Ararat Rescue: Severe altitude sickness with HAPE

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We had an expedition to climb Mt Ararat during which one of the climbers developed mountain sickness with HAPE (High Altitude Pulmonary Edema) also known as “Water in Lungs”, needed to be urgently evacuated and spent a few days in the hospital, including the ICU unit. In this blog post, I wanted to cover what this rescue entailed, as things at Ararat are different compared to Nepal, the Alps, or Aconcagua.

First, developing severe altitude sickness at Ararat is not expected to be likely. While Ararat is relatively high (5137m or almost 17000ft) during the standard climb you spend most of the time at about 3300m (3 nights) one night at high camp at 4200m and the total back and forth to summit from the camp takes up to 10h (we did it in 8). Also being a standalone Volcano Ararat typically allows for speedy descent – you can get from the high camp back to the base camp in about 2 hours, or descend from the summit to the high camp in about 3 hours. This means that when they start to feel bad, most people can choose to go down or at least not continue up, as happened with another group member.

However, this also means that local guides are not experienced with anything other than mild altitude sickness. There are also no medical professionals in the camps, no standby rescue team or helicopter to take you down. Local guides cooperate to manage all the rescue needs to the best of their ability. There was also no oxygen (in our or surrounding camps) or Dexamethasone, which is often used as an emergency medicine in cases of HAPE or HACE.

The complicating factor was also that the member in question was extremely athletic – An ultra-marathon runner, he knew how to tolerate suffering, so what could have made another person abandon the summit attempt was not enough to stop him.

If you do not have extensive high altitude experience, lack of reference can be quite a problem – of course, you heard you’re expected to feel worse at Altitude, but how much? It can be a hard question to answer before it becomes too late.

I had my finger Oxygen Saturation Sensor with me and we measured spending our first night at 3300m. The device did not show super reliable results, yet most members seemed to have an oxygen saturation of 85-90%, where this member had a saturation of about 75%. His Garmin watch showed a similar number. We discussed that he may have problems with acclimatization, but he assured us he feels reasonably well. In retrospect, Oxygen Saturation much lower than the rest of the group provided us with early warning and we could have paid more attention to it.

The plan for the day was to hike up to the high camp (4200m) and back for acclimatization purposes. All the group did it with a very good pace – 2.5h to go up, instead of 3-3.5h guides originally expected, including the member in question. This reduced my concern a bit as in previous cases of severe altitude sickness I’ve seen, people had a hard time keeping pace.

We came down, had dinner and everything was reasonably well. Some people reported headaches, poor appetite, and not sleeping well – things you would normally expect.

The next morning we were moving to high camp to attempt a summit the following night. One of our expedition members did not feel good and decided not to continue. The member, who required rescue, later decided to continue.

We went up at quite a relaxing pace, taking a longer time, this time around and the member could still maintain the pace. Later in the evening, he mentioned it was a bit harder than usual for him to maintain the balance, but he felt strong enough to stay the night and see how he felt.

During the night he coughed a lot. I asked him if it was a dry cough (rather common in the mountains) or a wet cough (one of the symptoms of HAPE), and he said it seemed dry. Later on, some climbers reported it was a wet cough, highlighting it might be hard for climbers to self-evaluate wet vs dry.

In any case, he did not feel well and the Oxygen Saturation sensor for some reason did not show any data for him (neither finger-based nor one in Garmin watch), so he decided to stay at the camp and go down with us when we’re back from the summit. This sounds sensible as it is not great to descend in the middle of the night and he was doing reasonably well (at least confidently walking by himself). We left him with the camp manager to look after, and around 1:30 am departed to push for the summit.

Around 10 am when we were coming back from the mountain, I could see a person moving very slowly to the restroom with another person’s assistance and recognized this is our member, who have deteriorated very significantly during the 9 hours since I last saw him. At this point, it became clear to me that urgent action was needed.

As I spoke to the member, he was really tired and lethargic, he was sitting in direct sun, not caring if he got sunburn. I asked him and the guides about the plan, and they told me he would go down on horse as soon as our horses came and guides would accompany him to prevent fall. This sounded like a reasonable plan.

At this point, I asked if they had any doctor on call, where they could consult about the situation, and maybe we could give him some meds to improve the situation. The guides said not to worry, as they had been guiding Ararat for 25+ years and he would get better when he went down. Gave him some water with electrolytes and this was it.

We packed member’s things from the tent, as he was not in condition to do so… and were waiting for the horses, while he was getting worse almost by the minute. I saw he had a hard time sitting on the chair and was almost falling asleep. He was also breathing very heavily and had a very high pulse rate.

Seeing this, the guides told me they were concerned if he could sit on the horse or fall asleep and fall from it… and their suggestion was maybe he needed to get some sleep. I think for some reason they thought he took some sleeping pills which was causing this behavior, while he told them he only took some paracetamol for headaches. I told them it is not the option and he needs to go down right now, and we need to figure out a way to do that.

The guides briefly considered carrying him down, enrolling our group for help but in the end decided to tie him down to the horse and have one person leading the horse and two guides by the sides to catch him if he fell. Finally, he started to be transported down.

At the same time, we contacted his emergency contact (the great thing about Ararat is good Cell coverage anywhere on the standard route on the mountain) and insurance to report the situation and got their confirmation he can be treated at any hospital in the area. We also arranged for him to be taken by the SUV from the base camp to the local private hospital to be seen immediately.

As he was brought down, the guides told me it looked like he was getting better and if he wanted to go to the hospital, or maybe he just wanted to recover at camp. As I saw him, he still could not walk on his own and was not thinking clearly, so I told them we needed to take him to the hospital. I told the member he would be taken to the hospital and he agreed.

As he was taken to the hospital I had a chance to talk to the guides to ask them how often they had to deal with something like this, and it turns out it is rather a rare occurrence – they have to take people down on the horse but usually because of broken legs or twisted ankles, not severe case of altitude sickness.

First, the member was taken to the “Özel mediza hastanesi”, Private hospital in Doğubeyazıt. They gave him oxygen and some meds, did an X-ray to discover liquid in his lungs, and decided they were not set up to deal with his condition and he needed to be moved to the teaching hospital in Agri, some 120km away (by the ambulance) It must be said they arranged all of this very quickly.

I was surprised though – the hospital closest to the mountain seems not to be set up or experienced dealing with altitude sickness conditions. I am comparing this to a very small hospital in Lukla, Nepal, which nevertheless seemed to be confident dealing with HAPE in the situation I experienced in the Nepal expedition.

It was very lucky we had Yulia, our expedition coordinator stayed in Doğubeyazıt while we were on the mountain, so she could accompany the member to the hospitals, and serve as a communication channel between his emergency contact, medical team, and us.

In the Teaching hospital, the member was admitted to the ICU, where they confiscated his cell phone which made communication challenging. In this government hospital, they did not have all the meds they needed so they sent Yulia to buy some at the pharmacy.

With oxygen and other treatment, the member felt better almost immediately, yet they held him in the ICU for 3 nights, and as I write this he is not yet discharged from the hospital. His partner could fly in to help with care.

It looks like the member is making a full recovery, yet of course, he gave us all quite a scare – with altitude sickness with HAPE and HACE, there is a possibility of really bad outcomes.

There are quite a few learning experiences here though: