Trek Safety in Nepal

Your Safety is our Top Priority:

Trek Safety in Nepal is always at the top of any agenda while organizing any of the adventure trekking and climbing trip in the Himalaya. All our trip leaders and trek guides are medically trained, experienced, work permanently for us. Each year, they refresh the training and update their skills on the Wilderness First Aid training as part of trekking safety in Nepal. They are experts in coping with any problems that may arise on any trip to ensure all of you have a safe and best Himalayan adventure. You can have complete confidence in our expertise and knowledge. Your safety on trekking or climbing trip in Nepal is on top priority. We carry a Portable Altitude Chamber (hyperbolic bag) or Oxygen along with a comprehensive medical kit in each of the high altitude trekking and climbing trips in the Himalayas. We plan adventure travel trips so that safety and comfort are not compromised. Acute Mountain Sickness is also known as AMS could be a life-threatening issue while trekking at a higher elevation in the Himalayas. Our responsible policy to have a trekker: a porter also adds a brick to your Nepal trek safety having enough trek crew in case. Of course, our porter carries less weight and they are ready to help at any place on the high Himalayan adventure journey.

One of our client feedback on AMS

I wanted to express my thanks to all at Mountain Monarch for the excellent service you gave to Nadine and me on our recent Island Peak trek. As you know I experienced a severe case of High Altitude Cerebral Edema at Gorak Shep and had to be put in the Portable Altitude Oxygen Chamber for several hours, before descending the next morning. The quick actions of the trek leader and other MM staff, perhaps Saved my life. They are all a credit to your company. I would have no hesitation in using MM again in any future trip to Nepal - perhaps with the help of Diamox I will one-day complete ascent of Island peak

Greg Martin, British
Everest base camp Island peak trip 2007

Acute Mountain Sickness ( AMS)

This Acute Mountain Sickness could be a big safety issue on a Himalayan adventure if not taken care of on time. Generally, AMS happens when our body fails to acclimatize to the decreasing amount of oxygen available at high altitude as we ascend higher above 2500 meters. Mountain Monarch trip itineraries have been professionally designed to minimize the effects of altitude mountain sickness. Extensive medical kits are carried on all our trips to ensure trekking safety in Nepal. Also, the Portable Altitude Chamber (a life-saving device in the case of AMS) is being carried as precautions on high altitude treks and climbing expeditions. All our group leaders/guides are well trained in Wilderness First Aid Course. They are competent to recognize any symptoms and to act accordingly on the very spot. However, we do recommend you get advice from your travel doctor or health advisor beforehand. Keeping a close eye on AMS and traveling with a medically trained guide we can minimize the risk and safety issue of AMS. Thus we ensure trekking safety in your Nepal adventure journey of a lifetime.

Prevention of Acute Mountain Sickness (AMS)

  • Allow sufficient time for acclimatization (After 3000 meters).
  • Do not make rapid Ascen or go too far too fast.
  • No Alcohol, Sleeping pills, and Smoking.
  • Drink more fluid 3 to 4 liters a day, clean water - boiled or treated / tea/coffee/soup/juice, etc.
  • Climb high and sleep low.
  • Do not trek/travel alone, take a guide/porter.
  • Follow the advice from your group leader and guides.
  • Descent if mild symptoms rapidly getting worse.
  • Never leave or descent sick person alone.
  • Avoid getting cold.

AMS become common above 3000 meter and present in the following ways:

  • Acute Mountain Sickness (AMS) is the most common and is not life-threatening.
  • HACE (High Altitude Cerebral Edema) is a life-threatening illness that can develop from AMS.
  • HAPE (High Altitude Pulmonary Edema) is a life-threatening illness; it may occur on its own, or with AMS or HACE.

AMS Symptoms and signs Should expect but not worry

  • Headache (typically throbbing, often worse for bending over or lying down), PLUS one or more of the following symptoms:
  • Tiredness, weakness.
  • Dizziness, lightheadedness.
  • Loss of appetite, nausea (or vomiting).
  • Insomnia, disturbed sleep, frequent waking.


