In the wake of Nepal’s earthquake and avalanche, which left thousands dead and hundreds of climbers stranded on Everest and other mountains, Global Rescue has spent the last 5 days responding to more than 100 requests for help. As one of the first responders on site in Lukla, our personnel triaged more than 200 humanitarian cases arriving by helicopter from the Mt. Everest region, working to support Nepalese government and other aid workers handle the very large number of cases.
We have deployed teams of paramedics and former military special operations personnel to Nepal and have executed over 45 rescues, evacuation and support operations.
Global Rescue Senior Specialist and paramedic Andy Fraser was preparing to provide support during the Himalayan climbing season and was among the foreigners in Nepal who experienced the earthquake. Andy, who works out of Global Rescue’s Bangkok Operations Center, specializes in remote area work and recently spent six months working in Zambia helping to train police, fire brigade and safari guides in wilderness trauma medicine. Andy previously served as a member of the Solo Rapid Response Unit with the London Ambulance Service, and has worked throughout in the Middle East and China.
Below Andy shares some thoughts on being one of the first responders in the midst of the devastation.
Tell us about your experience immediately after the quake struck.
I was in Lukla at first light on Sunday morning, triaging sherpas and climbers being brought down from Everest. It was relentless, lasting approximately six hours, with helicopters constantly bringing in casualties. I triaged in the helicopters and policemen stretchered the victims into the airport building which we had been commandeered and made into a field hospital.
What types of injuries were you seeing?
The injuries were traumatic in nature due to the avalanche – lots of fractured legs, arms, backs, necks and head injuries. Dr. Monica from Lukla hospital and I ran the operation. We triaged approximately 200 cases in 24 hours.
How is morale for those involved in the rescue effort, yourself included?
I can’t speak for others, many who are just arriving in the last day. For me, it’s just heartbreaking for the sherpas after last year.
Following the worst earthquake to strike Nepal in almost a century, Global Rescue is actively engaged on the ground conducting rescue operations for clients and members impacted by the tragedy.
The earthquake resulted in hundreds of deaths, injuries, and at least one reported avalanche on Mount Everest. The quake struck on Saturday shortly before noon local time with an epicenter approximately 50 miles from the capital of Kathmandu.
Global Rescue is deploying additional personnel to join its team already in Nepal for the Himalayan climbing season. Following the quake and avalanche, we are communicating with and providing intelligence to clients and members in the region to ensure their safety and are actively coordinating air resources for evacuations.
“This tragedy is heartbreaking, particularly after the events of the 2014 climbing season,” said Dan Richards, CEO and founder of Global Rescue. “The scale of the disaster is very large and our operations teams are working around the clock to ensure the safety of our clients and extract those who need it to safety.”
Global Rescue’s trained personnel have been conducting rescue and evacuation missions in Nepal every season for more than a decade. Global Rescue typically performs dozens of helicopter evacuations in the Himalaya each year. The company regularly sends its medical and security teams, including former military special operations personnel, critical care paramedics and physicians, around the world to personally respond to members facing emergencies.
To request assistance, please contact Global Rescue Operations at 617-459-4200 or firstname.lastname@example.org.
Phil Powers, Executive Director of the American Alpine Club
(Photo courtesy of the American Alpine Club)
American Alpine Club Executive Director Phil Powers has led dozens of expeditions to South America, Alaska and Pakistan's Karakoram Range, including ascents of K2 and Gasherbrum II without supplemental oxygen. He made first ascents of the Washburn Face on Denali and of Lukpilla Brakk's Western Edge in Pakistan, as well as the first winter traverse of the Tetons' Cathedral Peaks.
Phil recently spoke with Global Rescue about the upcoming Himalayan season, the AAC’s new campgrounds, and the tremendous rise in popularity of climbing gyms.
Q. The climbing season in the Himalaya is under way now through the next few months. What are your expectations for this season?
A. In big ranges like the Himalaya, the combination of extreme objective hazard and human ambition lead to a huge potential for accidents. Samuli Mansikka, 36, and Pemba Sherpa, 35, were just killed this week while descending from a successful summit of Annapurna; the season is clearly under way. Global Rescue is very much aware of the propensity for accidents during this pre-monsoon season.
Q. What are the upcoming seasons for other popular climbing spots?
In addition to pre-monsoon in the Nepal Himalaya, there is also a season in the fall after the monsoon retreats. The Karakorum Himalaya, which is further from the influence of the Indian Ocean, has a summer season like North America. Most of the climbing in Alaska happens in late spring and early summer. In South America -- places like Aconcaqua or Patagonia -- climbers are active from December through February. Antarctica has a similar season.
