Friends don’t let friends HAPE.

Ben Davies | BackcountryBackcountry | BrainsBrains
The Author, breathing hard for all the right reasons

Although not as well known as avalanches, HAPE ( high altitude pulmonary edema), otherwise   known as HAPO in the Indian regions of the Himalayas ( the British spelling is Oedema) is in fact the number one killer of people at altitude. Although not strictly correct, the same issues with breathing at altitude are known as altitude sickness, or sometimes Acute Mountain Sickness ( AMS).
Pulmonary Edema, or PE is a term most first responders are acquainted with, as it occurs frequently with heart attack victims. It is essentially fluid build up in the lungs, making it difficult to breathe. HAPE is a specialized form of a PE, brought on in its acute phase by exercise at altitude. The symptoms of HAPE are shortness of breath after exertion, difficulty walking uphill, fever, rapid irregular heartbeat, and a coughing up blood. Most of the time these symptoms are mild and heal quickly as the body acclimatizes.

Medical textbook image of Pulmonary Edema

Just because you are not climbing Everest, does not mean you shouldn’t be keeping an eye out for your ski partners getting HAPE. There are studies that put instances of it starting at altitudes as low as 2000m. A quick check of 50 major ski resorts all over the world, had all their top lifts at well above that figure.

The real issue with this affliction is that doctors are still not entirely sure who can get it, and who can’t. It doesn’t matter if you are an 80 year old grandmother walking up in the summer to enjoy the view, or an 18 year old climber climbing a route they have done many times. What is known, is that HAPE is eventually fatal. The fluid builds up in the lungs and you are unable to breathe. Fortunately, there is an easy way to alleviate the symptoms, one we’re all familiar with. Go down, fast! The medical treatment includes rest, administration of oxygen, and descent to a lower altitude. If you spot it early enough, your ski partner will feel better with a descent of only 500-1000m. If you are skiing at a ski area, this should be easy to do, just get to the base, as fast and safely as you can.
But what if you’re out in the back country, and your touring partner starts to show symptoms. If you are at high altitudes, most of the rescue teams now carry portable hyperbaric chambers, which can lower the pressure inside. This, added to supplemental oxygen, can save lives when quick descent is difficult.
But, even at lower altitudes, the trick is the same as you should be doing with your crew anyway. Keep an eye on them, is anyone going slower on the skin track than usual? Do they seem to be breathing harder than normal for this transition? Early detection is important, as it’s pretty easy to deal with at that point. The same reasoning as for avalanche danger in the back country applies. Be ready to turn around, and lose altitude whilst keeping an eye on them.
Remember, friends don’t let friends HAPE.

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