Words by Steve Sunny Whitfield
The exploration and expedition industries are some of the oldest in the world where medical professionals have been engaged for centuries. Examples include Dr Archibald Lang McLean (1885–1922), an Australian bacteriologist and chief doctor on the Sir Douglas Mawson's Australasian Antarctic Expedition (1911 -1914) . Historically through to recent times, expeditions have been supported by physicians; however, as a paramedic on expeditions over the last five years, I have undergone a transition from logistical roles to medical roles.
This retrospective account follows a 24-hour period working as an expedition medic (paramedic) during a high-altitude Himalayan expedition where I will carry the rudimentary tools needed to sustain and support life in an austere environment and provide pre-hospital care in extremes.
0400 - Reveille
My wrist-watch vibrated against my cheek announcing reveille. Although daylight was still hours away, I opened the hood of my minus 25 degree sleeping bag and instantly felt the bitterly cold dry air on my face. My tent buddy groaned a morning welcome as we both attempted to sit up. If you have never been inside a -25 degrees sleeping bag in the high Himalayas, put this on your bucket list! A task as simple as sitting up gives you the impression of life inside a cocoon, only the cocoon is located in the depths of a deep freeze and has inadvertently become part of your body’s frozen exoskeleton. In these conditions something as simple as putting boots on requires careful preparation and planning that is amplified by the confines of the small high-altitude tents. Although this situation sounds particularly trying, there is no place I would rather be at that moment because I am part of an expedition team aiming for a high Himalayan pass and these opportunities are not afforded often.
Our team has been self-sufficient for nearly five days, supported by a team of Sherpa guides and yaks. As I struggled to locate my gloves, the dim light from a distant head torch can be seen on the skin of the tent, and the crunch of footsteps on the ice and rock soon followed. “Namaste Mr Steve, hot tea”. It’s the voice of Pemba, one of our Sherpa guides. He has already awoken, dressed and equipped himself. He has also melted ice and made tea before I have even got one boot on!
These Sherpa people, the mighty unsung heroes of the mountain, first came into the region in the 16th century from Eastern Tibet. They have become the contemporary backbone of successful expeditions throughout the Himalayas. A study in 1976 (2) determined the remarkable fact that Sherpa people possess unique haemoglobin-binding enzymes and a doubled nitric oxide production that assist them in the high altitudes. This genetic adaptation occurred after generations of living in the high regions and has increased their lung efficiency in low oxygen conditions. The lack of these adaptations on my part provides the excuse for my protracted struggle to get my boots on before Pemba has delivered the tea!
0412 – Breakfast
The previous night my tent buddy and I suffered a thorough inconvenience. We had collapsed into our tent at 2200 and were soon insensible from the fatigue of the previous day. The mountain gods may have been displeased with our efforts because a few hours later, a katabatic wind stirred in the high valley and travelled down the mountain range. It gained momentum as it gusted through our small camp, causing the failure of two guy ropes supporting our tent. Without many options available in the dark and unable to call for assistance due to the ferocity of the wind, we opted for body weight and stones as tent anchors, thus a rather sleepless night ensued. When reveille sounded, it released us from our cold dark hell. Outside all was calm and I gratefully accepted the tea from Pemba, performed a quick stocktake of equipment and was thankful that the only casualty of the night was the loss of the inner of my glove. (Inners support peripheral thermoregulation and provide protection and comfort to your hands.)
Although desolate, the high lands of the Himalayas entice and engage explorers with their raw beauty. The previous evening, we had observed a stunning red sunset over the high ice-capped peaks and the following morning the moon was reflecting off them. Folklore ascribes a red sky at night as indicating clear weather ahead and sailors, climbers and explorers have passed the rhyme through generations (red sky in the morning – sailor’s warning, red sky at night – sailor’s delight). With that in mind and with the knowledge that mountain weather can change quickly, we struck camp and climbed northwest to the next way-point, closer to the high pass.
