Injuries on Everest

The last summit window was heralded as a great success by many teams. However it was not without incidents and many were not reported.

EverestER, the base camp medical facility on the south posted a very revealing report on this summit window. And there are other reports on both sides from this season.

First from the south and EverestEr:

Approximately 90 people reached the summit of Everest in the last few days, a rough total of Sherpas and foreigners. Congratulations to all for getting down alive, summit or no summit. There were no fatalities.

Along with summit bids, however, comes frostbite. The exposure to higher winds and lower temperatures on summit day is substantial. In addition, it’s hard to stay hydrated on summit day.  Most frostbite results from unanticipated exposure, such as a forced bivouac, or delays due to accidents on the mountain or becoming immobilized from trauma or exhaustion. A climber who can’t move for any reason high on Everest is in great danger of frostbite, as well as hypothermia.  The extreme hypoxia itself contributes to frostbite risk in addition to the freezing temperatures. Hypoxia diminishes the normal vasodilation that flushes the fingers with warm blood in response to getting cold. In addition, hypoxic brains can lead to poor decision making. Hydration is difficult when all water has to be made from ice, and cold water may not be appetizing in these conditions.

I think it’s surprising we don’t see more frostbite. The high-quality equipment is no doubt one reason for this.  What the Brits in the 20’s would have given for high-tech lightweight double boots and modern gloves and mitts! Another factor is today’s climber not having to remove gloves for tying knots, fixing ropes, handling stove fuel, etc, since the Sherpas do all these things. The guided member is also handed large mugs of tea or other liquids in camp and filled water bottles for the summit hike.

The most serious frostbite so far this season was in a climber who made the very poor decision to sleep just below the South Col, feeling too exhausted to make it the last 100 meters to camp. He slept on a rock, apparently attached to the fixed line, and somehow lost the mitt on his right hand during the night. He was climbing alone, his “teammates” apparently unaware of his location and he had no Sherpa support. Amazingly, he survived the night out without a tent, sleeping bag, stove to make water or any help. In the morning, he ascended to Camp 4 on the South Col and there received help in starting back down. His mind was obviously not working well; he was stumbling and confused, the main symptoms of high altitude cerebral edema. An Argentinean woman and two Spanish women must have seemed like angels to him – they assisted him down to safety without regard to their own schedules; others helped as well. He was still a bit confused when he arrived in our camp in the early evening.

Physical exam showed severe frostbite to his hands, right more than left, and to his ears, but no frostbite of the toes, a testimonial to the quality of his foot gear. We soaked his hands in warm water with Betadine, bandaged them with sterile gauze, and started him on ibuprofen, an anti-inflammatory drug helpful for frostbite. There is actually little more we can do for frostbite ment here at base camp. (The ment is within 24 hours of injury in a specialized center.) The next morning a helicopter whisked him to Kathmandu. The picture shows dark-colored fingers without blisters, indicating the tissue is without circulation and will likely require some amputation. Blisters are a good sign, indicative of live tissue underneath the skin.

The next day we had 3 more cases of severe frostbite. As usual, they were related to questionable decision making, hypoxia and dehydration. One climber decided to stop at the Balcony, on the way up, at about 27,700 ft. He was moving too slow and was very fatigued. He decided to wait for his teammates while they continued on to the summit. They returned 5 to 6 hours later. This man could have very easily descended, since ropes are fixed all the way from the Balcony to near his tent on the south Col. His self-imposed immobilization cost him most of his toes and one finger. See the picture below. The blister on the left great toe is a good prognostic sign, but blisters are absent on the other toes.

Unless promptly ed, subsequent care rarely makes a difference in outcome. That is, once the tissue is frozen and then thawed spontaneously on the mountain as the climber descends, the damage is done, and the result is already determined. The one thing doctors can do is to help prevent complications such as infection and give the tissue the chance of healing. Since prehospital ment is essentially futile, prevention is absolutely critical. Meticulous attention to keeping socks and gloves dry, staying hydrated, avoiding unnecessary stops and delays, and the use of electronic or chemical heaters are all strategies to prevent frostbite.

This post submitted by Dr Peter Hackett

And on the North, these reports.

Bill Fischer posted a debrief on his last few days on the north side this year. He left the expedition with eye problems. As I have said before, I thoroughly enjoyed Bill’s posts. He was candid, funny and had the courage to tell it like he saw it. In particular, I like this excerpt for his last post, the Blog of the Day:

While I am very sad that I wasn’t able to reach my goal of 26,000 ft and then the summit I realize that I made the right decision to come off the mountain. It is tough for me to realize that my body won’t accept going higher than 20,000 ft but that is the way it is. It isn’t possible for me to go back and try again.

Bill also made this mention of Team Jordan on the day of the avalanche that killed Hungarian climber Laszlo Varkonyi:

The day we hiked down to BC was the same day there was an avalanche on the North Col. Who knows whether we would have been caught in the avalanche. All I can tell you is that we were to climb up the North Col that day with team Jordan. Since we were more acclimatized than they were we would have been directly above them.

When the avalanche hit, it took out the two Hungarians killing one and injuring the other. The Hungarians were located right above team Jordan. The avalanche hit Jordan and knocked him into his father with Jordan’s crampon hitting him in the head. Fortunately for Paul and Jordan the ropes held them to the mountain and Paul got a cut above his eye that needed only 4 stitches.

Another injury not reported widely but noted when the Malta Everest team posted this with no further details:

… involved in rescue of a climber from a sister expedition who found herself in difficulty at south summit. She had to be carried down and now recovery process starts. She has been exposed to the death zone weather for more than 24hours. Greg and Victor were directly involved in the recovery operation.

Now the BBC is reporting that the youngest British climber to summit Everest, Bonita Norris suffered an injury on her descent:

Bonita Norris, 22, from Wokingham, suffered a back injury but is not seriously hurt, her family said. A Sherpa team helped bring her from close to the summit to Camp 3, lower down the mountain.

Once the report appeared on the BBC, this update was posted on Kenton Cool’s site:

The only hiccup of the day came when Bonita slipped on the way down and hurt her back and neck. This slowed her descent up and in the end I (Kenton) and a Sherpa team had to lower her down the final slopes from the Balcony to the South Col. The team finally all got back to the South Col camp at 2am after a pretty epic but ultimate safe descent from the top of the world.

Obviously any issue with a climber is serious and demands immediate attention. However it is also a learning opportunity that Everest is not a walk-up and cannot and should not be viewed as a simple hike at high altitude. Guides and/or private climbs should not hide accidents. They always happen and are learning opportunities.

Mike Farris is a superb excellent example of being open with his full report on his solo climb last year and subsequent severe frostbite and brush with death. Read his report on how full disclosure should be handled.

The American Alpine Club produces an annual journal of accidents. I have been featured in it! It is used by many climbers, guides and companies to learn how to avoid future mistakes or just back luck.

It is not about pride or protecting business; it is about sharing within the climbing community and saving lives.

Safe climbing to all those this weekend

Climb On!

Alan