Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

Risk Versus Benefit High-altitude mountaineers and trekkers are usually aware of altitude illness and quick to rec- ognize the patterns and trends. Some will push upward anyway and risk turning an anticipated problem into an existing problem. At least they are usually making the decision knowingly and can reduce the consequence with a quick turn- around. It would be very unwise, however, to take such a risk without the benefit of a quick and easy escape to lower elevation. More troublesome is altitude illness at moder- ate elevations where there are lots of people ski- ing, hunting, biking, and hiking who have little or no awareness of the risk. The Chambers of Commerce of mountain resort towns typically don’t post headache, nausea, and gasping for breath alongside their lists of amenities. People can spend a long time suffering before discover- ing that a course of acetazolamide or a night on low-flow oxygen can change everything. Although HACE is unlikely to become a serious problem at most ski resorts and mountain towns, this is not the case with HAPE. People die in hotel rooms surrounded by cold and flu medications, completely unaware of the real problem. HAPE can kill at elevations as low as 2,500 meters. It is the responsibility of guides, outdoor educators, and resort staff working at altitude to give their clients the risk awareness not provided by the Chambers. This might include a recommenda- tion to acquire prophylactic medication from their health care provider and to spend a night or two acclimatizing before beginning a backcountry trek. Mountain rescue teams and combat units that travel quickly to altitude have little choice but to use medication preventively to blunt the symp- toms of altitude illness long enough to complete the mission. The risk associated with the use of dexamethasone, a medication commonly used for this purpose, are acceptable for the benefit of being functional on scene. This risk versus ben- efit ratio may not make sense when applied by a climber just trying to meet a schedule.