Q. Tell us about the AAC’s new campgrounds. Have you seen a marked interest in camping by AAC members across the country?
We are just opening our newest at the gateway to the Shawangunks in New York. The Gunks campground has been a long time coming and we are really excited to finally open it. The campgrounds are for everybody (though AAC members get a discounted rate) and, yes, they are well-used.
Q. How is the popularity of climbing gyms impacting the climbing community? What things should people keep in mind as they transition from indoor to outdoor climbing?
A. Gyms are the biggest single trend facing climbing today, maybe ever. The Climbing Business Journal states that there are over 300 major gyms in the U.S. with 40 more opening this year. We estimate that about 2,000 people sign releases at those gyms every day. In other words, around 2,000 people are at least giving climbing a try every day. Some will stick with it and some will go outside. People get pretty strong and confident in a gym setting very quickly and making the move to outdoor climbing presents very real dangers. At the AAC, we are developing lesson plans and courses in partnership with regional clubs, like the Colorado Mountain Club (CMC), so we can meet this need. Interestingly, whether the accidents we see have to do with improper knots, lowering mistakes, or rappel errors, a majority of them have to do with not double-checking the systems you use. Climb with a partner you trust, communicate well, and check each other at every step. And of course, remember to get your Global Rescue membership before you head out – I know I will.
USMC SSgt. Charlie Linville during the 2014 Everest attempt (courtesy of The Heroes Project)
As the 2015 Himalayan climbing season begins, Global Rescue is proud to provide support to The Heroes Project and the group’s attempt to summit Mt. Everest this year. The Heroes Project was founded in 2009 and is comprised of three initiatives: (i) CLIMBS FOR HEROES which supports wounded veterans who climb mountains as part of their recovery process; (ii) HOPE FOR HEROES which supports community service programs that assist veterans and their families; and (iii) VOICE FOR HEROES which provides media support for veterans' issues.
To date, The Heroes Project team, including veterans injured in Iraq and Afghanistan, has summited the highest peaks on six of the seven continents. Last year, an attempt to summit Everest was postponed following the tragic death of 16 Sherpas in an avalanche. This climbing season, The Heroes Project team, which includes USMC SSgt. Charlie Linville, will be attempting once again to summit Everest. A documentary on The Heroes Project and their completion of the Seven Summits is scheduled to be released in late 2015.
Global Rescue is proud to provide travel risk and crisis management services to The Heroes Project climbers as they make their push for the world’s highest summit.
Global Rescue Associate Medical Director Eric Johnson, MD (left), in Nepal with aircraft personnel
As another Himalayan climbing season begins in earnest, Global Rescue has some information to share that should help our members deal with altitude sickness. Global Rescue Associate Medical Director Eric Johnson, MD, has been practicing high altitude medicine for decades, is one of the founders of Everest ER (the medical clinic at Everest base camp) and is an expert in treating altitude-related illnesses. Dr. Johnson offers this advice on how to recognize, treat, and avoid altitude sickness.
Altitude Sickness – What is it?
Altitude sickness is best defined as a series of symptoms that occur during travel at high elevation. It can affect anyone who travels at altitude, regardless of age, fitness level, gender or ethnicity and if you’ve had it before, you may be more prone to recurrence. Symptoms are generally diagnosed in three broad categories:
Acute Mountain Sickness (AMS):
AMS is the most common and least dangerous type of altitude sickness. The symptoms mirror those of a bad hangover and typically start at 8,000 feet in elevation. Symptoms usually start within a day or two of traveling to a new elevation and can include:
--Loss of appetite
--Nausea, sometimes with vomiting
High Altitude Cerebral Edema (HACE):
HACE is less common than AMS but much more serious. With HACE, the brain swells significantly, causing a loss of coordination both mentally and physically. HACE is especially dangerous to those climbing or mountaineering where the inability to ambulate (i.e. climb) can cost one’s life. These symptoms appear along with typical AMS indicators. The following symptoms of HACE typically start after one to three days at altitude:
--Extreme tiredness and weakness
--Trouble walking normally
--Confusion and irritability
--Acting drunk or confused
High Altitude Pulmonary Edema (HAPE):
HAPE is also less common but more dangerous than AMS. HAPE occurs when fluid accumulates in the lungs and usually starts after two to four days at elevation. The symptoms of HAPE are:
--Feeling breathless, with worsening exercise tolerance; shortness of breath at rest
--Trouble walking uphill
If climbers begin to experience symptoms from HACE or HAPE, they should descend immediately and NOT continue to ascend on their trek or climb. Staying at the same altitude and allowing one’s body to acclimatize to the altitude can resolve mild symptoms of AMS. In an emergency, some mountain clinics may use oxygen (“the” drug at altitude) and/or a Gamow bag, a portable hyperbaric chamber that can increase the atmospheric pressure inside of it. Physicians may also prescribe medicines such as Acetazolamide (brand name Diamox) and Dexamethasone (brand name Decadron) to prevent and treat altitude sickness. If the issue is serious enough to warrant the use of these medicines, you should immediately descend.
