Microsoft word - accident on river 07-21-2005.doc

Thursday, July 21, 2005
Accident on river brings home safety issues
By DAVE MCKEE, for the Chronicle
In the fascinating world of a columnist it seems that much of the average week is spent with eyes open and nose to the
ground in hopes that some shred of a topic will surface before the dreaded deadline strikes. At times ideas come easily,
simply jumping from headlines or recent adventures. The other 49 weeks of the year, precious topics run scarce, hiding in
corners or the cracks of the sidewalk, forcing one to dig deep or create something out of absolutely nothing.
Having recently experimented with AquaVu underwater video technology, it seemed that this week's musing would be
easy and I had anxiously looked forward to exposing the finer points of becoming one with the mysteries of the deep.
Unfortunately, the train of thought was put on hold.
Just two days after writing a fairly serious column concerning the inherent risks involved with recreating on local rivers, I
was exposed to the subject first hand. And regardless of the irony involved with the situation, a somewhat traumatic river
rescue was enough to open my eyes just that much further.
Though details of the event are many, I'll keep it brief as the lesson to be learned requires some room. Here it goes -
Saturday morning, nearly eighty degrees, clear skies and the Yellowstone River between Livingston and Big Timber. Four
people, one canoe, sitting in it backwards, going through the rapids, not wearing life jackets, already been drinking.
Presumably this presents an image of which the outcome seems somewhat inevitable.
The sheer miracle involved with making it as far from the boat ramp as they did will leave me eternally perplexed. Still,
luck only runs so deep and when the canoe dumped its load amongst the river's currents just downstream from the honey
hole, distance left us no choice but to watch. Never would I have predicted the following as we pulled anchor and pushed
ahead to help.
Unable to swim, a female member of the crew had been drug to the willows by one of her counterparts. There in the mud
they sat, he with his arms around her, she seemingly lifeless apart from violent seizing and uncontrollable shaking.
Inexperienced and fortunately naive to human trauma aside from basic Red Cross first aid/CPR training, I was shocked to
be standing face to face with an actual, real life medical emergency just two miles from basically nowhere. Had a doctor
not been on board the Pequod that morning, I can't be sure how I would have handled the situation.
Looking back, hypothermic symptoms seemed obvious - weak pulse, uncontrolled shaking, absolute disorientation. In the
summer heat who would have guessed? Probably not me, not in July. Anyway, as I went for the cell phone and 911,
attempts to get her dry and warm almost instantly brought some stability to the situation and within the hour, actual
medical technicians arrived on the scene.
While I can't be sure, it's probably safe to assume that the outcome was probably less than severe. Even still, as I sit here
now reviewing the situation and considering what I might have learned, it's embarrassing to recognize how little I've been
prepared to handle. First Aid was simply a guide license requirement and something I hadn't taken too seriously. I'd
laughed about the CPR dummy, I'd drawn in my textbook assuming all the while that it wouldn't happen to me.
In the case of a wilderness emergency how would you react? How well prepared are you to handle the worst? For years
I'd conveniently forgotten to consider these questions assuming eternal optimism would prevail. Now, having been given a
dose of reality, I'm forced to take a good hard look at the potential of any outdoor situation. So I ask myself these
questions as we all probably should before an emergency stares us in the face.
If I have a cell phone to call 911, does it have enough battery to last at least an hour to relay directions to medical
personnel or to receive instructions on how to handle the problem? While out on the water or back in the mountains, do I
know where I am, could I describe my whereabouts if necessary? And what's in my backcountry first aid kit anyway?
What are the symptoms of hypothermia, the onset of a heart attack or low blood sugar? How do we treat each one and do
we have the necessary ingredients to do so? Can we handle a broken limb, a snakebite or massive puncture wound with
excessive bleeding. Could we give rescue breathing, revive the victim of a lightning strike, remove a barbed hook from
someone's nose? The list goes on.
It's pointless to run from the reality in terms of basic emergency care. By doing so we force ourselves into the dangerous
position of being able to look back and wonder what we could have done differently. So stay safe and next week we'll be
back to the lighter side.
Wilderness First Aid Basics
Pre-class Reading

The Associated Press
Updated: 7:57 a.m. CT Oct 15, 2007
WHITE HAVEN, Pa. - A Boy Scout played dead when attacked by a bear during a camping trip, avoiding serious injury.
Chris Malasics, 14, curled up in the fetal position in his sleeping bag after the bear ripped down his tent at Hickory Run
State Park around 11:30 p.m. Friday.
"I was just trying to figure out what to do to not get hurt," he told the Daily Local News of West Chester.
As the bear started tossing Malasics around, a Scout leader tried to create a disturbance by banging pots and pans and
flashing car headlights. The bear eventually wandered off.
Malasics, of Chester Springs, was taken to a hospital for treatment for his cuts and bruises. He was also given a
precautionary rabies shot.
Malasics said the experience will not deter him from going camping. In the future, though, he intends to make sure he
has a pepper spray for bears, and perhaps a gun.
"I know how to shoot," he said.
Copyright 2007 The Associated Press
Friday , July 21, 2006
A black bear that bit a sleeping Boy Scout through the wall of his tent was shot after it later returned to the camp,
authorities said.
Colton Stewart, 14, woke up early Wednesday to a burning sensation in his upper arm, and then realized it was a bear
biting his arm through the tent, state wildlife officials said. He pulled away and heard the bear run off through the brush.
"It wasn't biting viciously. They put their mouth on things to see what they taste like," said Anis Aoude, regional wildlife
manager for the state Division of Wildlife Resources. "In this case, there just happened to be a kid's arm on the other
side of the tent."
The bite was not serious, but camp officials notified the state, which sent a game warden to the Adventure Park Scout
Camp in central Utah.
That evening, as barbecued ribs were being prepared for the 90 Scouts, the 2- to 3-year-old female bear wandered back
into the area, DWR Central Region Supervisor John Fairchild said.
"It wasn't afraid of anybody," Fairchild said. "It paralleled the camp, and the conservation officer waited for the bear to get
away from the people in a safe area before he shot it."
The bear had apparently become habituated to eating human food and had lost its fear of people, making it dangerous so
close to the camp.
EASTON, Pa. — William Fahr, still a little sore, stood before his fellow Boy Scouts this week and told them they shouldn't
be afraid of camping. It's unlikely, he told them, that a bear would bite them, too.
Fahr, a Scout with Minsi Trails Council Boy Scout Troop 33 of Pen Argyl, was bitten Sept. 15 by an American black bear
on a Boy Scout camping trip.
By Sept. 18 he was walking with a slight limp and dreading a rabies shot. But he said he was fine, just worried that the
biting will make his fellow Scouts afraid of camping.
"It's a one-in-a-million chance'' to be bitten by a bear, the 12-year-old Bangor boy said after he suffered puncture wounds
on his upper left leg from the teeth of a bear that was likely after some chocolate.
"You should keep going camping,'' Fahr said. “ I am.''
Fahr, who was treated at an area hospital and released early Sunday, was sharing a tent with two other Scouts, one of
whom, against advice ("Don't bring food in the tent. That's rule No. 1,'' Scoutmaster Kevin Penrose said) brought candy
bars inside.
Fahr was sleeping about 9:30 p.m. when he awoke to find he was suddenly sharing the tent with something else.
The bear had bitten through the tent, leaving a 2-foot gash, and then through the boy's sleeping bag. It dug its teeth into
a fleshy part of Fahr's leg.
When Fahr yelled out, Scout leader Chris Witmer — who later thanked the boys for their bravery — scared off the bear.
Scout leader Karen M. Giroux tended to Fahr and the 11 other Scouts on the trip

Tuesday, August 10, 1999, 12:00 AM
By Bob Hague
A 14-year old boy is recovering after being attacked by a black bear Monday morning. The boy was at a Boy Scout camp
in Washburn County when the bear wandered into the camp, dragged the boy's tent (with the kid inside) nearly 80 feet,
and then began ravaging it. The boy's father got the bear to flee after throwing a rock and a log at it; the teen is
hospitalized but expected to fully recover. It's the third bear attack in northern Wisconsin this year, but this is the first
unprovoked attack, and DNR officials say it's a very rare occurrence.

