altitude sickness, what's your call?

[sleeping bear]

Alright, so this is sort of an extension on the "worst case scenario" thread and also some fodder for a course in which I'm studying judgment.

Here's the scenario:
You're leading a group of people on a two week trip in the mountains.
There are ten people altogether. This could just be a group of friends, but let's say you have the most outdoor experience of any of them. One member of the group (we'll call him John) began to display symptoms of acute mountain sickness (AMS) on the second day of the trip at about 11,000'. John deteriorated throughout that day, ending with a vomiting spell in the middle of the night. You didn't evac them because it was dark. In the morning John claimed to be feeling better and did look better. The group spent the day in camp resting. The next day John AMS claimed to be feeling much better and was ready to move camp. The group packed up and planned to cross a 13,000' pass and camp at about about 11,400' on the other side. At 12,000' John looks terrible again, but insists he can keep going. You take heavy items from his pack and redistribute them throughout the group. At 12,500' John begins vomiting again. Now he says his extremeties are tingling and he has a pounding headache. Clouds are rolling in and thunderstorms are the norm at this time of day. The rest of the group is in good condition, but you've been moving really slowly to accomodate John. Do you continue over the pass knowing that you will camp low on the other side? Or, do you turn the group around and go back down this side of the pass?

I have very little experience with AMS or elevation. I do not know which is the correct decision, and am looking for input from those with more high altitude expereince.

 

[sapblatt]

Get him out of there...I would not push thru a pass with t-storms in the future with someone who at best is questionable...

 

[cbcbd]

How many more miles to get over the pass? Is the hiking exposed?


Not knowing all details it's hard to tell, but the only answer is that altitude sickness can only be treated by moving to a lower elevation.

Having seen someone who on day one was vomiting and then the following day was stumbling along the trail like he was drunk, I could see how this situation could get very dangerous not just for AMS John but for the whole group who will now have to go a slower pace (and maybe not miss the T-storms) and will have to watch out for John to make sure he doesn't fall over.

IMO, the best thing to do would be to get to a lower elevation using the shortest way - being over the pass or back where you came from - in this case I'm guessing that going back the same way is it.

 

[David Metsky]

If John was showing signs of AMS on the second day at 11,000' then I'd make sure he goes down right then and there, not climbing higher. I'd never have started out for the pass after John's first bout with AMS. If it progressed to the current scenario then you get John to lower altitude ASAP, forget the pass. It's a no brainer.

-dave-

 

[MichaelJ]

What Dave said. Unless you could prove the first bout wasn't altitude-related (ie, bad food), he's got to go down, don't even attempt going up further with him in the first place, even if he feels/looks better.

 

[nartreb]

Further dittoes. But let's make this interesting: you're at 12500', just below a 13000' pass. On the other side (where you planned to go) is a quick, easy descent to a campsite at 11,400' that's also near a hut with a telephone, and a road that leads to a hospital. The way you've come is a longer, more difficult hike back to your previous campsite at 11,000', which itself is a full day's hike back to any kind of civilization. Both routes are entirely above treeline and the thunderstorms look likely to give both routes a pounding. Does your answer change?

(I'll wait a bit before giving mine.)

 

[Gris]

Further dittoes. But let's make this interesting: you're at 12500', just below a 13000' pass. On the other side (where you planned to go) is a quick, easy descent to a campsite at 11,400' that's also near a hut with a telephone, and a road that leads to a hospital. The way you've come is a longer, more difficult hike back to your previous campsite at 11,000', which itself is a full day's hike back to any kind of civilization. Both routes are entirely above treeline and the thunderstorms look likely to give both routes a pounding. Does your answer change?

(I'll wait a bit before giving mine.)

Eeeewww keeewl!

Half the group goes back w/ John (those that draw the short straws). The other half runs over the mountain pass dodging bolts and have stories to tell that night as they wonder about John, but not too much. The strongest of the proceeding mountain pass group continue on to the hut and make a call to see if anything further need be done for John and, if necessary, alert anyone needed that's John is shuffling back and ask that John call the hut to confirm he is OK. The following night John calls the hut, says he's fine wishes he could still be on the trip and then describes in great detail the perfect steak he is eating in town, as well as the ice-cold, flavorful, seasonal hand-crafted micro-brews he is enjoying as he speaks...

 

[sleeping bear]

wow, great responses!

I guess I know what I'd do in this situation, but wanted to hear input from a broad and different range of experiences.

For the clarification that someone asked about-
Going over the 13,000' pass means you're above treeline for another 2 miles. Continuing up means at least another four miles to the next possible campsite. If you go back the way you came it's 2 miles to the previous night's site. It's also 1:30 in the afternoon.

If you go over the pass and John continues to deteriorate, it is possible to get out of the mountains without goving back abover 11,000'.

 

[David Metsky]

If someone is showing signs of AMS you go down. Going up is just going to make things worse and potentially move the situation from critical to fatal. Even with all those extenuating circumstances, your first call should be to lose elevation. You can deal with the evac later.

Mild to moderate headaches are not AMS, although they can be sign. Vomiting, pounding headaches, inability to catch your breath even after extended rest? Go down, do not pass go, do not collect a body bag.

 

[DrewKnight]

Limited experience with AMS... but...

I would tend agree with the nuanced/risk management approach to the problem. If the terrain ahead is harder than where we've just come from, or John has any sign of pulmonary edema (cough, fluid in lungs, blue lips, etc.), then it's get lower as quickly as possible, which presumably means turn back.