  • Rest (avoid even the slightest exertion if this is possible) at the same (or lower) altitude until the symptoms clear (up to 4 days)
  • Drink enough to keep your urine pale and plentiful.
  • Use ibuprofen or paracetamol for headache.
  • Consider Diamox (125 to 250 mg 12-hourly) for 3 days, or for the rest of the time at altitude if symptoms return.
  • Consider Stemetil (or other anti-vomiting medication) for persistent nausea/vomiting.
  • If AMS symptoms are severe, give oxygen (1 to 2 L/min) OR use a pressure bag until symptoms clear.
  • Check the victim regularly for signs of HAPE and HACE, especially during the night.
  • Descend far enough to clear symptoms (at least 500m/1640ft) if symptoms of AMS do not improve or get worse.

Facts on HAPE and HACE

  • HACE or HAPE occurs in approximately 1 to 2% of people going to high altitude.
  • HAPE and HACE may occur alone or together.
  • HAPE is roughly twice as common as HACE.
  • HAPE causes many more deaths than HACE.
  • HAPE may appear without any preceding symptoms of AMS.
  • HAPE is more likely in people with colds or chest infections.
  • HAPE often comes on after the second night spent at a higher altitude.
  • HAPE can develop even after descending from a higher altitude.
  • HACE usually develops after symptoms of AMS have appeared and often gets rapidly worse during the night.
  • HACE may develop in the later stages of HAPE.

HACE (High Altitude Cerebral Edema)

Symptoms of HACE are caused by an accumulation of fluid in or around the brain. Typically symptoms and signs of AMS become worse and HACE develops. Someone with HAPE may also develop HACE.

Symptoms and Signs

  • Severe headache, which often feels worse on lying down and is not relieved by ibuprofen, paracetamol, or aspirin.
  • Tiredness, severe fatigue.
  • Nausea and or vomiting may be severe and persistent.
  • Loss of coordination, clumsiness. The victim needs help with simple tasks such as tying their shoelaces or packing their bag. They cannot do the finger-nose test.
  • Staggering, falling. They cannot do the heel to toe walking test or the standing test.
  • Blurred or double vision, seeing haloes around objects.
  • Loss of mental abilities such as memory. They cannot do a simple mental arithmetic test.
  • Confusion, hallucinations.
  • Behavior change (aggression, apathy, etc.)
  • Drowsiness, difficulty to wake up, coma, death

Tests for HACE

  • Heel-to-toe walking test: The victim is asked to take 10 very small steps, placing the heel of one foot to the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped.
  • Standing test: The victim stands with eyes closed, feet together and arms by their sides.
  • Finger-nose test: With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of their nose with an index finger then extending this arm to point into the distance (a useful test if the victim is in a sleeping bag).
  • Mental arithmetic test: Give the victim a mental arithmetic test, eg. subtract 7 from 100, 7 from 93, and so on (but remember some people may be poor at arithmetic even at sea level).
  • If the victim cannot do any of the above tests easily (or refuses to cooperate), or show excess wobbling or falling over in the two first tests (be prepared to catch the victim if they fall over!), assume they are suffering from HACE. If in doubt about the victim's performance, compared with a healthy individual. Be prepared to keep repeating these tests.

How to Treat ( Guideline)

