
Once stabilized and with surgery back at home recommended as the best course of action, the member was flown from Skardu, via Islamabad, Saudi Arabia, Paris and finally to Atlanta, Georgia.
The X-rays showed seven fractures in the member’s tibia, fibia and ankle, resulting in a surgery that added 17 screws and two plates. Prognosis for recovery is very good.
“Global Rescue got me home in a timely manner to have surgery. Without Global Rescue, I may have had no options for surgery.”
An American Alpine Club member for several years, the member learned of Global Rescue through the organization and “always had that card in my back pocket. Global Rescue did everything they advertised.”
Grounded for at least a year, the member notes that he will get back to running and biking. “I may pursue simpler mountains but climbing’s in my blood and what I love to do.”
Sadly, three of the member’s climbing mates perished during the climb a few days before he was helicoptered out. “Someone was watching over me.”