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.”
Climbers and trekkers continue to share their positive experiences with Global Rescue. Over the years, we have conducted hundreds of rescues in the world’s remote places. Nowhere have our services been used more frequently than in the Himalaya. The country of Nepal, in particular, has averaged over 20 rescues per year for the last several years and many of these rescues have included high altitude evacuations from Everest itself. Looking back through the years, we’ve rounded up some of the highlights. Our ability to perform a field rescue continues to be unique in the industry and we couldn’t be more pleased that our services allow our members to return safely from the world’s wild places.
Helicopter evacuation to Kathmandu
In April, a Global Rescue member developed severe abdominal pains during his trek to Everest Base Camp. Given the severity of his situation, Global Rescue evacuated him by helicopter to Kathmandu where he was admitted to the hospital for treatment.
Helicopter evacuation from Everest Base Camp
Dr. Robert Vestal, a member of the Wilderness Medical Society, expressed his gratitude to Global Rescue for successfully evacuating him. He commented, "I was exceedingly glad to have a Global Rescue membership.
“Thank you” from American Alpine Club’s Steve Swenson
Descending from the Sasser Kangri II in the Eastern Karakoram, American Alpine Club president Steve Swenson became seriously ill. Global Rescue managed a complex evacuation in a restricted area near the border with Pakistan and China that was not open to civilian aircraft.
Global Rescue evacuates climber off glacier in Pakistan
A climber had severe frostbite while on the Gasherbrum Glacier in Pakistan. Global Rescue dispatched a helicopter to the camp on the glacier and evacuated the man to a hospital in Skardu, Pakistan, for stabilization.
Further information about Global Rescue for climbers and trekkers can be found here.
As the Everest summit season comes to an end, Global Rescue is proud to have helped a great number of climbers. From minor medical advisory services to evacuations of those critically ill or injured, it has been another busy spring in the Himalaya.
However, a recent article published by the British Mountaineering Council has shed a critical light on the practices surrounding the helicopter rescue industry in Nepal. It highlights a growing trend that is making it increasingly difficult for companies like Global Rescue to provide affordable services to the climbing community.
Mountain tourism in Nepal is booming and along with it the helicopter based services. An increasing number of operators have aircraft that make high altitude rescue a realistic option that simply did not exist in the past.
This growth in capabilities has undoubtedly led to lives being saved but it also may have caused the emergence of a culture that financially encourages some guide companies to request helicopter evacuations in non-emergency situations and has, in certain cases, resulted in outright fraud.
It is important to stress that this appears to be an issue caused by a small minority of unscrupulous operators. Global Rescue has long-standing partnerships with many of the leading guide companies and like us, they are concerned. They simply want to provide clients with robust evacuation options while protecting themselves financially.
In the BMC article Ed Douglas provides a detailed assessment of the current situation and outlines 5 particular scams that we urge you to be aware of:
1 - Unnecessary Evacuation of someone who would recover.
Inexperienced trekkers can be persuaded by lodge owners or trekking guides that they need treatment in Kathmandu, when descent or analgesics would suffice. That treatment can often be hugely profitable: a straightforward check-up following evacuation can cost up to $800 and two or three days in hospital $5,000. At least one helicopter-charter company now has its own medical facility where patients are delivered after being evacuated – a new twist on unscrupulous cab drivers taking you to his ‘brother’s’ hotel.
2 - Overcharging for the rescue.
This can work in other ways. Lodge owners calling in a chopper for a stricken guest have been known to ask for goods to be flown in on the incoming flight, and tourists in the area may find themselves being offered a cash-in-hand ride back to Kathmandu.
3 - Charging twice for the same rescue.
An organizer in the Manaslu region arranged a helicopter evacuation for two clients – from different countries – suffering from altitude sickness. He learned later that both insurance companies had been billed for the entire $5,000 cost of the charter, totaling $10,000. The profit on the deal would have been around $7,000.
4 - Trekkers or climbers looking for a fast ride down following an expedition.
With the right contacts, it’s not difficult to get what looks like bona fide documentation saying that a rescue was medically justified and the insurance company picks up the bill. This isn’t confined to Nepalese trek leaders
5 - Deliberate scheduling of a ‘rescue’ flight in a trekker’s itinerary to save them time.
This was offered without prompting to a Dutch group planning a complex itinerary in the Kangchenjunga area. When they decided to include two friends for part of it, they received an email from their agent:
“In the beginning they have to pay helicopter cost in Nepal, when they completed there [sic] trekking and arrive in Kathmandu I will make the doctor report saying that we need to rescue the people from Ghunsa because they are ill and the aviation people will too make the certificate saying that we are rescuing these people.”
The plan, the agent says, will be ‘a good solution for them,’ and to reassure their prospective clients, the agent goes on to say: ‘I started Nepal tourism business since 1990 most of the time I did the same like this and there was no problem at all until now.
The full article can be read here
Further information on Global Rescue for climbers and trekkers can be found here
A member's view up the Khumbu Valley in Nepal
The Everest season is now well under way and it has been a busy time for Global Rescue, with a number of successful evacuations already conducted. With the summit window approaching, we wish everyone a safe and succesful climb.
In April, a Global Rescue member developed severe abdominal pains during his trek to Everest Base Camp. Given the severity of his situation, Global Rescue evacuated him by helicopter to Kathmandu where he was admitted to the hospital for treatment.
On his safe return home, he wrote to thank Global Rescue:
"Six days into a trek to Everest Base Camp I developed a potentially life threatening condition that required immediate evacuation off the mountain. Global Rescue arranged for a helicopter to pick me up within an hour of the initial call to them and then had me delivered to a Kathmandu medical facility for emergency treatment within less than an hour after that. The physicians there were clear with me that had I not received such a timely evacuation, I would have suffered potentially irreparable organ damage.