September 24, 2007
Here's an account of the latest Bear-Scout encounter in my part of the world-
From the Wilkes Barre Times Leader
By Tom Venesky
A Boy Scout from the Lehigh Valley area suffered three puncture wounds Saturday by a bear that entered his tent at
Hickory Run State Park. It’s the second time this summer a bear has harassed a human in a White Haven area
Pennsylvania Game Commission Wildlife Conservation Officer Fred Merluzzi said the bear was attracted by candy bars
that were left inside the tent. The 12-year-old scout was taken to the hospital after the attack and released, Merluzzi said.
The incident occurred at approximately 9:30 p.m. in the park’s organized tent camping area while the scout and two
others slept in the tent. The bear tore the rear corner of the tent and grabbed the scout by the left front pocket of his
jeans, according to Merluzzi. He said several smaller size Snickers bars were found at the scene.
A scoutmaster ran to the scene after he heard the three scouts screaming and saw the eyes of a bear in the woods,
Merluzzi said, but couldn’t estimate its size. The Game Commission placed several live traps in the area and one bear –
a 253-pound male, was trapped and relocated on Wednesday.
The Associated Press
Updated: 1:37 p.m. CT June 18, 2007
AMERICAN FORK, Utah - Wildlife officers fatally shot a black bear Monday, hours after an 11-year-old boy was snatched
from his family's tent and killed, a rare attack in Utah's Wasatch Mountains.
With 26 dogs assisting them in the search, authorities were confident that the bear was the same one that ripped through
the tent shortly before midnight Sunday.
The bear was killed about 11:30 a.m. MDT near the area where the victim was mauled, said Lt. Scott White of the Utah
Division of Wildlife Resources.
"Truly a tragic event. . Events of this type are extremely rare in Utah," Jim Karpowitz, director of the wildlife agency,
said at a news conference before the bear's death was reported.
"I know of no other fatalities by a black bear in Utah," he said.
The boy, his mother, stepfather, and a 6-year-old brother were sleeping in a large tent in a primitive camping area, about
30 miles southeast of Salt Lake City.
The stepfather heard a scream, and the boy and his sleeping bag were gone. A host from a nearby campground
contacted police.
"When we got up there we realized, hey, this looks like a bear. The sleeping bag was pulled out of the tent," said Lt.
Dennis Harris of the Utah County sheriff's office.
He said the boy's body was found about 400 yards away, in the direction of another campsite where a bear was seen
earlier in the weekend and pursued by dogs without success. Authorities believe it was the same bear that killed the boy.
"When it's hot and dry like this, bears are short of food," Karpowitz said.
The Utah wildlife agency and the U.S. Forest Service pursued the wounded bear with the help of a helicopter. It was
described as a male, possibly 300 pounds, and "jet black."
American Fork Canyon is a popular camping destination and home to Timpanogos Cave National Monument. Harris said
the family was camping about two miles up a dirt road.
"It's shaken everybody up. We're all distraught," said Scott Root, conservation outreach manager at the Utah wildlife
agency. "It could put a lot of fear in the public."
It was not known what provoked the bear, though a bear can smell food for miles.
"They stick their nose in the air. It's like radar," said Hal Black, a biologist at Brigham Young University in Provo.
In July 2006, a black bear bit the arm of a 14-year-old Boy Scout while he slept in a tent, also in Utah County. The female
bear returned to the campground and was killed. The boy was not seriously injured.
2007 The Associated Press.

I was an advisor with our Philmont crew (731-X, Boy Scout Troop 318, Bethlehem, PA, Trek 28, July 31-August 12) this
summer. Our crew unfortunately witnessed the bear attack commented on in rec.Scouting.usa.
The attack occurred at Copper Park camp, just below Baldy's summit, about 1:30 pm on August 5, 1997. Our crew had
just returned from climbing Baldy, had lunch, and while doing cleanup (in preparation for an afternoon nap, after 3 days of
difficult, rainy uphill trekking on Trek 28) one of our Scouts noticed a small bear coming toward our campsite from the
wooded hillside of Baldy. The small black bear was slowly ambling towards our tents, eyeing us with interest from about
50 yds. away, and, while most of our crew quickly gathered our food and smell able to hoist into the bear bag, the other
two adults and I walked a little towards the bear and yelled and generally carried on to persuade him to leave us (2 years
ago our Troop had its campsite attacked at dusk on an Appalachian Trail backpack in E. PA, we lost all 7 tents to the
critter's curiosity (no injuries) -- and our food, which was "safely" stored in a 15 ft. high bear bag at the time -- and since
then we take no chances with bruins).
The bear reluctantly ambled away from us and it took us a moment to realize that it was headed for an adjacent campsite,
about 200 yds away, which had no visible crew but did have visible packs and tents present. By then our entire crew was
assembled, along with a few of those from the crew from Arizona we had been trekking with for days, about 15 people.
When the bear entered the other campsite and headed for the nearest backpack, we all began hollering and jumping
around, trying to distract it. As we stood about 75 ft. away, he rose on his hind legs (at which point I said to my
companion, a Bethlehem Police officer who was with me during our PA bear attack, "Mark, this is NOT good") and glared
at us. We all stopped yelling and, without warning, the bear leaped into the middle of the nearest tent, about 6 ft. away
from him.
Immediately screams emanated from the tent and we realized with surprise that someone was asleep inside the tent. As
we ran toward the tent, a man stumbled out of the next tent in his underwear and, apparently half asleep, screamed,
"There's kids in there! There are kids in there!” One of us yelled at him to stop running -- he was only 20 ft. from the bear
-- but he kept on going until he was about 6 feet from it.
Meanwhile (as we learned later), the bear, being surprised by the boy's screams, lashed out and bit him in the back (the
bear's initial collapse onto the tent had hit the boy in the right arm, causing a shallow 6 inch gash). The crazed onslaught
of the man in his underwear -- who turned out to be the Scoutmaster of the crew, startled the bear, who slowly backed out
of the campsite and stood glaring at us. My policeman friend, angry, picked up a rock and hurled it at the bear, hitting it in
the butt as it climbed up the hillside and into the woods of Baldy.
The entire sequence in the crew's camp took about 2 minutes.
The Scoutmaster was somewhat in shock and partly asleep, while the injured Scout staggered around the campsite in his
underwear, bleeding slightly and hysterical. My 15 year old son, Stephen, our crew leader went over to the injured Scout
and helped his dazed crew give him first aid while we awoke the rest of the sleeping crew.
One of our crew's advisors and one of the advisors from the Arizona crew, along with 3 older Scouts, then ran 3 miles
down Baldy to BaldyTown camp (Copper Park is not staffed) for Ranger help, in a downpour. About an hour later 2
Rangers with a large First Aid kit arrived on foot, followed about a half hour later by more Rangers in a 4 wheel drive. By
then all 10 crew were down from Baldy, the rain and cold had intensified, and the advisors from each crew notified the
Rangers that none of us was willing to camp that night again in Copper Park, under the circumstances. Although
BaldyTown is not usually a campsite, the Rangers agreed to let us all hike down there for the night, which all 100 or so of
us did, in a hypothermic downpour.
Philmont Moral: bear bag your smell ables, don't even carry really smelly stuff like unduly odiferous sunscreen, know your
first aid, and have an emergency plan.
Asst. Scoutmaster Troop 318 (Scoutmaster 1993-97)
Bethlehem, PA
Caught Between a Rock & a Hard place
Aaron Rolston’s Story
AT 11 O'CLOCK ON THE NIGHT OF FRIDAY, April 25, 27-year-old Aaron Ralston parked his truck at the Horseshoe
Canyon Trailhead, west of Canyonlands National Park in southeastern Utah, and slept in the covered bed. The next
morning at 9:15, he bicycled 15 miles south along Maze-Robbers Roost Road until he reached a shortcut leading to the
head of Bluejohn Canyon's main fork. He locked his mountain bike to a juniper tree and set out on foot toward the gulch.
By 2:45 p.m., Ralston had started his solo descent into the deep, narrow slot of Bluejohn Canyon. Passing over and then
under boulders that clogged the three-foot-wide penumbral passage, Ralston was negotiating a ten-foot drop between two
ledges when an 800-pound boulder shifted above him. He snapped his left hand out of its path in time, but his right hand
was smashed between the rock and the sandstone wall. Ralston was trapped, alone in a remote canyon. Rescue was
unlikely: He'd neglected to inform anyone of where he was going, which he later acknowledged is "something I almost
always do but I failed to do this time."
After the boulder crushed his hand, Ralston explained at the press conference, "I very quickly figured out some of my
options. I began laying plans for what I was going to do." He also inventoried his provisions: two burritos, one liter of
water, and some candy bar crumbs. One possibility was that "someone would happen along the trail" and rescue him. No
one did, so he spent the first of five nights in the slot canyon working on Plan B: futilely chipping away at the rock with his
multitool, a cheap knockoff of a Leatherman model.
The next day, Sunday, using his climbing gear and his search-and-rescue skills, he moved to Plan C: rigging ropes in an
attempt to hoist the boulder off his hand. This also failed.
On Monday, he rerigged the ropes and again tried moving the rock. "At no point was I ever able, with any of the rope
mechanics, to get the boulder to budge even microscopically," Ralston said.
He thought a lot about dying and was afraid at first, but he "came to peace with death over the time spent in the canyon."
On day four of his ordeal, Tuesday, April 29, Ralston ran out of water. Realizing he would die of dehydration within days,
he prepared to reckon with his last resort: severing his hand with the blunt blade of his multitool.
"Essentially I got my surgical table ready and applied the knife to my arm, and started sawing back and forth. But I didn't
even break the skin. I couldn't even cut the hair off of my arm, the knife was so dull," he said.
On Wednesday, he managed to puncture the skin but realized he wouldn't be able to cut through the bone.
By Thursday, May 1, growing weak and having passed through stages of depression, hope, and prayer, Ralston decided
he would have to break his arm near the wrist to extricate himself. "I was able to first snap the radius," he calmly recalled,
"and then, within a few minutes, snap the ulna at the wrist, and from there I had the knife out and applied the tourniquet
and went to task. It was a process that took about an hour."
He sawed through the soft tissue between the broken bones and amputated his hand.
Ralston rigged his rope, set his anchors, rappelled 60 feet to the floor of Bluejohn Canyon, and hiked five miles
downstream into Horseshoe Canyon, supporting the bloody stump of his right arm in a makeshift sling fashioned from a
CamelBak pack. He ran into three hikers from Holland who gave him Oreos and water and helped him carry his pack
another mile. At 3 p.m., he was finally rescued by a helicopter, which had begun searching for him when friends in Aspen,
worried because he hadn't shown up for work, called the Utah authorities.
People absolutely can be trained to survive," says Frank Heyl, a retired air force officer and director of the Combat
Aviation Survival School, in Helena, Montana. "Everybody is born with the will to survive," says Heyl, "but it's like a
muscle or a skill. You've got to nurture it, train it, build it up."
You can pick up the basics from any survival manual or basic wilderness-safety course: Never venture into the
backcountry alone without leaving word of your intended route and return date. Always, even on a day hike, stock your
pack with the fabled "ten essentials": knife, water, food, matches, map and compass, headlamp, cord, proper clothing,
and sun protection. Heyl puts two additional items at the top of the list: "Your head is number one. It's the best survival
tool there is. Number two: a basic med kit and the understanding of how to use it."