  • Descend immediately (prompt descent will begin to reverse the symptoms). Descend as low as possible, at least 1000m /3280 ft. Descend at night or in bad weather if necessary. Carry the victim if possible, as the exertion of walking can make the illness worse.
  • If descent is not immediately possible (eg. dangerous terrain or weather, not enough helpers, or while waiting for a helicopter), oxygen or the use of a PAC and appropriate medications will keep the person alive until descent can be undertaken.
  • Give oxygen:
    i) From a bottle using a mask (2 to 4 L/min), OR
    ii) By using a pressure bag (this is roughly the equivalent of 2 to 4 L of oxygen/min).
    NB: If both oxygen and a pressure bag are available, give the oxygen while the bag is being prepared and after the victim comes out of the bag. Do not give oxygen inside the bag unless it is designed for this purpose and you have been trained to do so.
  • Give medications:
    i) 8 mg of dexamethasone at once (by mouth, IV, or IM) followed by 4 mg 6-hourly. Dexamethasone takes several hours to work. Stop it once below 2500m/8200ft AND after at least 3 days of treatment by tailing off the dose slowly (give the last 3 doses 12-hourly)
    ii) Diamox 250 mg 8 to12-hourly
    iii) Treat persistent vomiting with anti-vomiting medication
  • Prop the victim up in a semi-reclining position as lying down flat may make their condition worse
  • Avoid even the slightest exertion if this is possible. Even walking a few steps may make their symptoms worse or reappear. Do not leave the victim alone.
  • If a person is turning blue or is falling into unconsciousness, give them rescue breathing before they stop breathing.

HAPE (High Altitude Pulmonary Edema)

Symptoms of HAPE are due to the accumulation of fluid in or around the lungs. It may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases), or it may develop at the same time as AMS. HAPE can easily be mistaken for a chest infection or asthma: if in doubt treat for both.

Possible Signs and Symptoms

  • A reduction in physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs that HAPE is developing.
  • Breathlessness. In the early stages of HAPE, this may mean just taking a bit longer to get one breath back on resting after mild exercise. Later on, there is a marked breathlessness with mild exercise. Finally, breathlessness occurs at rest. Record the respiratory rate (NB: At 6000m/19700ft, class="normal" acclimatized respiration rate is up to 20 breaths per minute).
  • The dry cough may later become wet with frothy sputum, which may be bloodstained (pink or rust-colored). This is a serious sign.
  • Wet sounds in the lungs when breathing in deeply (place your ear on the bare skin of the victim back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE: this is called dry HAPE.
  • There may be mild fever up to 38.5 C, a sense of inner cold, pains in the chest.
  • Blueness or darkness of face, lips, tongue, or nails due to lack of oxygen in the blood (cyanosis).
  • Drowsiness, difficulty waking up, coma, death.

Treatment Guidelines

Same general treatment as for HACE, EXCEPT:

  • Use oxygen or the PAC and appropriate medications will keep the person alive until descent can be undertaken Give medications:
    i) Nifedipine. This should only be used if bottled oxygen or a pressure chamber is not available and the victim is warm and well hydrated. Give the modified release (MR) form of the tablets (20 mg 12-hourly for 2 or 3 days). If a fall in blood pressure occurs due to nifedipine (pallor, weak rapid pulse, dizziness on standing), treat as a shock
    ii) Diamox 250 mg 8 to 12-hourly
    III) An asthma reliever spray (2 puffs 4-hourly) may help.

Our Medicine box checklist

  • Acute Mountain Sickness: Portable Altitude Chamber (hyperbolic bag).
  • Acute Mountain Sickness- Diamox, dexamethasone.
  • Antiseptics (disinfectant): Dettol, iodine solution, Burn cream (Silvazine, Burnol).
  • Pain Killers (analgesics): Paracetamol (Panadol), Aspirin, Ibuprofen.
  • Antibiotics (infection): Amoxycillin, Cephalexin, Ciprofloxacin, Cotrimoxazole, Doxycycline, Erythromycin, Metronidazole, Tinidazole.
  • Eye and Ear Infection: Chloramphenicol.
  • Fungal infection: Miconazole.
  • Nausea and vomiting-Stemetil.
  • Indigestion Antacid tablets.
  • Constipation Durolax.
  • Anti Motility Immodium, Lomotil.
  • Acute Mountain Sickness Diamox, dexamethasone.
  • Respiratory Medication: Sinutab, Lemotab, Asthma spray.
  • Anti Allergy and Anti Inflammatory: Hydrocortisone cream Calamine, Polaramine.
  • Dental Clove oil
  • Instruments: Thermometer, tweezers, scissors.
  • Dressing and wound: cotton buds and roll, square and sterile gauze, triangular, adhesive, and elastic bandages.