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Altitude sickness death

How do you prepare for the rigorous physical requirements of high elevation adventure? Strength and endurance are key, but are only part of a more complex equation. How do you prepare for changes in altitude, exposure, diet, etc.? How do you mentally prepare? Learn from others and share what you know about training in advance for outdoor adventures.
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Re: Altitude sickness death

Postby ManOfTooManySports » Sat Aug 18, 2012 4:54 pm

orbweaver (great name!), the good news is that if you do have to bail out, you can stay low and head out at Florence Lake. You'd have to string together some rides to get to the east side, but that would be the least of your problems.



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Re: Altitude sickness death

Postby overheadx2 » Sat Aug 18, 2012 10:55 pm

My post was not to have people second guess going (death is very rare) or be afraid to go, simply to let friends looking for packing info and advice know what to look for in case they happen to be that 1 in a million. I have never mentioned HAPE to any one asking for packing advice. Being susceptible to AMS myself, I usually don't feel great the fist night, but feel fine the next AM. If you wake the second or third day and continue to note decline, I would certainly monitor what's happening. As we have heard from several people, if you continue to decline over days, simply call it off and try another day. If you are solo, and have concerns, maybe a Delorme or spot is in order (probably not a bad idea on a solo trip any way).
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Re: Altitude sickness death

Postby Trent » Tue Aug 21, 2012 11:35 am

Reading all these replies,,,, there's a couple of things to be aware of that would apply to both AMS and injuries.

First of all, if you're "solo" in the backcountry and have the misfortune to break an ankle, get AMS [cerebral or pulmonary edema] or something, you're going to be a "permanent fixture" there unless you have some sort of "communication" with the outside world. I carry a sat phone [Iridium] and a ACR NOAA 406 mh rescue beacon. I've tested the sat phone in some very remote areas,,,, it's always worked.

The Sequoia / King's Canyon Park Service's "emergency" phone number, to be used ONLY if there's a true emergency, is 559/ 565-3195. While this may seem paranoic, consider that you may run across some other trekker in distress. The "Spot" things don't always work in the backcountry for some reason.

Secondly, if you have to be flown out [helicopter] be aware that they [the Sheriff's Department, Park Service, etc] are going to send you the bill. It ain't cheap, figure on $10,000 or so.

The answer to this is "Global Rescue insurance" 617/ 459-4200 [Globalrescue.com]. The deal is that if you are more than 160 miles from your "home base" [your residence] they will cover the cost of your "rescue", the cost of getting you to the hospital, and if need be the cost of getting you all the way back to your home. From virtually anywhere on the planet. It does not cover your medical expenses, just the rescue and transportation part.

I've got it, just hope I never have to use it.
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Re: Altitude sickness death

Postby AlmostThere » Tue Aug 21, 2012 11:45 am

Please stop telling people county search will charge. WE DO NOT.

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Re: Altitude sickness death

Postby acvdmlac » Wed Jul 15, 2015 1:42 pm

I am so sorry to learn about this terrible loss. My condolences to the family of the deceased. I can only imagine how painful this must be for the family and friends 4 years later and beyond.

What I have to add to this important thread, is to emphasize how much children and adolescents are more susceptible to altitude sickness (as well its sometimes co-morbid condition of dehydration/heat illness, hypothermia, or hyponatremia--sodium deficiency from a combination of sweating, excessive water consumption, and inadequate ingestion of salty foods). Children and adolescents are also less able to recognize, report, and communicate about symptoms, than adults.

These are obvious points once one stops to think about them, but I had not given them adequate consideration until I reached for the wilderness med hand-book in my first aid kit after my friend's fit, athletic, and stoic 14 year-old suddenly started complaining of severe fatigue, malaise and nausea and then started shivering and vomited fluids just after drinking about a half-liter of (tap) water, at our urging, at the end of a strenuous ascent in 6 hours over 6 miles, from an 8,000' trailhead to 10,600' Baker Lake (Great Basin National Park, Nevada, not Sierra in CA, but still relevant, I think).