Hiker Survives Five Days in Lava Field
Associated Press
Sunday July 24, 2005
A hiker lost for five days in a lava field near a volcano says he survived by drinking water he squeezed from moss in a
mostly barren landscape. Gilbert Dewey Gaedcke III, 41, was rescued Friday afternoon after a teenager on a helicopter
tour spotted him stumbling across the rocky lava, trying to attract attention with a mirror from his camera.
Gaedcke had been missing since Sunday night, when he decided to take a hike across desolate lava fields near Hawaii
Volcanoes National Park to get a closer look at an active volcano.
The experienced hiker from Austin, Texas, said he saw no water, but there were pockets of jungle-like vegetation
sprinkled throughout the old lava flow.
Gaedcke said he crawled beneath the vines and lick moisture off leaves. Then he found moss growing on trees, and was
able to squeeze enough water from it to drink.
"It was muddy, green, mossy water, but it worked," he said Saturday. "If I hadn't found that I'd be dead right now," he said.
Gaedcke said tour helicopters had flown overhead all week, but he was unable to attract attention because clouds
blocked the sun.
Then, late Friday afternoon, another one flew over. Aboard was 15-year-old Peter Frank, who spotted the odd glint in the
late afternoon sunlight.
"It was the only thing like that out there," said Frank, of Pasadena, Calif. "As we got closer we realized it was a man."
Gaedcke, dehydrated, but otherwise OK after surviving five days in the heat, was lost amid acres of blackened volcanic
"I wound up on some of the most vicious terrain I've ever seen," he said as he rested at a friend's home before flying
home. "It's all gray rock — terrible stuff — then vegetation like an oasis, then more gray rock."
Gaedcke's rented car had been found days earlier at the end of a road near an old lava flow bordering the east side of the
333,000-acre national park. Police had few leads to follow.
Fire crews and rangers from the park searched for days on foot and on horseback. Helicopters buzzed the area, but there
was no sign of Gaedcke.
Then, Frank spotted what looked like a toy pinwheel glinting in the sunlight. His mother, Diann Kim, said her son asked
Blue Hawaiian Helicopters pilot Cliff Muzzi to get a closer look.
"As we got closer you could see the man flashing a mirror and waving a dark orange fabric," she said. "As he was coming
down the path, clearly he couldn't move that well."
Kim's daughter, Hannah, and a friend wrapped bottles of water in airsickness bags to drop to the distressed hiker. "It was
so amazing," Kim said. "To see a person out there was like seeing a person on the face of the moon.
After returning his passengers to Hilo International Airport, Muzzi headed back to retrieve Gaedcke, then whisked him
back to the airport about 17 miles to the northeast. Medical crews were waiting to take him to Hilo Medical Center.
Gaedcke said he saw the bright glow of the lava and then turned to go back to his car, but missed it as he walked in the
dark. He hiked inland, expecting to intersect with the road, but by morning, he was lost.
"My feet feel like I had a 30-day adventure," he said. "And if it weren't for my feet, I'd be dancing a jig right now."
Local News | Injured mountain climber dies after daring rescue | Seattle Times Newspaper Permission to reprint or copy this article or photo, other than personal use, must be obtained from The Seattle Times. Call 206-464-3113 or e-mail [email protected] with your request. Injured mountain climber dies after daring rescue
By Ian Ith
Seattle Times staff reporter
LONGMIRE, Mount Rainier National Park — The climber whose partner was injured and later died while climbing Mount Rainier was evacuated by helicopter from the north face of the mountain today. Scott Richards, 42, was taken from the mountain late this morning and was reportedly in good condition and being given a medical Related stories
evaluation. He was taken to Mount Rainier National Park offices, Friends remember man who died
on Mount Rainier
Rescuers try to reach fallen
"He is flat-out exhausted. He basically hasn't slept in four days," climber on Mount Hood
Other links
His fellow climber, Peter Cooley, 39, of Cape Elizabeth, Maine, was Portland Press Herald: Falls happen, even among the best injured in a fall Saturday and died yesterday afternoon after a helicopter rescued him from a steep ridge at the 12,000 foot level on the mountain. He died before reaching a hospital, according to the Pierce County Medical Examiner's office. It was the first fatality on the mountain in more than a year and a tragic end to what was shaping up as one of the most dangerous and complicated rescue missions anyone here could recall. A few hours before Cooley's death was announced, people had expressed relief after a days-long rescue ended when the cloud cover broke and allowed an Oregon National Guard helicopter to pluck him off the mountain. Cooley's parents had just arrived at park-service headquarters at Longmire when the helicopter rescue took place. Cooley suffered a severe head injury and a dislocated shoulder when he fell. Richards, also of Cape Elizabeth, had stayed with Cooley since the accident. Cooley was married and had three children: boys in kindergarten and third grade, and a daughter in fifth grade. Originally from Connecticut, he had a master's degree in business administration from Stanford University and worked for Idexx Laboratories. Cooley and Richards were drawn to each other by their love of mountain climbing. Cooley once worked as part of a search-and-rescue team on Mount McKinley in Alaska, the highest peak in North 11/15/2007 Local News | Injured mountain climber dies after daring rescue | Seattle Times Newspaper America, and has climbed it solo. This was his fourth ascent of Mount Rainier. The two climbers were stranded on Liberty Ridge, one of the more difficult routes up the mountain. And the two couldn't have been in a less accessible place, park rangers said. "There are just so many things that can interfere with help and getting to you quickly," said Lee Taylor, a parks spokeswoman. Nonetheless, rangers yesterday lauded Cooley's strength and Richards' nerve in keeping his climbing buddy stable as they waited through an agonizing second day for a rescue. Before the weather broke suddenly at mid-afternoon, rangers had been laying plans for a difficult and complicated rescue on foot. Two rangers, David Gottlieb and Charlie Borgh, had climbed all day Sunday and half of yesterday to reach Richards and Cooley. "This route claims a lot of people," said Mike Gauthier, a senior climbing ranger. When the rangers reached the men, they called doctors at Harborview Medical Center for advice, but there wasn't much to give. "Even if you had an emergency-room physician up there, there's not much you can do at 12,000 feet," Taylor said yesterday afternoon. "So we just have to get him out as quickly as we can." But Gottlieb and Borgh hadn't carried camping gear on their hasty ascent, so their initial plan was to leave Richards and Cooley and descend halfway down the ridge to meet other rangers and bivouac for the night. The plan called for another team of rangers, who were camping on Carbon Glacier, to scale Liberty Ridge this morning and begin a laborious process of lowering Cooley down the mountain by hand. But about 3 p.m., a small helicopter managed to reach Liberty Ridge and drop enough gear for the rangers to stay overnight with the stranded men. Just as the weather on Rainier can change in a moment, so did all of the complex plans. The men on the mountain spotted their weather window about 3:50 p.m., and the National Guard's Chinook helicopter took off almost immediately from Yakima, where it had been waiting for an opportunity. When the helicopter reached the climbers, crew members lowered a hoist to lift Cooley, who had already been strapped onto a stretcher, and then headed to Madigan Army Medical Center near Tacoma. Cooley died en route. Though no one died on Rainier last year, the mountain claims nearly three lives a year on average, according to park statistics. "I just hope this isn't a sign of things to come this summer," Gauthier said. 11/15/2007 Local News | Injured mountain climber dies after daring rescue | Seattle Times Newspaper Ian Ith: 206-464-2109 or [email protected] The Associated Press contributed to this report. Copyright 2004 The Seattle Times Company 11/15/2007 Outdoor Action Guide to
Hypothermia and Cold Weather Injuries
by Rick Curtis
Traveling in cold weather conditions can be life threatening. The information provided here isdesigned for educational use only and is not a substitute for specific training or experience.
Princeton University and the author assume no liability for any individual’s use of or relianceupon any material contained or referenced herein. Medical research on hypothermia and coldinjuries is always changing knowledge and treatment. When going into cold conditions it is yourresponsibility to learn the latest information. The material contained in this article may not bethe most current. Copyright 1995 Rick Curtis, Outdoor Action Program, Princeton University.
How We Lose Heat to the Environment
Core - 98.6
Periphery - 98.6
Periphery - 88
1. Radiation - loss of heat to the environment due to the temperature gradient (this occurs only as long as
the ambient temperature is below 98.6). Factors important in radiant heat loss are the surface area and thetemperature gradient.
2. Conduction - through direct contact between objects, molecular transference of heat energy
a. Water conducts heat away from the body 25 times faster than air because it has a greater density (therefore a greater heat capacity). Stay dry = stay alive!
b. Steel conducts heat away faster than waterExample: Generally conductive heat loss accounts for only about 2% of overall loss. However, with wet 3. Convection - is a process of conduction where one of the objects is in motion. Molecules against the
surface are heated, move away, and are replaced by new molecules which are also heated. The rate ofconvective heat loss depends on the density of the moving substance (water convection occurs morequickly than air convection) and the velocity of the moving substance.
a. Wind Chill - is an example of the effects of air convection, the wind chill table gives a reading of the amount of heat lost to the environment relative to a still air temperature.
4. Evaporation - heat loss from converting water from a liquid to a gas
a. Perspiration - evaporation of water to remove excess heat• Sweating - body response to remove excess heat Insensible Perspiration - body sweats to maintain humidity level of 70% next to skin - particularly ina cold, dry environment you can lose a great deal of moisture this way Respiration - air is heated as it enters the lungs and is exhaled with an extremely high moisturecontent It is important to recognize the strong connection between fluid levels, fluid loss, and heat loss. Asbody moisture is lost through the various evaporative processes the overall circulating volume isreduced which can lead to dehydration. This decrease in fluid level makes the body more susceptibleto hypothermia and other cold injuries.
Response to Cold
Cold Challenge - (negative factors)
TemperatureWet (rain, sweat, water)Wind (blowing, moving, e.g. biking) Total = Cold Challenge
Heat Retention - (positive factors)
Size/shape (Eskimo vs. Masai)Insulation (layering/type)Fat (as insulation)Shell/core (shunt blood to core) shell acts as a thermal barrier Total = Heat Retention
Heat Production - (positive factors)
Total = Heat Production
Production < Cold Challenge = Hypothermia
Your Body Core Temperature
1. Heat is both required and produced at the cellular level. The environment acts as either a heating or a cooling force on the body. The body must be able to generate heat, retain heat, and discharge heat depend-ing on the body activity and ambient external temperature.
2. Body temperature is a measure of the metabolism - the general level of chemical activity within the body.
3. The hypothalamus is the major center of the brain for regulating body temperature. It is sensitive to blood temperature changes of as little as 0.5 degrees Celsius and also reacts to nerve impulses received fromnerve endings in the skin.
4. The optimum temperature for chemical reactions to take place in the body is 98.6 degrees F. Above 105 F many body enzymes become denatured and chemical reactions cannot take place leading to death.
Below 98.6 F chemical reactions slow down with various complications which can lead to death.
5. Core = the internal body organs, particularly the heart, lungs, and brain.
Periphery = the appendages, skin, and muscle tissue.
6. Core temperature is the temperature that is essential to the overall metabolic rate of the body. The tem- perature of the periphery is not critical.
How Your Body Regulates Core Temperature
1. Vasodilation - increases surface blood flow, increases heat loss (when ambient temperature is less that
body temperature). Maximal vasodilation can increase cutaneous blood flow to 3000 ml/minute (averageflow is 300-500 ml/minute).
2. Vasoconstriction - decreases blood flow to periphery, decreases heat loss. Maximal vasoconstriction can
decrease cutaneous blood flow to 30 ml/minute.
3. Sweating - cools body through evaporative cooling
4. Shivering - generates heat through increase in chemical reactions required for muscle activity. Visible
shivering can maximally increase surface heat production by 500%. However, this is limited to a fewhours because of depletion of muscle glucose and the onset of fatigue.
5. Increasing/Decreasing Activity will cause corresponding increases in heat production and decreases in
6. Behavioral Responses - putting on or taking off layers of clothing will result in heat regulation
1. Hypothermia - “a decrease in the core body temperature to a level at which normal muscular and cere-
bral functions are impaired.” - Medicine for Mountaineering 2. Conditions Leading to Hypothermia
Alcohol intake - causes vasodilation leading to increased heat loss 3. What are “hypothermia” temperatures
Any temperature less than 98.6 degrees can be linked to hypothermia (ex. hypothermia in theelderly in cold houses) or peripheral circulation problems such as trench foot and frostbite.
4. Signs and Symptoms of Hypothermia
a. Watch for the “-Umbles” - stumbles, mumbles, fumbles, and grumbles which show changes in motor
b. Mild Hypothermia - core temperature 98.6 - 96 degrees F
Can’t do complex motor functions (ice climbing or skiing) can still walk & talk c. Moderate Hypothermia - core temperature 95 - 93 degrees F
Loss of fine motor coordination - particularly in hands - can’t zip up parka, due to restrictedperipheral blood flow Irrational behavior - Paradoxical Undressing - person starts to take off clothing, unaware s/he iscold “I don’t care attitude” - flattened affect d. Severe Hypothermia - core temperature 92 - 86 degrees and below (immediately life threatening)
Shivering occurs in waves, violent then pause, pauses get longer until shivering finallyceases - because the heat output from burning glycogen in the muscles is not sufficientto counteract the continually dropping core temperature, the body shuts down onshivering to conserve glucose Person falls to the ground, can’t walk, curls up into a fetal position to conserve heat Muscle rigidity develops - because peripheral blood flow is reduced and due to lactic acid andCO buildup in the muscles at 90 degrees the body tries to move into hibernation, shutting down all peripheral blood flowand reducing breathing rate and heart rate.
at 86 degrees the body is in a state of “metabolic icebox.” The person looks dead but is stillalive.
e. Death from Hypothermia
Breathing becomes erratic and very shallow Cardiac arrythmias develop, any sudden shock may set off Ventricular Fibrillation 5. How to Assess if someone is Hypothermic