0628 – The journey continues
We made good time through the glacial moraine and the weather was looking great. I was dealing with the loss of an inner for my right-hand glove from the previous night and it was a noticeable loss.
0748 – Shingles
It became obvious that one of our Sherpa guides was unwell and suffering pain. Examination showed he had shingles and would be unable to continue. I provided pain relief and then he and another Sherpa began their slow journey back.
1056 - Dehydration, blisters and sunburn
A considerable part of the medic’s role is emotional support and minor medical ailments. After numbers of hours of steady progress through the valley I was called to attend a team member with a burst blister resulting in exposed tissue, and I improvised a second skin from strapping tape. I carry a number of broad-spectrum antibiotics if an infection occurs.
In extreme conditions, you adapt to working with what you have and quickly learn that minor issues can become game-changers if not addressed promptly. The adage “prevention is better than a cure” rings true in this remote and severe environment, but you cannot mitigate all risks.
1302 Lake Louise Score review
Earlier, with the support of the team leader and team Sidar (Nepali leader), we implemented a buddy hydration system whereby team-mates monitor the fluid intake of their climbing partner, and their exposure and sunburn potential. The radiation from the sun coupled with the blinding reflection from the snow burns exposed skin swiftly. We gathered in a small depression for a short lunch stop that allowed for a quick review to occur. Thankfully the team members had thus far maintained regular observations.
At this altitude, it is also imperative that climbers are monitored for signs of acute mountain sickness (AMS) and the Lake Louise Score is a simple method employed daily as a risk reduction strategy. Two climbers presented with headaches at different times and they were monitored for AMS and encouraged to drink more water. Diamox (Dexamethasone) is carried to mitigate altitude issues but the best method is to get low – fast.
1623 Lost climber
As the day wound down our team sought a safe camping site. Before the first yak was unloaded, we were notified via radio that a Korean climber was missing from another party. She had been seen in our vicinity a few hours before our arrival. With last light looming we decided to raise camp first and then plan a response. Meanwhile, several Sherpas moved to the camp boundary and were banging cooking pots with stones. Interestingly, as our team planned a search pattern, the lost climber arrived into our camp having been attracted by the banging sound the Sherpas made. Such a simple solution had saved a life.
1928 Team management
Just before dinner I performed the daily health checks on the team members that graph any developing trends and kindly reminded them to ensure care and personal hygiene of hands, feet and teeth. Lapses in such hygiene essentials in the harsh mountainous terrain could result in issues that impact the progress of the entire expedition. One person had developed a sore throat and was encouraged to drink more water and use a throat gargle.
2008 Planning, preparation and reflections
As I finished the clinical notes on the team, I noted that we had covered 16.6 kilometres today. With eight days remaining, the team was in a good position to complete their objective. I caught a last glimpse of the northern stars over the Himalayan peaks before I turned in for the evening.
0400 is the scheduled reveille when my watch will again signal for us to continue this journey.
This has been a typical 24 hours in the mountains as an expedition medic. Although it was not filled with mass trauma and evacuations (these do happen), the majority of the role is prevention and team management. The influence paramedicine is making on the Expedition Medicine industry is growing and opportunities are expanding. A wise man once told me to surround myself with people who are faster, smarter and better than me. He said the more you listen, the more you learn, the more you learn, the more opportunity you will discover so get out there and explore.
Adapted from the original article: 24 Hours in the Life of an Epedition Medic (Vol 46). Found at https://paramedics.org/publications/response. Used with permission.
Guly H. Archibald Lang McLean (1885–1922) – Explorer, writer and soldier. Journal of Medical Biography. 2015;26(1):43-48.
Morpurgo G, Arese P, Bosia A, Pescarmona G, Luzzana M, Modiano G et al. Sherpas living permanently at high altitude: a new pattern of adaptation. Proceedings of the National Academy of Sciences. 1976;73(3):747-751.