If it's "merely" that John is feeling rotten from the altitude (people don't generally die from nausea and a thumping head. About half a lifetime ago, I spent two days at 18,000 feet at the base of Everest, feeling like I was suffering the world's worst tequila hangover), and making it over the pass is a shorter path to lower altitude and relative security, I would at least consider that alternative.

Ditto with the encroaching possibility of storms. If going any higher increases exposure, then that would vote against, particularly with a member of the group moving slowly. If the risk profile is equal and getting through and down the other side reduces overall exposure... press on.

All that said, I would generally err on the side of turning back if the other variables weren't well known or understood.

By the way, while my wife and I were only suffering mild AMS and were able to 'enjoy' two days at Rongbuk Monastery, on day two we met up with a European trekker who had a moderately advanced case of pulmonary edema, complete with bubbly breaths and blue lips. We took in back down in our "freelance" Land Rover to a small village at about 14,000 feet (where we proceeded to get stuck overnight in the rising glacial river). Just going down 4000 feet substantially improved his symptoms, and he was back to more-or-less normal at 12,000 feet a couple days later.

 

[skiguy]

Down...down....down. On another note did John have any other acclimitizing before day two at 11000? Did he have any other experience at Altitude prior to this trip. IMO 11000 is pretty high for someone who has not been to that altitude before to know how their body is going to react. Not that there are not plenty of climbers who would do fine jumping up to 11000 from sea level in one day but on the other hand I would prefer a bit more acclimitizing. You are writing about judgement correct?

 

[DougPaul]

There are 3 ways of treating severe AMS:
1. Go down.
2. Go down.
3. Go down.


Actually administering oxygen or using a Gamow bag (http://en.wikipedia.org/wiki/Gamow_bag)--the equivalent of going down a few thousand feet--can also help, but most hiking parties do not carry them. As these are generally just preludes to the three main methods listed above.

Doug

 

[skiguy]

There are 3 ways of treating severe AMS:
1. Go down.
2. Go down.
3. Go down.


Actually administering oxygen or using a Gamow bag (http://en.wikipedia.org/wiki/Gamow_bag)--the equivalent of going down a few thousand feet--can also help, but most hiking parties do not carry them. As these are generally just preludes to the three main methods listed above.

Doug

One of These can go a long way for preventative measures. Gamow Bags can be rented FYI.

 

[tallguinness]

Been there

Been there...I was at 14400' and got the hurling and finger numbness thing. Found my symptoms pretty-much disappeared back at 12500' with a little food and drink. Best to go down.

 

[jime]

Having started getting the symptoms at 8,000 and tossing my cookies many times at 10,000 I would heartily echo the wisdom of getting them down as quickly as possible. Someone described my case as "mild". Trust me there is nothing "mild" about AMS!! Yuck!

 

[DougPaul]

Having started getting the symptoms at 8,000 and tossing my cookies many times at 10,000 I would heartily echo the wisdom of getting them down as quickly as possible. Someone described my case as "mild".

Mild cases often progress to severe if you stay put. Someone with a mild case can often walk out unassisted (should be accompanied), but may require help as the symptoms get worse.

Doug

 

[nartreb]

>Mild cases often progress to severe if you stay put. Someone with a mild case can often walk out unassisted (should be accompanied), but may require help as the symptoms get worse.


Precisely. In our hypothetical, the victim is still able to walk. The priority is to make sure he stays that way. Go downhill, do not go uphill.
Though the remaining uphill distance is small, and the rescue options on the other side are better than on this side, the risk of worsening the victim's condition outweighs this. You probably don't have the equipment or manpower to treate acute pulmonary or cerebral edema, or to carry the victim down the mountain. And even in the best case, it would take a few hours for any rescue to reach you. So if you proceed as planned, you are gambling your friend's life on him being able to make it over the pass.
Whereas if you retreat, you lose a day or two off your planned itinerary, nothing else.


Recall that there are ten people in the group. Assume that nobody has a radio or phone. Do you send part of the group over the pass to the cabin that has a phone? If so, who do they call and what message do they deliver?

 

[TomD]

I used to live in La Paz, Bolivia at 11.5K ft. After coming back home from college in the states (Ohio), I woke up coughing blood-pneumonia or most likely HAPE. The solution was about 10 days in a clinic on oxygen. I had been sick there one other time-when I first got there-also resulted in a hospital stay-not sure what caused that.

As far as your scenario, down quickly would be my choice. As for the chance of bad weather, lightning is always a possibility. If you want a good read on that subject, read "Shattered Air" about a group of hikers hit on Half Dome. If that doesn't scare the heck out of you, nothing will.

 

[RoySwkr]

If this person really has AMS, they need to go down

Of course dehydration and other common mountain conditions have similar symptoms to AMS and deciding whether this person needs to be evacuated or should continue (particularly if they insist on going on) is the sort of thing that makes enemies of former friends

I do feel that your timeline shows that an irresponsible decision has already been made, hiking above treeline in the W you should not still be going up at 1:30 pm you should already be headed down - you obviously left camp much too late to still be so close and you are lucky not to have been hit by lightning already (if it took since 8:30 to get this far of course you need to go back)

 

[sierra]

This is easy, go down as soon as symptons arrive or you bear the responsibility. Those who flirt with this course of action will pay dearly.