He hadn't eaten or drunk much water that afternoon while we back-packed, but probably sweat profusely while he kept up with me, carrying a full back-pack, as I pushed my own limits to get to a camp-able site before dark (after a later-than-planned start and inability to locate campsites along the way as described in our trail guide). He had fallen asleep briefly when we arrived at the lake, and it was after being woken up by his father that he started complaining of nausea, and then vomited. His pulse was rapid, my partner (also a medical professional) estimated about 90 bpm (the second had on her watch was too small to read even by bright LED light--something to think about when selecting a time-piece for field use). He seemed slightly clumsy and lethargic, but not grossly uncoordinated. His mood and mental status seemed grossly normal, although I didn't check for full orientation. His respiration was of grossly normal rate and rhythm, without coughing, shortness of breath, headache, or muscle cramps. He did not want to drink fluids or eat, and attributed his vomiting to contamination of the water we had asked him to drink. This was his first back-packing experience at altitude. It was too dark to check reliably for cyanosis (blue lips and fingernails). I was assuming that altitude was the culprit, and did not reach for the thermometer in my kit. I don't recall any abnormal sweating.

After vomiting he was drowsy, just wanted to sleep, and was able to climb into his tent and lie down without further incident.

As a medical professional and experienced high-altitude back-packer, but without specific training in wilderness or altitude medicine, I at least recognized the severity and danger of the situation. I identified acute altitude sickness as the most likely and primary cause of his symptoms that should be assumed present, and recommended immediate descent. I offered to use my SAR beacon to call for emergency transport as the most rapid and safe option (night had fallen, and the 14-year old was in no shape to hike back down). His father declined, and luckily, his son slept well through the night was symptom-free the next day. We descended back to the trailhead the next morning without further incident.

The previous two nights we had car-camped at 7,500' and 6,500' (after starting from sea level), and the previous two days we were continuously above 5,000', including drive over 9,600' Sonora Pass, so I hadn't thought the altitude would have proved so much of a problem--it might not have for most adults, although we all had some mild and transient symptoms of altitude sickness by the time we got to 10,000' (no surprise to me). The weather was hot at the trailhead--I'd guess upper 80s, and probably reduced to low-60s by the time we got to Baker Lake at nightfall. Without any wind or water immersion, I wouldn't expect hypothermia as a risk at those temps. The water loss during hiking was probably more significant than I am used to in the Sierra Nevada--Nevada's Snake Range felt much drier.

In retrospect, I found my hand-book helpful only in confirming the severity of the situation, but inadequate in presenting a clear differential diagnosis between altitude sickness vs. hyper- or hypo-thermia and/or hyponatremia. There is some overlap in symptoms among all of them, and it seems that altitude sickness could be present simultaneously with any of the other 3. (I am also curious whether anyone know whether prior mild hyperthermia could make one more vulnerable to subsequent hypothermia following a severe temperature drop, as a consequence of over-compensation and disruption of the body's thermo-regulatory mechanisms). My recent experience tells me that the differentiation among these conditions is not as easy in an actual wilderness back-packing setting as it might seem in a textbook or clinic--yet critical to make rapidly and accurately, because the treatments are in some ways opposite (whether or not to administer heat vs. cold, fluids/type of food vs. not, etc.), depending on the cause. Mis-diagnosis/mis-management could prove fatal.

I am still researching and analyzing his signs and symptoms to try to better identify the likely relative contributions to this incident. I suspect too-rapid altitude ascent as the primary cause, exacerbated by a combination of dehydration, over-exertion, and over-compensation of the his thermoregulation during a rapid drop from hot to cool. I'll follow up with another post if/when I'm able to locate or present ways to more rapidly and reliably distinguish illness from heat- vs. cold- vs. altitude vs. exertion and hyponatremia--in the field with nothing more than a watch and a thermometer (that can give accurate readings by head-lamp), and simple knowledge that any lay-person could easily and rapidly make use of.

My suggestions for now: when planning back-packing or day-hiking with children and adolescents, consider their greater vulnerability to extremes and changes in weather and altitude; monitor their drinking, eating, exertion and fatigue levels carefully; stay extra-vigilant to early warning signs/symptoms, and don't presume that they can or will communicate regarding their symptoms the way most adults would.

Even for adults, I recommend more careful consideration of the risks of acute altitude sickness than I think is sometimes exhibited by trip recommendations that start with ascents to 10,000' + altitudes on Day 1 without reference to acclimatization for those coming from altitudes below 7-8,000'. Ascents over 10,000' + passes on Day 1 or even 2 are particularly dangerous because of the necessity to go back up and over the pass to get to lower altitude, unless one is prepared to call for emergency help, which is of course inconsistent with responsible trip-planning and advice.