If shivering can be stopped voluntarily = mild hypothermia Ask the person a question that requires higher reasoning in the brain (count backwards from 100 by 9’s). If the person is hypothermic, they won’t be able to do it. [Note: there are also other conditions suchas altitude sickness that can also cause the same condition.] If shivering cannot be stopped voluntarily = moderate - severe hypothermia If you can’t get a radial pulse at the wrist it indicates a core temp below 90 - 86 degrees The person may be curled up in a fetal position. Try to open their arm up from the fetal position, if itcurls back up, the person is alive. Dead muscles won’t contract only live muscles.
Core Temperature
Signs & Sym ptom s
Cold sensation, goose bum ps, unable to perform com plex tasks with hands, shiver can be m ild to severe, hands num b Shivering, intense, m uscle incoordination becom es apparent, m ovem ents slow and labored, stumbling pace, mild confusion, m ay appear alert. Use sobriety test, if unable to walk a 30 foot straight line, the person is hypotherm ic.
Violent shivering persists, difficulty speaking, sluggish thinking, amnesia starts to appear, gross m uscle movements sluggish, unable to use hands, stumblesfrequently, difficulty speaking, signs of depression, withdrawn Shivering stops, exposed skin blue of puffy, m uscle coordination very poor, inability to walk, confusion, incoherent/irrational behavior, but m ay be able tom aintain posture and appearance of awareness M uscle rigidity, sem iconscious, stupor, loss of awareness of others, pulse and respiration rate decrease, possible heart fibrillation Unconscious, heart beat and respiration erractic, pulse m ay not be palpable Pulmonary edem a, cardiac and respiratory failure, death. Death m ay occur before Treating Hypothermia
The basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace thebody fuel they are burning up to generate that heat. If a person is shivering, they have the ability to rewarmthemselves at a rate of 2 degrees C per hour.
Mild - Moderate Hypothermia
1. Reduce Heat Loss
a. Additional layers of clothingb. Dry clothingc. Increased physical activityd. Shelter 2. Add Fuel & Fluids
It is essential to keep a hypothermic person adequately hydrated and fueled.
Carbohydrates - 5 calories/gram - quickly released into blood stream for sudden brief heat surge -these are the best to use for quick energy intake especially for mild cases of hypothermia Proteins - 5 calories/gram - slowly released - heat given off over a longer period Fats - 9 calories/gram - slowly released but are good because they release heat over a long period,however, it takes more energy to break fats down into glucose - also takes more water to breakdown fats leading to increased fluid loss GORP - has both carbohydrates (sticks) and protiens/fats (logs) Alcohol - a vasodilator - increases peripheral heat loss Caffeine - a diuretic - causes water loss increasing dehydration Tobacco/nicotine - a vasoconstrictor, increases risk of frostbite 3. Add Heat
Body to body contact. Get into a sleeping back, in dry clothing with a normothermic person inlightweight dry clothing Severe Hypothermia
1. Reduce Heat Loss