The best way to prevent altitude sickness is to add a day or two into your trip to let yourself acclimatize to the new elevation. Even if these days aren’t specifically scheduled, give yourself an extra floating day to spend in case someone does come down with AMS and needs an extra day to adjust. Since AMS can resemble the symptoms of a hangover, it is important to refrain from drinking while at elevation. Not only will it make it difficult to discern the difference between a hangover and AMS, but it is also a good idea to stay in top shape while climbing or trekking. If you are traveling to a high elevation area, speak with your doctor about proper preparation.
A good review article with additional guidelines can be found at the Wilderness Medical Society: www.wms.org.
About the Author
Eric Johnson, MD, joined Global Rescue as an Associate Medical Director in 2009. He is an expert in wilderness and altitude medicine and is a past President of the Wilderness Medical Society where he has served on the Board of Directors since 2006. Dr. Johnson also serves on the Board of Directors of the Himalaya Rescue Association and is a founding physician at Mt. Everest ER, the medical clinic located at Mt. Everest Basecamp. Dr. Johnson is a graduate of the University of Minnesota and the University of Minnesota Medical School.
Irena Mrak on the slopes of Makalu
In October 2014, Slovenian geography professor, experienced climber and American Alpine Club member Irena Mrak was attempting Mount Makalu (8463 m) and conducting glacier research on the slopes of the mountain, on the border of Nepal and China. After spending four weeks above 5800 m, she fainted on the last morning in Advanced Base Camp, after descending and cleaning the high camps the day before.
Mrak’s boyfriend, Dr. Tomaž Goslar, told The Himalayan Times: “On that day, her friends had called me in Slovenia to inform me that she had been complaining about difficulty in breathing and blurred vision. It was then that I felt something was seriously wrong.”
Her condition deteriorated quickly and she lost consciousness within four hours of the beginning of symptoms. She was airlifted from Makalu Advanced Base Camp to Lukla, where initial medical treatment was performed prior to continuing the transport to Kathmandu.
The south face of the mountain
At the time, Mrak was in critical condition. She had been admitted to the Intensive Care Unit and was breathing on a ventilator. For several hours, her pupils were unresponsive, she did not react to pain, and her condition did not appear to be improving. Hospital staff presumed that Mrak would not live due to severe High Altitude Cerebral Edema (HACE) but continued their efforts.
Hospital staff called Global Rescue, and we immediately deployed one of our critical care paramedics to Mrak’s bedside in Kathmandu. Once our paramedic arrived, he quickly arranged to have all of Mrak’s medical records sent to the Global Rescue medical team for careful review by Global Rescue and Johns Hopkins physicians. The following day, Mrak showed signs of increased consciousness and began breathing spontaneously, ultimately regaining consciousness. Once out of ICU, Mrak continued to receive treatment for HACE and for a retinal hemorrhage.
The Global Rescue personnel met with Mrak’s physicians, obtaining details regarding the retinal hemorrhage from the ophthalmologist who examined her and assisting with the management of her care by relaying information to and from the attending and Global Rescue’s physicians.
With all tests and lab values showing continuous improvement in the following days, the Global Rescue medical team recommended that Mrak would be ready to be discharged shortly and to fly home to Slovenia. Dr. Goslar, an ICU physician in Slovenia, had flown to Nepal to be with Mrak and accompanied her home. He expressed his gratitude to the Global Rescue team.
Today, Mrak has made a nearly full recovery. She continues to experience residual visual disturbance in both eyes. Based on further ophthalmological evaluations, Mrak’s specific eye injury showed her case to be unusual, even exotic, since a similar case has not yet been recorded in the medical literature. After four months, she has regained some vision and can read with difficulty but still cannot see colors properly. Mrak is optimistic that it will resolve even though the doctors are unsure. Her illness was most likely a result of complete physical exhaustion after long exposure to high altitudes, extreme weather conditions (cold and wind), and poor diet (canned food, low on vitamins).
“Global Rescue responded immediately and had their paramedic on site in less than 24 hours,” she noted. “The Global Rescue operations personnel knew all the details about my case and could provide them to my family. Global Rescue gathered all the necessary medical information from family members and shared them with hospital staff. I would like to especially recognize the Global Rescue paramedic who attended to me for his professional attitude and warmth.
“Global Rescue did their job well. I have already informed the Alpine Association of Slovenia about our positive experience and will definitely recommend your services in the future,” she said.
