How to Prevent Mountain Tregedies

HEALTH HOW TO PREVENT MOUNTAIN TRAGEDIES
Altitude sickness has played a leading role in many of the world’s worst mountain tragedies — but it can be prevented if you take simple precautions and know what symptoms to look out for

The thrill of trekking at high altitudes among Asia’s spectacular mountain ranges can carry a huge risk. Yet despite well publicized incidents, many climbers remain unaware of the symptoms and causes of AMS Photo: Colin Galloway

You’ve finally made it. The air is razor sharp, the views are magnificent—and you have the world’s worst hangover. If you’re above 2400m, chances are you’re suffering from altitude sickness and, unlike a hangover, it can kill you.

Acute mountain sickness (AMS) — also known as hypoxia or altitude sickness — is a hidden killer. It strikes almost without warning and it leaves you helpless, unable to think rationally or act safely. Some of the fittest, most experienced mountaineers of the 20th century have fallen victim to this illness, and died because of it.

But altitude is not only a problem for those attempting Everest and K2. Visiting many of Asia’s high trails, trekking peaks and volcanoes will put you in the danger zone. In Nepal, one in every 30,000 trekkers dies of altitude sickness and many others are evacuated or have their trips ruined because of altitude induced illness.

Know your enemy
As altitude increases air pressure decreases, so at 5500m there is about half the oxygen, CO2 and nitrogen found at sea level. This means the oxygen in your blood — and therefore the amount available to muscles -and the brain — also drops. Given time and the right conditions. however. your body can usual compensate for this in a process known as acclimatization.

But if you ascend too quickly or try to work too hard there isn’t enough oxygen available for your body to function properly. It suffers from lack of oxygen, a condition called hypoxia, and you develop symptoms of AMS (see box).

No-one is immune
Individuals vary in how quickly they acclimatize but everyone will get sick if they ascend faster than their bodies can adjust. Most people start to feel the effects of altitude at around 2400m but cases have been known to occur at only 1800m.

Although being physically fit will help you do the work involved in walking or climbing it has no influence on whether you develop AMS or not. ANIS is not a barrier you can “push” through and however well acclimatized you are you won’tperform as well as yco do at sea level.

Previous success visits to high altitude do not guarantee you worst have problems — although experience should increase you chances of recognizing the symptoms of Acclimatization is lost it the same rate it is gained, so if you spend more than one to weeks at sea level between high altitude trips you will have to acclimatize again. Ever those who normally live at high altitudes AMS if they go to small level then ascend t quickly, and anyone who stays for long periods at over 5200m will suffer gradual physical deterioration.

Be prepared
The best way to avoid altitude sickness is to check that sufficient time has been allowed for acclimatization when planning your trip. Don’t assume that schedules drawn up by commercial operators suit you, or accept something just because you are told it is “normal” practice. On a trip to Nepal I encountered two people on a trek organized by a famous MOL taineer. Their first acclimatization day at 5400m. One didn’t make it that far and the other had to be carried out.

If you are flying or driving to high titude (2400m or above) make sure are no strenuous activities planned least a couple of days. Once above 30 you should not ascend more than 300m day, and for every 900m gained you should have an acclimatization or rest day. Local conditions, such as a lack of camp sites, may mean this schedule has to be adjusted, but the overall speed of ascent shouldn’t be increased. For example, if you have to ascend 600m in one day, you should spend the next day acclimatizing at that altitude before moving on.

Remember this is a rough guide only. You may have to go slower or, if you develop symptoms, stop or descend, so it is useful to have a few spare days available.

Taking preventive medication such as Diamox (acetazolamide) can aid acclimatization, but you should discuss this with your doctor. The drug isn’t a cure for altitude sickness and using it won’t compensate for an over-ambitious schedule.

A pre-trip medical check-up is recommended for everyone. You should seek expert medical advice if you are pregnant, have any sort of health problem, or intend taking children, as they are particularly sensitive to higher altitude.

If you’re travelling with a commercial group you should check whether oxygen and/or a portable pressure chamber will be carried. These can be useful to relieve symptoms in an emergency — but they are not a substitute for descending.