Hypothermia Wrap: The idea is to provide a shell of total insulation for the patient. No matter how
cold, patients can still internally rewarm themselves much more efficiently than any external rewarm-
ing. Make sure the patient is dry, and has a polypropylene layer to minimize sweating on the skin. The
person must be protected from any moisture in the environment. Use multiple sleeping bags, wool
blankets, wool clothing, Ensolite pads to create a minimum of 4" of insulation all the way around the
patient, especially between the patient and the ground. Include an aluminum “space” blanket to help
prevent radiant heat loss, and wrap the entire ensemble in plastic to protect from wind and water. If
someone is truly hypothermic, don’t put him/her naked in a sleeping bag with another person.
2. Add Fuel & Fluids

Warm Sugar Water - for people in severe hypothermia, the stomach has shut down and will not digest
solid food but can absorb water and sugars. Give a dilute mixture of warm water with sugar every 15
minutes. Dilute Jello™ works best since it is part sugar and part protien. This will be absorbed directly
into the blood stream providing the necessarry calories to allow the person to rewarm themselves. One
box of Jello = 500 Kilocalories of heat energy. Do not give full strength Jello even in liquid form, it is
too concentrated and will not be absorbed.
Urination - people will have to urinate from cold diuresis. Vasoconstriction creates greater volume
pressure in the blood stream. The kidnies pull off excess fluid to reduce the pressure. A full bladder is a
place for additional heat loss so urinating will help conserve heat. You will need to help the person
urinate. Open up the Hypothermia Wrap enough to do this and then cover them back up. You will need
to keep them hydrated with the dilute Jello solution described above.
3. Add Heat
Heat can be applied to transfer heat to major arteries - at the neck for the carotid, at the armpits for thebrachial, at the groin for the femoral, at the palms of the hands for the arterial arch.
Chemical heat packs such as the Heat Wave™ provides 110 degrees F for 6-10 hours.
Hot water bottles, warm rocks, towels, compresses For a severely hypothermic person, rescue breathing can increase oxygen and provide internal heat.
Apply heat
Is a situation in which the core temperature actually decreases during rewarming. This is caused by peripheral
vessels in the arms and legs dilating if they are rewarmed. This dilation sends this very cold, stagnate blood
from the periphery to the core further decreasing core temperature which can lead to death. In addition, this
blood also is very acetic which may lead to cardiac arrythmias and death. Afterdrop can best be avoided by not
rewarming the periphery. Rewarm the core only!
Do not expose a severely hypothermic victim to extremes
of heat.