I feel very grateful, relieved and lucky that my friend's son suffered no harm, and hope that this information will stimulate more discussion and awareness of these issues and prevent preventable and tragic losses such as described above.
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Re: Altitude sickness death

Postby Cross Country » Wed Jul 15, 2015 7:39 pm

Jim, 11 anos, Mike 6 anos and I went on two trips with no problems and I had neve experienced a problem in about 300 days during 15 years. On thier 3rd trip we drove from Sea Level to Onion Vally and went over Kearsarge Pass in the same day. They didn´t seem to be having big problems going up, but near the pass they were VERY tired. That night neither could eat dinner and went to bed a 7:30. They slept until 8 the next day. From the time they told me they couldn´t eat I knew I had made a big mistake. I altered our trip and we went to Charlotte Lake and stayed there 2 days instead of going to Gardner Basin. When we left they did fine and we hiked out to Onion. I was perfectly ready to stop at Kearsarge Lakes but they wanted to hike out. I learned a VERY cheap lesson and never did anything like that with them for the rest of thier backpacking lives (8 more years)
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Re: Altitude sickness death

Postby Jimr » Wed Jul 15, 2015 8:45 pm

My kid had a bout of AMS last year that caused us to abort. When I was 14, I went to Blue Lake out of Sabrina with an uncle of mine. First backpacking trip. It was also one of the first years permits were required. While waiting for him to go back down to Bishop, waiting on the TH (that I swear went around the other side of the lake that it currently does). I started eating wild currants just off of the trail after watching somebody pass us and start scarfing them. I was sick for 3 days. Couldn't keep much down, headache, nausea, etc. Drift fishing from an inflatable raft was fine (rainbows in the lake at that time), but camping on the island, no bueno.

We always thought I was sick from the unknown berries, but now I'm sure it was AMS.
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Re: Altitude sickness death

Postby chrismis21 » Thu Jul 16, 2015 4:07 pm

First, I'm very sorry to hear of their loss. That must be a terrible feeling. As a parent, I can't imagine the agony, especially from doing something they most likely loved so much to share as a family.

I have four young children and my wife and I take them out hiking often. It's one thing to push them a bit, but we try to stay very mindful of how everyone's feeling. We won't take them to high altitude until they're old enough to exhibit or explain any symptoms better. My oldest is 6, and we're planning a daddy/daughter backpacking trip in a few weeks. We're headed up to the Cottonwood Lakes area, spending a night at HM before we shove off. If we get up there and altitude is presenting an issue, we'll go on a backup hike and overnight a bit further south (closer to home instead of further) that puts us at a lower elevation, regardless of our original goal. Putting my child in harm's way is the absolute last thing I would ever do or want to do!
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Re: Altitude sickness death

Postby acvdmlac » Tue Jul 21, 2015 1:02 pm

In my own experience, response to altitude also seems to be variable, making it less predictable and easily preventable than it sounds in textbooks. I've had AMS triggered by drive from sea level to 7,500' in one day; I've also gone to 8,500 on Day 1, 10,500 on Day 2 and over 11,000'-12,000' passes on Day 3 from sea level with no trouble. I've seen similar variability in my various traveling companions. Staying well-hydrated and avoiding extremes of exertion until acclimated does seem to help, but erring on the side of safety is increasingly built into my back-pack plans.

For those consulting this forum to plan trips at altitude at the first time, or with relatively little personal experience at altitude, it can't be emphasized enough that vulnerability to AMS is determined by genetics and not by fitness, i.e. no amount of sea-level training can prevent it, and you won't know what your personal genetic disposition is until you find out the hard way. And kids and adolescents are more vulnerable than adults, and men more than women.
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Re: Altitude sickness death

Postby Cross Country » Thu Jul 23, 2015 10:28 pm

I wrote a good entry on this subjuct that I was pretty sure was here. I must not have hit submit.
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Re: Altitude sickness death

Postby ERIC » Fri Jul 24, 2015 7:15 am

I see your response, about 4-5 posts above.
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Re: Altitude sickness death

Postby Tom_H » Sat Jul 25, 2015 8:58 pm

My condolences to the family, though I notice this thread was resurrected after a 3 year hiatus. As an instructor, several times I had to evacuate kids who just weren't physically prepared to be on the trail. We always communicated many months ahead of time the need for conditioning and asked for confirmation, but still there were some who had not done so. We had far fewer problems in the Appalachians than the Sierra and more in the Rockies than the Sierra, which is not surprising.

Knowing the warning signs of AMS, pulmonary, retinal, and cerebral edemas is important. If you a newbie, either get some training or do your first trips with someone who has experience. Heading out into the wilderness by yourself unprepared is a dangerous thing. I know I'm preaching to the choir here, but Mav (bless him) organizes far too many searches for those who have gone missing.
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