Global Rescue also closely monitored my condition throughout the period before I was finally discharged to determine if further evacuation for medical care might be necessary. They remained in daily contact with me until after my return to the U.S., where I underwent additional evaluation and treatment by my own physicians.
I will never travel without having Global Rescue to turn to given the ever present possibility that a medical emergency requiring evacuation might occur. Thanks Global Rescue !!!
Further information about Global Rescue for climbers and trekkers can be found here
Don't let you expedition go south...
By Jeff Wise, American Alpine Club
Whether you love hiking, climbing, mountain biking, or kayaking, you probably know a lot about outdoor safety.
But if your expedition goes sour, first aid training and compass skills might not be enough to pull you from a life-threatening morass.
Here at the American Alpine Club, we’ve seen a little innovation go a long way, so we put together some of our favorite backcountry tips and tricks:
1. Fire Starters You Didn’t Know You Had.
Cleaning wounds is not a high priority when you’re lost or close to hypothermic. Bust out the first-aid kit anyway! You’ll find a few staples—alcohol swabs and cotton balls—that serve double duty as fire starters in an emergency. For extra spark, coat the cotton in petroleum jelly. Duct tape is also flammable, which demonstrates yet again that it is, without question, the most versatile tool in the universe. Or is it?
2. Fishing Line—The New Duct Tape
Duct tape is good, but fishing line might be even better. Not only is fishing line super lightweight, but it also has dozens of backcountry uses when you’re in trouble. Hungry? Catch your food. Exposed or broken? Tie up a tarp for your shelter, repair clothes and shoes, or stitch up your wounds.
Stranded? Use the line to make a signal kite. Simply construct the frame from sticks, tent poles, or trekking poles. Build the body from a bright shirt or section of space blanket. Then tie it all together and launch it to direct rescue crews to you—or for impromptu fun on a windy day. Fishing line can even function better than tweezers to remove ticks: just tie an overhand knot around the head, get it snug, and pull away from the skin. Top that, duct tape!
3. The Sun: Nature’s Iodine
For safe drinking water in the backcountry, filters and tablets are best, of course. But there’s another crafty way to do away with dangerous bacteria in your water.
Pack a plastic bottle of soda and drink it the first night of your trip. Save the bottle because the thin layer of polyethylene terephthalate (PET) allows the sun’s ultraviolet radiation to perform a bit of magic. Just fill the bottle most of the way with your questionable water, shake it up, top it off, cap it, and put it in direct sunlight.
In one afternoon the combination of heat and radiation will have killed most, if not all, of the microbes that could do you harm. For the same reason, the top few inches of lake water are the cleanest because of the power of the sun. Remember to choose clean snow over lake ice because bacteria can survive for months in the ice, and use a bandana or shirt to remove large particulates and silt.
4. No Cell Service? No Problem.
It’s no surprise that making a cell phone call requires satellites to know where you are. Use that to your advantage when you’re having an emergency in no-man’s-land. Even with zero cell service, you may be able to give emergency or rescue teams clues to your whereabouts.
If you can’t call 911 or send a text, at least turn on your phone to drop “digital breadcrumbs” that may aid those looking for you. Make sure your emergency contact at home knows about this trick and has your phone number and service provider at the ready.
5. The Back-Up Plan
Most adventurers have health insurance or accident insurance, but not many have rescue insurance. Whether you’re all about the weekend epic or a long trek overseas, rescue insurance protects you from insane five-digit costs. Even here in the United States, some local rescue groups and some governmental agencies are beginning to charge for rescue services.
Having the right insurance—available from Global Rescue or by joining the American Alpine Club—also creates peace of mind for you and your family and friends. If you have insurance and something does go wrong, you can focus on getting healthy instead of worrying about the rescue bill.
Know other interesting survival tips? Have an epic rescue story? Share them in the comments below—we’d love to hear from you.
About the American Alpine Club
The American Alpine Club is a nonprofit organization that provides benefits, knowledge, inspiration, and conservation for the outdoor community.
All members benefit from a Trailhead Rescue service from Global Rescue and many climbers traveling abroad choose to upgrade to the full Global Rescue membership.
Learn more about AAC programs and member benefits at americanalpineclub.org
As usual Global Rescue was kept busy assisting members during the Himalayan climbing and trekking season. We conducted a number of rescues in Nepal, including high altitude evacuations from Everest itself. To support operations, a Global Rescue paramedic was on the ground in Nepal during peak season.
One member, Dr. Robert Vestal, writes to thank Global Rescue:
Dear Global Rescue,
Obviously you are aware that I had to be evacuated by helicopter from Namche Bazaar on Friday, April 27. Obviously, I was hugely disappointed that I could not continue my trek to Everest Base Camp. However, I was exceedingly glad to have a Global Rescue membership. I was equally glad that Bob Veno, a paramedic in your operations group, had been deployed to Kathmandu to represent Global Rescue and assist with any and all medical problems encountered by Global Rescue members. He was there at the airport when the chopper touched down. He accompanied me in the ambulance to the hospital and stayed with me many hours during the course of my hospitalization.
Basically, Bob shepherded me through the entire hospitalization process and made sure that the necessary studies were done for evaluation and that we had copies of the medical records and reports. I also know that he performed a similar role for others during his deployment in Nepal. I was hugely impressed with his interpersonal and technical skills, as well as his valuable field experience in many diverse settings. He made a big difference to me and others while he was in Nepal. I will not hesitate to recommend Global Rescue to anyone who is contemplating a trip where an evacuation or medical transport may be needed.
Finally, many thanks to everyone at Global Rescue including the staff taking calls 24/7 in the office and your physician medical consultants, such as Doctor Eric Johnson, for providing me with the best available care and transport surrounding my injury.
Member - Wilderness Medical Society