CPR & Hypothermia
When a person is in severe hypothermia they may demonstrate all the accepted clinical signs of death: Comatose & unresponsive to any stimuli But they still may be alive in a “metabolic icebox” and can be revived. You job as a rescuer is to rewarm the
person and do CPR if indicated. A hypothermia victim is never cold and dead only warm and dead. During
severe hypothermia the heart is hyperexcitable and mechanical stimulation (such as CPR, moving them or
Afterdrop) may result in fibrillation leading to death. As a result CPR may be contraindicated for some hypoth-
ermia situations:
1. Make sure you do a complete assessment of heart rate before beginning CPR. Remember, the heart
rate may be 2-3/minute and the breathing rate 1/30 seconds. Instituting cardiac compressions at this point
may lead to life-threatening arrythmias. Check the carotid pulse for a longer time period (up to a minute)
to ascertain if there is some slow heartbeat. Also, even though the heart is beating very slowly, it is filling
completely and distributing blood fairly effectively. External cardiac compressions only are 20-30%
effective. Thus, with its severely decreased demands, the body may be able to satisfy its circulatory needs
with only 2-3 beats per minute. Be sure the pulse is absent before beginning CPR. You will need to
continue to do CPR as you rewarm the person.

2. Ventilation may have stopped but respiration may continue - the oxygen demands for the body havebeen so diminished with hypothermia that the body may be able to survive for some time using only theoxygen that is already in the body. If ventilation has stopped, artificial ventilation may be started toincrease available oxygen. In addition, blowing warm air into the persons lungs may assist in internalrewarming.
Check radial pulse, between 91.4 and 86 degrees F this pulse disappears Check for carotid pulse - wait at least a full minute to check for very slow heartbeat If pulse but not breathing or slow breathing, give rescue breathing (also adds heat).
If no discernible heartbeat begin CPR and be prepared to continue - persons with hypothermia havebeen given CPR for up to 3.5 hours and have recovered with no neurological damage Cold Injuries
Tissue temperature in cold weather is regulated by two factors, the external temperature and the internal heatflow. All cold injuries described below are intimately connected with the degree of peripheral circulation. Asperipheral circulation is reduced to prevent heat loss to the core these conditions are more likely to occur.
1. Factors influencing cold injuries

Wind chill - increases rate of freezing dramatically Moisture - wet skin freezes at a higher temp than dry Contact with metal or supercooled liquids (white gas) Women do better in cold than men (greater subcutaneous body fat) 2. Cold-induced Vasodilation - When a hand or foot is cooled to 59 degrees F, maximal vasoconstriction
and minimal blood flow occur. If cooling continues to 50 degrees, vasoconstriction is interrupted byperiods of vasodilation with an increase in blood and heat flow. This “hunting” response recurs in 5-10minute cycles to provide some protection from cold. Prolonged, repeated exposure increases this responseand offers some degree of acclimatization. Ex. Eskimos have a strong response with short intervals inbetween.
3. Pathophysiology of Tissue Freezing - As tissue begins to freeze, ice crystals are formed within the cells.
As intracellular fluids freeze, extracellular fluid enters the cell and there is an increase in the levels of
extracellular salts due to the water transfer. Cells may rupture due to the increased water and/or from
tearing by the ice crystals. Do not rub tissue; it causes cell tearing from the ice crystals. As the ice melts
there is an influx of salts into the tissue further damaging the cell membranes. Cell destruction results in
tissue death and loss of tissue. Tissue can’t freeze if the temperature is above 32 degrees F. It has to be
below 28 degrees F because of the salt content in body fluids. Distal areas of the body and areas with a
high surface to volume ratio are the most susceptible (e.g ears, nose, fingers and toes - this little rhyme
should help remind you what to watch out for in yourself and others).
Surface frostbite generally involves destruction of skin layers resulting in blistering and minortissue loss. Blisters are formed from the cellular fluid released when cells rupture.
Deep frostbite can involve muscle and bone Cold R es ponse
Mild Fr ostnip
Superfic ial Frost bit e
Deep Frostbite
Sens ation
4. Cold Response

Circulation is reduce to the are to prevent heat loss.
5. Frostnip

White, waxy skin, top layer feels hard, rubbery but deeper tissue is still soft Most typically seen on cheeks, earlobes, fingers, and toes Rewarm the area gently, generally by blowing warm air on it or placing the area against a warm Do not rub the area - this can damage the effected tissue by having ice crystals tear the cell
6. Frostbite

Skin is white and “wooden” feel all the way through Superficial frostbite includes all layers of skin Deep frostbite can include freezing of muscle and/or bone, it is very difficult to rewarm the appendage without some damage occurring Superficial frostbite may be rewarmed as frostnip if only a small area is involved If deep frostbite, see below for rewarming technique 7. Rewarming of Frostbite

Rewarming is accomplished by immersion of the effected part into a water bath of 105 - 110 degrees F.
No hotter or additional damage will result. This is the temperature which is warm to your skin. Moni-
tor the temperature carefully with a thermometer. Remove constricting clothing. Place the appendage in
the water and continue to monitor the water temperature. This temperature will drop so that additional
warm water will need to be added to maintain the 105 - 110 degrees. Do not add this warm water
directly to the injury. The water will need to be circulated fairly constantly to maintain even tempera-
ture. The effected appendage should be immersed for 25 - 40 minutes. Thawing is complete when the
part is pliable and color and sensation has returned. Once the area is rewarmed, there can be significant
pain. Discontinue the warm water bath when thawing is complete.
Do not use dry heat to rewarm. It cannot be effectively maintained at 105 - 110 degrees and can cause
burns further damaging the tissues.

Once rewarming is complete the injured area should be wrapped in sterile gauze and protected frommovement and further cold.
Once a body part has been rewarmed it cannot be used for anything. Also it is essential that the part
can be kept from refreezing.
Refreezing after rewarming causes extensive tissue damage and may result
in loss of tissue. If you cannot guarantee that the tissue will stay warm, do not rewarm it. Mountaineers
have walked out on frozen feet to have them rewarmed after getting out with no tissue loss. Once the
tissue is frozen the major harm has been done. Keeping it frozen will not cause significant additional
8. Special Considerations for Frostbite

If the person is hypothermic and frostbitten, the first concern is core rewarming. Do not rewarm thefrostbitten areas until the core temp approaches 96 degrees.
No alcohol - vasodilation may increase fluid buildup No smoking - nicotine as a vasoconstrictor may increase chances for developing frostbite Liquids such as white gas can “supercool” in the winter (drop below their freezing point but not freeze).
White gas also evaporates quickly into the air. Spilling supercooled white gas on exposed skin leads toinstant frostbite from evaporative cooling. Always were gloves when handling fuel.
Touching metal with bare skin can cause the moisture on your skin to freeze to the metal. (In really coldconditions, metal glasses frames can be a problem). When you pull away, you may leave a layer of skinbehind. Don’t touch metal with bare skin.
9. Trench Foot - Immersion Foot
Trench foot is a process similar to chillblains. It is caused by prolonged exposure of the feet to cool, wet
conditions. This can occur at temperatures as high as 60 degrees F if the feet are constantly wet. This canhappen with wet feet in winter conditions or wet feet in much warmed conditions (ex. sea kayaking). Themechanism of injury is as follows: wet feet lose heat 25x faster than dry, therefore the body uses vasocon-striction to shut down peripheral circulation in the foot to prevent heat loss. Skin tissue begins to diebecause of lack of oxygen and nutrients and due to buildup of toxic products. The skin is initially red-dened with numbness, tingling pain, and itching then becomes pale and mottled and finally dark purple,grey or blue. The effected tissue generally dies and sluffs off. In severe cases trench foot can involve thetoes, heels, or the entire foot. If circulation is impaired for > 6 hours there will be permanent damage totissue. If circulation is impaired for > 24 hours the victim may lose the entire foot. Trench Foot cuasespermanent damage to the circulatory system making the person more prone to cold related injuries in thatarea. A similar phenomenon can occur when hands are kept wet for long periods of time such as kayakingwith wet gloves or pogies. The damage to the circulatory system is known as Reynaud’s Phenomenon.
Treatment and Prevention of Trench foot