Light exercise assists acclimatization so if you have no symptoms use spare time to explore. It is okay to exceed the allocated “height” for the day provided you return to sleep at the lower level (this is the meaning of the climbing motto “climb high, sleep low”). Even at sea level blood oxygen concentrations drop during sleep. At high altitudes, when blood oxygen levels are already low, this increases the chance of AMS. Even descending just a few hundred metres to sleep can make a big difference.

You can also help your body acclimatize by walking slowly and using local porters or pack animals to minimize your load. This is one instance when the tortoise definitely wins out over the hare — and it’s also an excellent opportunity to take time to enjoy the spectacular views and appreciate the trip.

Dehydration is a major problem at high altitude because rapid, deep breathing of cold, dry air increases fluid loss. You may not feel thirsty but aim to drink at least four litres of fluid a day. Water, soft drinks, and soup are ideal. Go easy on drinks containing caffeine — coffee, tea, cola drinks and hot chocolate — which can increase fluid loss. Also avoid alcohol as it dehydrates the body. Keep a check on the other end too. Increased urinary output is a sign that you are acclimatizing properly. A decrease or dark-coloured urine is a serious warning that you are not.

Your body is already working a lot harder to get the oxygen it needs so don’t hamper it further by smoking. Avoid sleeping tablets, or sedatives which can dangerously decrease respiration rates.

Some people find that occasionally taking a series of deep breaths is helpful but don’t overdo this or you may hyperventilate. Make sure your bedroom or tent is well ventilated.

Stay Alert
Altitude sickness can seriously affect your judgement, so it is important that everyone in the party knows the symptoms and watches for them in others. including local employees. Victims may deny they are ill, hide symptoms, and become paranoid. Anyone displaying even mild.-V\IS should not be left alone as their condition can deteriorate rapidly. It is also possible for apparently well acclimatized people to suddenly develop serious forms of AMS.

Illness at altitude should always be considered to be AMS until proven otherwise. Prior to 1960 many people died because AMS was mistaken for pneumonia. It can also mimic a hangover or flu.

Descent is the only treatment for AMS but fortunately it is a very effective one and most people recover completely.

SYMPTOMS & TREATMETN OF AMS
• headache
• shortness of breath during exertion
• disturbed sleep
• dizziness or light-headedness
• minor swelling of hands and face
• irregular breathing, usually in sleep
• loss of appetite
• weakness
• nausea

Treatment:
Do not continue to ascend with any symptoms of AMS. If symptoms do not abate, or continue to worsen after rest, you must descend until comfortable even if it means splitting up the group. Descent is the only sure treatment for AMS — delay can be fatal. Often you will be able to continue after rest at a lower altitude. If in doubt, you should always descend.

SEVERE
• rapid pulse (110 per minute) at rest
• rapid respiration (20 plus breaths per minute) at rest
• low urine output
• persistent severe cough
• coughing up watery or frothy, white, pink or rust-coloured material
• bluish tinge to lips, face, or nails
• marked swelling of the hands and face
• wet, bubbly sounding breathing
• vomiting
• severe persistent headache
• excessive fatigue
• loss of co-ordination or staggering
• severe weakness
• inability to solve simple problems, e.g. reading a watch when reflected in a mirror.
• confusion/irrational behaviour/may deny illness
• unconsciousness/coma

Treatment
Immediate descent is essential. Even one of these symptoms can indicate High Altitude Pulmonary Edema (HAPE), fluid in the lungs, or High Altitude Cerebral Edema (HACE), swelling of the brain. Both can kill within hours so fast action is essential. Do not wait for a helicopter or until morning. Use oxygen or a portable pressure chamber during —but not instead of — descent. Even descending a few hundred metres can make a huge difference. You may have to be carried to avoid further exertion. Both HAPE and HACE can occur suddenly in people who seemed to have acclimatized well.

Other medication
Check with a doctor on the possible side-effects of medication at high altitude. Women should not take oral contraceptives at high altitude.