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.
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!
“Are you covered if you fall during a hike on the Inca Trail in Peru and you need to be evacuated? How about if you're on a safari in an African jungle and one of the animals comes too close and you get hurt?”
These are questions posed to adventure travelers by About.com Adventure Travel writer Lois Friedland. Too often, travelers learn too late that their travel insurance covers less than they thought, and that no one is coming to assist them after an injury.
Friedland spoke with Global Rescue CEO and founder Dan Richards about the company and the services it offers. Global Rescue “is not travel insurance, it's more like AAA for your body, rather than your car," explains Richards. Unlike most companies, Global Rescue will deploy personnel to the site of injury or illness.
Read the full article here.
Page 1 of the Boston Globe on Monday, Sept. 2, 2013, included a feature story on Global Rescue. The article, headlined “World’s perils give rise to a rescue business,” leads with Global Rescue’s recent Egypt evacuations and also touches upon the firm’s prior operations there during the Arab Spring in 2011 as well as other missions around the world in countries including Haiti and Japan.
An excerpt from the article:
At a time when companies are sending employees to every corner of the globe and adventure travelers are seeking thrills in droves, Global Rescue’s evacuation and medical assistance services are in great demand. The prevalence of natural disasters, terrorist attacks, and civil uprisings also means travelers are more likely to find themselves in crisis.
“You start collecting the data and looking at the direction all these numbers are going in, and there’s kind of a disturbing parity,” said Dan Richards, the former private equity investor who started Global Rescue in 2004. “We’re responding to a need that is real and growing.”
Read the full article here.
Global Rescue continues to be actively engaged with clients who remain in Egypt. We evacuated 60 members in July, but some chose to remain in the country. We continue to consult with them to be sure they make the best decisions for their safety, which includes sheltering in place and making preparations to evacuate if necessary.
For anyone who currently is in Egypt, please heed this advice:
· Avoid all but essential movement and remain in secure accommodation.
· If movement is necessary, travel during daylight hours only, using stringent journey-planning procedures, and confirm that routes are clear prior to departure.
· Ensure that you maintain communications with family, friends and business colleagues via phone, text AND email daily to ensure that they know you are safe. Since one mode of communication may be unavailable, don’t rely on just one.
· Organize your belongings. Gather all critical documents, passports, visas, and all currency (local, domestic and credit cards) and be sure they are readily accessible if you need to leave quickly.
· Continuously monitor events. Keep yourself informed and talk to people. Be aware of what is happening around you and continually check on the status of the nearest airport.
Anyone who is aware of members in an area in need of assistance is encouraged to contact the Global Rescue Operations Center at +1 617-459-4200 and email@example.com.
Executives from Global Rescue, provider of the highest quality medical, security, transport and crisis response services for corporations and individuals, will present best practices on crisis management at this year's Global Business Travel Association conference to be held in San Diego, CA. The event, which runs from August 4-7, 2013, at the San Diego Convention Center, will highlight recent trends and industry insights for business travel professionals who operate throughout the world.
Global Rescue executives will discuss the need for comprehensive, integrated emergency action plans for rapid response during mass evacuations. The session, Mass Evacuations: A Tale of Two Crises, is scheduled for Monday, August 5, 2013, 10:30 a.m. – 11:30 a.m.
Large-scale evacuations present unique challenges to enterprises with impacted employees. Normal means of egress are typically impeded by events such as infrastructure damage, sporadic or calculated violence, anti-foreign sentiments, and closed borders and ports. The session will focus on what organizations can do to be prepared and will highlight two real-life case studies that focus on best-practices and common mistakes. It will conclude with actionable strategies participants can use to evaluate and strengthen their own corporations' travel risk and crisis management programs.
GBTA attendees are invited to visit the Global Rescue team at booth #2858. To learn more, visit www.globalrescue.com.