Includes careful washing and drying of the feet, gentle rewarming and slight elevation. Since the tissue
is not frozen as in severe frostbite it is more susceptible to damage by walking on it. Cases of trench
foot should not walk out; they should be evacuated by litter. Pain and itching are common complaints.
Give Ibuprofen or other pain medication.
Prevention is the best approach to dealing with trench foot. Keep feet dry by wearing appropriate foot-wear. Check your feet regularly to see if they are wet. If your feet get wet (through sweating or immer-sion), stop and dry your feet and put on dry socks. Periodic air drying, elevation, and massage will alsohelp. Change socks at least once a day and do not sleep with wet socks. Be careful of tight socks whichcan further impair peripheral circulation. Foot powder with aluminum hydroxide can help. High altitudemountaineers will put antiperspirant on their feet for a week bfore the trip. The active ingredient, alumi-num hydroxide will keep your feet from sweating for up to a month and their are no confirmedcontraindications for wearing antiperspirant. [Some studies have shown links between alumnium in thebody and Alzheimers.] Vapor barrier socks may increase the possibility of trenchfoot. When you areactive and you are wearing a vapor barrier sock, you must carefully monitor how you sweat. If you aresomeone who sweats a lot with activity, your foot and polypropylene liner sock may be totally soakedbefore the body shuts down sweating. Having this liquid water next to the skin is going to lead to in-creased heat loss. If you don’t sweat much, your body may shut down perspiration at the foot before itgets actually wet. This is when the vapor barrier system is working. You must experiment to determineif vapor barrier systems will work for you.
10. Chillblains

Caused by repeated exposure of bare skin to temperatures below 60 degrees Particularly found on cheeks and ears, fingers and toes Women and young children are the most susceptible The cold exposure causes damage to the peripheral capillary beds, this damage is permanent andthe redness and itching will return with exposure 11. Avoiding Frostbite and Cold related Injuries

“Buddy system” - keep a regular watch on each other’s faces, cheeks, ears for signs of frostnip/frostbite Keep a regular “self check” for cold areas, wet feet, numbness or anesthesia If at any time you discover a cold injury, stop and rewarm the area (unless doing so places you at
greater risk).