Concluded Mrak: “The fast reaction of my climbing partner Mojca Svajger, the people in the ABC, Dr. Barun Rai, the American climber Garrett Madison and his Norwegian client Andrea, the Nepali staff, the doctors in Vajodha hospital in Kathmandu, and the quick and very professional response of Global Rescue saved my life.”
Irena Mrak (center),with climbing partner Mojca Svajger (left), and Global Rescue paramedic Michael James (right).
(All photos courtesy of Irena Mrak)
Noted alpinist Ian Welsted embarked on his first trip to Nepal in September 2014 to tackle the challenge of climbing the south face of Nuptse. It is “one of the truly legendary big walls of the Himalayan mountains,” Welsted later described it in his Alpinist magazine account.
Ian Welsted climbing snow at 6,000 meters during the pair’s first attempt.
Jason Kruk at the team’s high point of 6,500 meters on their second attempt, looking up at the 7,750 meter west summit of Nuptse.
Welsted and climbing partner Jason Kruk had spent six weeks in a base camp at 5,400 meters on the south face of Nuptse. Following an attempt to climb to approximately 6,500 meters on the mountain, the pair realized that they would not be able to succeed in climbing it. They descended, headed to the nearest town, and rested there for a couple of days. Their plan was to walk to Lukla, two or three days away, on a well-beaten trekking trail.
It was not to be. On the first day of hiking, as they had descended to about 3,800 meters, Welsted suddenly lost consciousness. Once he regained consciousness after several minutes, he experienced headache, weakness and nausea.
“Jason phoned Global Rescue,” said Welsted.
The Global Rescue operations team spoke with the guide accompanying the team and immediately arranged a helicopter evacuation to Kathmandu. Upon landing, Welsted was transported by ambulance to a hospital.
At the Kathmandu hospital, Welsted underwent a battery of tests, including an EEG, a CT scan, and later, an MRI. Global Rescue operations professionals worked tirelessly to obtain copies of all tests, records and labs for the Global Rescue medical team to scrutinize.
Welsted confirmed that, while he had been taking good care of himself, he had never previously spent such a long period of time at such a high altitude. Looking back, Welsted believes he passed out due to fatigue, stress, or some combination of the two.
“With Nuptse, you’ve got a base camp of 5,400 meters, which is certainly quite high. To climb at that altitude, you have to acclimate and we went for quite a long time,” he said. “Spending six weeks at 5,400 meters is the longest I’ve been at that high altitude for sure.”
Jason Kruk getting ready for the day in a lightweight tent at about 6,000 meters with the famous Ama Dablam peeking out from behind.
The Global Rescue team worked closely with Welsted’s doctor until Welsted was ready to be discharged.
“One of the Global Rescue operations staff called me while I was still in the hospital and set everything in motion,” said Welsted. “Our tickets were changed so that I could fly home earlier. I thought Global Rescue services were great.”
Welsted advised Global Rescue once he had safely returned to Vancouver, offering his sincere gratitude, and noting that he would be renewing his membership.
“Global Rescue covered all of my needs, more than to my expectations,” said Welsted, “I was heli-evacuated quickly and efficiently and then transported to the top hospital in Kathmandu. Upon discharge, Global Rescue took care of changing my return date to Canada, which was very helpful as I was in no great condition to deal with tracking down airline details.
“Without Global Rescue coverage, I would be out of pocket for the helicopter evacuation, which I am told would have cost upward of $5,000. I was on a mountaineering trip which already had a considerable bill attached, so I was very glad to have the Global Rescue coverage.
“I’ve shopped around quite a bit -- for example, the British Mountaineering Council has some kind of rescue insurance -- but Global Rescue seems to be the best way of doing things that I’ve found.”
Welsted, an American Alpine Club member who had previously traveled to Pakistan on three occasions, recalled how he first learned about Global Rescue.
“Steve Swenson, who was president of the American Alpine Club, was the one who introduced the idea of Global Rescue to us, and I joined the AAC to get a discount on the membership,” said Welsted. “I know that Global Rescue had rescued Steve about two years ago in India. So, for climbers, Global Rescue definitely seems like it works really well.”
Welsted concluded, “I definitely will not go on a similar trip without Global Rescue coverage in the future. After this experience, I will continue to recommend Global Rescue coverage to all of my climbing partners and friends going on mountaineering trips overseas.”
Jason Kruk low on the mountain at approximately 5,500 meters with Ama Dablam behind.
Jason Kruk following a steep snow pitch in afternoon cloud buildup at 6,300 meters.
Jason Kruk below the unclimbed "Cobweb wall" section of the face, the objective the pair had chosen to attempt.
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.