About Global Rescue
Global Rescue is a worldwide provider of integrated medical, security, intelligence and crisis response services to corporations, governments and individuals. Founded in partnership with Johns Hopkins Medicine, Global Rescue's unique operational model provides best-in-class services that identify, monitor and respond to potential threats. Global Rescue has provided medical and security support to clients during every globally significant crisis of the last decade. Memberships start at $119 and entitle members to rescue and transport services to their home hospital of choice.
Dr. John Schmeelk, a university teacher, suffered a life threatening cardiac condition while living in Qatar. Global Rescue medical teams were soon on the ground, overseeing his initial treatment and orchestrating his subsequent evacuation by air ambulance to Israel for a life saving procedure.
In his letter Dr. Schmeelk recounts his experience and explains how Global Rescue provided so much more than evacuation services:
January 21, 2013
Dear Global Rescue:
Now that I am safely back in the United States and on my way to recovery, I want everyone at Global Rescue to know how very grateful my wife, Jean, and I are for the wonderful, literally life-saving care that you provided not only for me but for her as well.
During the early hours of Friday, March 16, I was admitted into Qatar’s national hospital’s state-of-the-art heart pavilion that had just opened in October 2011. My defibrillator/pacemaker had shocked me twice in two days, and this was just the beginning of increasingly more shocks as my arrhythmia worsened. Very soon after my Human Resources Director put Global Rescue on alert that I might need to be evacuated to the US, Jean and I met David, a Global Rescue Medical Specialist, at my hospital bedside. He immediately began inquiring of the nurses and doctors about the details of my condition and my medications, and he began instructing Jean about taking carefully detailed notes, asking questions, and getting names of everyone who gave us information. He also encouraged her to go home and rest while he stayed with me. We had thought of Global Rescue as an evacuation service, but we were to learn that they are so much more.
On March 23, before I was stable enough to be evacuated, David was recalled to the US to handle another case. His replacement, a paramedic named Andrew, arrived on March 26 and continued the same extensive and informative care that David had performed. He monitored nurses’ care, explained what they were doing, occasionally assisted me himself, and asked both the nurses and my doctors questions that Jean and I did not know to ask. When we realized that I needed a heart ablation that the hospital could not perform if faulty nodes existed inside the heart tissue, Global Rescue immediately began contacting nearby hospitals trying to locate one that would be able to give the degree of care I needed. (I could not be directly evacuated to the US because I was not stable enough to endure the long commercial flight, and the medivac plane required refueling every three hours, making a long, trans-Atlantic flight even longer and more difficult.)
Once an appropriate hospital was located in Tel Aviv, Israel, Global Rescue arranged the medivac aircraft and doctor that would take me there, and they booked a commercial flight for Jean. When complications delayed our leaving the airport, Global Rescue in Boston stayed in touch with Jean via cell phone during her layover and arranged a hotel room for her to spend the night so she could arrive at the hospital about the same time that I did. Once on our way, Andrew accompanied me in the medivac closely monitoring my condition along with the evacuation doctor during the entire flight. The next day, he would leave me briefly to meet Jean when she arrived at the Tel Aviv airport. I learned later that Global Rescue’s “point man” on the ground in Tel Aviv arranged for a gentleman from the Israeli State Department to meet Jean at the door of the airplane when she landed and to escort her through Passport Control, ensuring that she moved quickly through the process and forestalling any language problems. This is but one example of the multitude of ways in which he proactively cared for both of us during the month of April while we were in Tel Aviv. In addition, he arranged resort accommodations for Jean within walking distance of the hospital at a greatly reduced rate, gave her several brief tours of the city, frequently talked with my doctors and relayed their information to Jean and me, to name just a few of his many ways of caring for us.
One of the most touching acts performed by Global Rescue was personally escorting Jean to Jerusalem to the Wailing Wall so she could post a prayer for my recovery before my first ablation. Such thoughtfulness and care were far beyond the call of duty, but very deeply appreciated by both of us.
