L Wallis, J Matthews. Medical Support on a Himalayan Expedition.

Introduction The number of people travelling to high altitude regions, especially in South America, Nepal and India, has risen enormously in the past 10 years. Alongside this increasing popularity of altitude trekking there has been an increase in the number of service expeditions. In October 2000, a Joint Service Expedition spent a month in Nepal attempting to scale Lobuche East, one of the trekking peaks in the Everest region of Northern Nepal. This expedition was one of four Service expeditions in Nepal at that time. Despite being unsuccessful in reaching the summit at 6119 metres, the group trekked to a maximum elevation of 5100m before being forced to return to Kathmandu. Providing medical support in the unique environment of the mountains presents a challenge both due to the high altitude and also the remoteness of the region. We describe the preparations that were undertaken prior to the expedition leaving the UK and also the medical supplies taken. We then discuss three cases of altitude related illnesses from the expedition to illustrate the type of problems that can be faced in this unique environment. Finally we discuss the use of a pulse oximeter at high altitude and the controversial use of prophylactic acetazolamide by the group. Preparation The group for the expedition came together about a year before it was due to depart. Amongst the group were two Naval doctors and one Naval Chief Medical Assistant. The expedition, four weeks in total, was to include a short visit to a clinic that had been set up by the Chief MA in the Megauli region of Southern Nepal (see maps Figures1 and 4). For most of the nine members of the group, it was their first trip to Nepal and would be their first mountaineering experience. It was essential, therefore, that we had two RAF mountain leaders in the group (Figure 2). Advice about medical stores was sought