12. Eye Injuries
Caused by forcing the eyes open during strong winds without goggles Treatment is very controlled, rapid rewarming e.g. placing a warm hand or compress over theclosed eye. After rewarming the eyes must be completely covered with patches for 24 - 48 hours.
Put hand over eye until ice melts, then can open the eye Prevention by wearing good sunglasses with side shields or goggles. Eye protection from sun isjust as necessary on cloudy or overcast days as it is in full sunlight when you are on snow. Snowblindness can even occur during a snow storm if the cloud cover is thin.
Eyes feel dry and irritated, then feel as if they are full of sand, moving or blinking becomesextremely painful, exposure to light hurts the eyes, eyelids may swell, eye redness, andexcessive tearing Bibliography
Hypothermia: Causes, Effects, and Prevention, Robert Pozos, David Born, New Century, 1982.
Management of Wilderness and Environmental Emergencies, Paul Auerbach, Edward Geehr, Macmillan, 1983.
Medicine for Mountaineering, James Wilkerson, The Mountaineers, 1992.
Hypothermia - Death by Exposure, William Forgey, ICS, 1985.
Hypothermia, Frostbite, and other Cold Injuries, James Wilkerson, Cameron Bangs, John Hayward, The Moun-taineers, 1986Medicine for the Backcountry, Buck Tilton and Frank Hubbell, ICS Books, 1994.
This article is written by Rick Curtis, Director, Outdoor Action Program. This material may be freely distributedfor nonprofit educational use. However, if included in publications, written or electronic, attributions must bemade to the author. Commercial use of this material is prohibited without express written permission from theauthor. Copyright 1995 Rick Curtis, Outdoor Action Program, Princeton University.
The W ind Chill Index
Environmental Temperature (Fº)
Wind Speed
Apparent Temperature (Fº)
Little D anger of ex pos ed flesh fr eezing.
Increasing danger o f exposed flesh freezing (flesh can freeze within 1 minute).
Great danger of exposed flesh freez ing (flesh can freeze within 30 seconds).
OA Guide to High Altitude: Acclimatization and Illnesses Outdoor Action Guide to
High Altitude: Acclimatization and Illnesses
by Rick Curtis, Director, Outdoor Action Program
z Back to the AEE Wilderness Safety Page z OA Guide to High Altitude: Acclimatization & Illness - Adobe Acrobat version (18K) Other Altitude Information
{ Adobe Acrobat Reader - free for downloading { Altitude Illness - from NOLS Wilderness First Aid { Himalayan Rescue Association - information on altitude illness recognition and treatment Traveling at high altitude can be hazardous. The information provided here is designed
for educational use only and is not a substitute for specific training or experience. Princeton
University and the author assume no liability for any individual's use of or reliance upon
any material contained or referenced herein. This paper is prepared to provide basic
information about altitude illnesses for the lay person. Medical research on high altitude
illnesses is always expanding our knowledge of the causes and treatment. When going to
altitude it is your responsibility to learn the latest information. The material contained in
this article may not be the most current. Copyright 1995 Rick Curtis, Outdoor Action
Program, Princeton University.
High altitude-we all enjoy that tremendous view from a high summit, but there are risks in going to high altitude, and it's important to understand these risks. Here is a classic scenario for developing a high altitude illness. You fly from New York City to a Denver at 5,000 feet (1,525 meters). That afternoon you rent a car and drive up to the trailhead at 8,000 feet (2,438 meters). You hike up to your first camp at 9,000 feet (2,745 meters). The next day you hike up to 10,500 feet (3,048 meters). You begin to have a severe headache and feel nauseous and weak. If your condition worsens, you may begin to have difficulty hiking. Scenarios like this are not uncommon, so it's essential that you understand the physiological effects of high altitude. What is High Altitude?
Altitude is defined on the following scale High (8,000 - 12,000 feet [2,438 - 3,658 meters]), Very High (12,000 - 18,000 feet [3,658 - 5,487 meters]), and Extremely High (18,000+ feet [5,500+ meters]). Since OA Guide to High Altitude: Acclimatization and Illnesses few people have been to such altitudes, it is hard to know who may be affected. There are no specific factors such as age, sex, or physical condition that correlate with susceptibility to altitude sickness. Some people get it and some people don't, and some people are more susceptible than others. Most people can go up to 8,000 feet (2,438 meters) with minimal effect. If you haven't been to high altitude before, it's important to be cautious. If you have been at that altitude before with no problem, you can probably return to that altitude without problems as long as you are properly acclimatized. What Causes Altitude Illnesses
The concentration of oxygen at sea level is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, the concentration remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,658 meters) the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. This extra ventilation increases the oxygen content in the blood, but not to sea level concentrations. Since the amount of oxygen required for activity is the same, the body must adjust to having less oxygen. In addition, for reasons not entirely understood, high altitude and lower air pressure causes fluid to leak from the capillaries which can cause fluid build-up in both the lungs and the brain. Continuing to higher altitudes without proper acclimatization can lead to potentially serious, even life-threatening illnesses. Acclimatization
The major cause of altitude illnesses is going too high too fast. Given time, your body can adapt to the decrease in oxygen molecules at a specific altitude. This process is known as acclimatization and generally takes 1-3 days at that altitude. For example, if you hike to 10,000 feet (3,048 meters), and spend several days at that altitude, your body acclimatizes to 10,000 feet (3,048 meters). If you climb to 12,000 feet (3,658 meters), your body has to acclimatize once again. A number of changes take place in the body to allow it to operate with decreased oxygen. z The depth of respiration increases. z Pressure in pulmonary arteries is increased, "forcing" blood into portions of the lung which are normally not used during sea level breathing. z The body produces more red blood cells to carry oxygen, z The body produces more of a particular enzyme that facilitates z the release of oxygen from hemoglobin to the body tissues. Prevention of Altitude Illnesses
Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications. Below are a few basic guidelines for proper acclimatization. z If possible, don't fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up. z If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours. z If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day. z "Climb High and sleep low." This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude. z If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease (&quotDon't go up until symptoms go down"). OA Guide to High Altitude: Acclimatization and Illnesses z If symptoms increase, go down, down, down! z Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly acclimatized before going higher. z Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear. z Take it easy; don't over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms. z Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms. z Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at z The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other Preventive Medications
z Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen,
thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no difference for most people with the lower dose, although some individuals may need 250 mg.) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat. z Dexamethasone (a steroid) is a prescription drug that decreases brain and other swelling
reversing the effects of AMS. Dosage is typically 4 mg twice a day for a few days starting with the ascent. This prevents most symptoms of altitude illness. It should be used with caution and only on the advice of a physician because of possible serious side effects. It may be combined with Diamox. No other medications have been proven valuable for preventing AMS. Acute Mountain Sickness (AMS)
AMS is common at high altitudes. At elevations over 10,000 feet (3,048 meters), 75% of people will have mild symptoms. The occurrence of AMS is dependent upon the elevation, the rate of ascent, and individual susceptibility. Many people will experience mild AMS during the acclimatization process. Symptoms usually start 12-24 hours after arrival at altitude and begin to decrease in severity about the third day. The symptoms of Mild AMS are headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise. Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside within 2-4 days as the body acclimatizes. As long as symptoms are mild, OA Guide to High Altitude: Acclimatization and Illnesses and only a nuisance, ascent can continue at a moderate rate. When hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip. AMS is considered to be a neurological problem caused by changes in the central nervous system. It is basically a mild form of High Altitude Cerebral Edema (see below). Basic Treatment of AMS
The only cure is either acclimatization or descent. Symptoms of Mild AMS can be treated with pain
medications for headache and Diamox. Both help to reduce the severity of the symptoms, but remember,
reducing the symptoms is not curing the problem. Diamox allows you to breathe faster so that you
metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is
especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have
an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five
days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is
125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no
difference for most people with the lower dose, although some individuals may need 250 mg.) Possible
side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These
side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped.
Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic
to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic
reactions to people with no previous history of Diamox or sulfa allergies.
Frank Hubbell of SOLO in
New Hampshire recommends a trial course of the drug before going to a remote location where a severe
allergic reaction could prove difficult to treat.
Moderate AMS
Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting,
increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia). Normal
activity is difficult, although the person may still be able to walk on their own. At this stage, only
advanced medications or descent can reverse the problem. Descending even a few hundred feet (70-100
meters) may help and definite improvement will be seen in descents of 1,000-2,000 feet (305-610
meters). Twenty-four hours at the lower altitude will result in significant improvements. The person
should remain at lower altitude until symptoms have subsided (up to 3 days). At this point, the person
has become acclimatized to that altitude and can begin ascending again. The best test for moderate AMS
is to have the person "walk a straight line" heel to toe. Just like a sobriety test, a person with ataxia will
be unable to walk a straight line. This is a clear indication that immediate descent is required. It is
important to get the person to descend before the ataxia reaches the point where they cannot walk on
their own (which would necessitate a litter evacuation).
Severe AMS
Severe AMS presents as an increase in the severity of the aforementioned symptoms, including
shortness of breath at rest, inability to walk, decreasing mental status, and fluid buildup in the lungs.
Severe AMS requires immediate descent to lower altitudes (2,000 - 4,000 feet [610-1,220 meters]).
There are two other severe forms of altitude illness, High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. When they do occur, it is usually with people going too high too fast or going OA Guide to High Altitude: Acclimatization and Illnesses very high and staying there. The lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain. High Altitude Pulmonary Edema (HAPE)
HAPE results from fluid buildup in the lungs. The fluid in the lungs prevents effective oxygen
exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, and
this can lead to cyanosis, impaired cerebral function, and death. Symptoms include shortness of breath
even at rest, "tightness in the chest," marked fatigue, a feeling of impending suffocation at night,
weakness, and a persistent productive cough bringing up white, watery, or frothy fluid. Confusion, and
irrational behavior are signs that insufficient oxygen is reaching the brain. One of the methods for
testing yourself for HAPE is to check your recovery time after exertion. If your heart and breathing rates
normally slow down in X seconds after exercise, but at altitude your recovery time is much greater, it
may mean fluid is building up in the lungs. In cases of HAPE, immediate descent is a necessary life-
saving measure (2,000 - 4,000 feet [610-1,220 meters]). Anyone suffering from HAPE must be
evacuated to a medical facility for proper follow-up treatment.
High Altitude Cerebral Edema (HACE)
HACE is the result of swelling of brain tissue from fluid leakage. Symptoms can include headache, loss
of coordination (ataxia), weakness, and decreasing levels of consciousness including, disorientation, loss
of memory, hallucinations, psychotic behavior, and coma. It generally occurs after a week or more at
high altitude. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary
life-saving measure (2,000 - 4,000 feet [610-1,220 meters]). There are some medications that may be
prescribed for treatment in the field, but these require that you have proper training in their use. Anyone
suffering from HACE must be evacuated to a medical facility for proper follow-up treatment.
Other Medications for Altitude Illnesses
z Ibuprofen is effective at relieving altitude headache.
z Nifedipine rapidly decreases pulmonary artery pressure and relieves HAPE.
z Breathing oxygen reduces the effects of altitude illnesses.
Gamow Bag (pronounced ga´ mäf)
This clever invention has revolutionized field treatment of high altitude illnesses. The bag is basically a sealed chamber with a pump. The person is placed inside the bag and it is inflated. Pumping the bag full of air effectively increases the concentration of oxygen molecules and therefore simulates a descent to lower altitude. In as little as 10 minutes the bag can create an "atmosphere" that corresponds to that at 3,000 - 5,000 feet (915 - 1,525 meters) lower. After a 1-2 hours in the bag, the person's body chemistry will have "reset" to the lower altitude. This lasts for up to 12 hours outside of the bag which should be enough time to walk them down to a lower altitude and allow for further acclimatization. The bag and pump weigh about 14 pounds (6.3 kilos) and are now carried on most major high altitude expeditions. Bags can be rented for short term trips such as treks or expeditions. Cheyne-Stokes Respirations
Above 10,000 feet (3,000 meters) most people experience a periodic breathing during sleep known as OA Guide to High Altitude: Acclimatization and Illnesses Cheyne-Stokes Respirations. The pattern begins with a few shallow breaths and increases to deep
sighing respirations then falls off rapidly. Respirations may cease entirely for a few seconds and then the
shallow breaths begin again. During the period when breathing stops the person often becomes restless
and may wake with a sudden feeling of suffocation. This can disturb sleeping patterns, exhausting the
climber. Acetazolamide is helpful in relieving the periodic breathing. This type of breathing is not
considered abnormal at high altitudes. However, if it occurs first during an illness (other than altitude
illnesses) or after an injury (particularly a head injury) it may be a sign of a serious disorder.
z Mountain Sickness, Peter Hackett, The Mountaineers, Seattle, 1980. z High Altitude Illness, Frank Hubble, Wilderness Medicine Newsletter, March/April 1995. z The Use of Diamox in the Prevention of Acute Mountain Sickness, Frank Hubble, Wilderness z The Outward Bound Wilderness First Aid Handbook, J. Isaac and P. Goth, Lyons & Burford, z Medicine for Mountaineering, Fourth Edition, James Wilkerson, Editor, The Mountaineers, z Gamow Bags - can be rented from Chinook Medical Gear, 34500 Hwy 6, Edwards, Colorado Additional Reading:
z Altitude Illness Prevention & Treatment, Steven Bezruchka, The Mountaineers, Seattle, 1994. z Going Higher, Charles Houston, Little Brown, 1987. z High Altitude Sickness and Wellness, Charles Houston, ICS Books, 1995. z High Altitude Medicine and Physiology, Ward Milledge, West, Chapman and Hall, New York, This article is written by Rick Curtis, Director, Outdoor Action Program. This material may be freely distributed for nonprofit educational use. However, if included in publications, written or electronic, attributions must be made to the author. Commercial use of this material is prohibited without express written permission from the author. Copyright 1998 Rick Curtis, Outdoor Action Program, Princeton University.


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