We remained in Global Rescue’s care about six weeks, until they were able to deliver us personally to my cardiologist’s office in New York and hear that both my cardiologist and the ICD team were satisfied with my condition.
This past holiday season, my wife and I were able to celebrate more joyfully than ever before this year because we both know that these were holidays I might very well not have lived to see. We send our deepest thanks to each of you—and we know there were many more “behind the scenes” whom we did not meet—at Global Rescue who participated in my evacuation.
With deepest respect and gratitude,
Dr. John Schmeelk
While in Germany vacationing with his family, a member was attempting to board a train when he fell into the gap between the train and the platform, severely lacerating his leg. Soon after the incident, his son contacted Global Rescue.
After the initial call, local medics arrived on the scene and transported the member to a nearby hospital, where physicians attempted to control the bleeding and performed an x-ray. On first review, local medical staff in Germany felt that the situation was stable and that there was no evidence of any fractures or injury beyond the laceration.
After reviewing the injury with local doctors, it was decided that the best course of action would be for the member to remain in Germany for a further 5 days to determine whether the leg was stable for transport and if a skin graft would be required. The member could then be transported to his home hospital in Houston for further treatment.
Global Rescue took steps to ensure the member remained comfortable in hospital and contacted his wife, who helped obtain the release of relevant medical records. These allowed Global Rescue medical teams to better understand whether appropriate care was being received and what the next steps should be in the treatment process.
As a result of the extended stay and to monitor the patient during the onward transportation, Global Rescue deployed medical personnel to Germany who met the injured member and his wife at the hospital, arranged his discharge, and oversaw his transport.
Once on the ground in Houston, Global Rescue arranged ground transportation for the member from the airport to ER at the receiving hospital.
After an ER evaluation and diagnostics, it was determined that the member’s injury was healing well and the situation did not require further hospital admission.
While vacationing in Greece, a US citizen experienced an unprovoked seizure that lasted for nearly thirty minutes. Hospitalized locally, she was placed into a medically induced coma. Shocked by this sudden episode, the patient’s sister contacted Global Rescue.
At the request of family members, Global Rescue organized the patient’s transportation from the Greek hospital to the US in order to ensure that the patient was receiving the highest level of care possible. Global Rescue coordinated communication between the hospital in Greece, the patient’s family, and specialists at a leading US hospital. Doctors were advised to prepare a place for the patient, who would be transferred from the Greek hospital as soon as her condition was diagnosed as ‘safe for travel.’ The patient was cleared for travel aboard a medically equipped jet, and family members made plans to arrive at the receiving hospital immediately following the patient’s admission.
The patient was flown from the hospital in Greece directly to Boston. After coordinating with the flight crew, Global Rescue assured family members that the patient’s vital signs remained stable throughout the transport process and that the flight went without incident. The patient was met by two Global Rescue paramedics at the airport, who provided direct care during the ambulance transport to the hospital. All important medical information was relayed to staff members at the receiving hospital, who were fully prepared to receive the patient and begin medical procedures upon arrival.
The patient continues to make a recovery and family members thanked Global Rescue for their work and support throughout this difficult event.
Global Rescue was recently contacted by a member who had suffered a suspected stroke while skiing in Chambery, France. He was immediately transported to a local hospital where he was admitted. To ensure the patient received the best possible treatment, the decision was made to immediately deploy a Global Rescue paramedic to the patient’s bedside. Once on the ground, the paramedic was able to work with local doctors and communicate test results to Global Rescue’s waiting medical team and specialists at Johns Hopkins Medicine. Given the severity of the injury, it was decided that the best course of action was to transport the member to Geneva, where he would be able to receive improved diagnostics and treatment, prior to transporting him home. After receiving stabilizing care in Switzerland, the member was judged well enough to be transported back to his home hospital in Scotland. Due to his condition he was unable to travel by air so Global Rescue’s deployed paramedic escorted him by train to his home in Scotland. The member and his family arrived safely in Edinburgh and were promptly seen by the Head of Neurology.