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 adventure trekking and climbing trip in the Himalayas. All our trip leaders and trek guides are medically trained and experienced and 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 trips in Nepal is a top priority. We carry a Portable Altitude Chamber (hyperbolic bag) or Oxygen and a comprehensive medical kit in each high-altitude trekking and climbing trip in the Himalayas. We plan adventure travel trips so that safety and comfort are not compromised. Acute Mountain Sickness, also known as AMS, could be life-threatening 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 by having enough trek crew in case. Of course, our porters carry less weight and are ready to help anywhere on the high Himalayan adventure journey.

One of our client feedback on AMS

I wanted to thank all at Mountain Monarch for the excellent service you gave Nadine and me on our recent Island Peak trek. As you know, I experienced a severe High Altitude Cerebral Edema at Gorak Shep. I had to be put in the Portable Altitude Oxygen Chamber for several hours before descending the following day. 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 not hesitate to use MM again on any future trip to Nepal. With the help of Diamox, I will probably one day complete the ascent of the island peak.

Greg Martin, British
Everest base camp Island peak trip 2007

Acute Mountain Sickness ( AMS)

This Acute Mountain Sickness could be a significant 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 altitudes 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 a precaution 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 recommend you get advice from your travel doctor or health advisor beforehand. By keeping a close eye on AMS and traveling with a medically trained guide, we can minimize the risk and safety issues of AMS. Thus, we ensure trekking safety during 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 daily, 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 get worse.
  • Never leave or descend a sick person alone.
  • Avoid getting cold.

AMS becomes common above 3000 meters 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.
  • If symptoms return, consider Diamox (125 to 250 mg 12-hourly) for three days or the rest at altitude.
  • 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 signs clear.
  • Check the victim regularly for signs of HAPE and HACE, especially at night.
  • If symptoms of AMS do not improve or worsen, descend far enough to clear them (at least 500m/1640ft).

Facts on HAPE and HACE

  • HACE or HAPE occurs in approximately 1 to 2% of people going to high altitudes.
  • 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 initial 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 worsens rapidly at night.
  • HACE may develop in the later stages of HAPE.

HACE (High Altitude Cerebral Edema)

HACE is caused by an accumulation of fluid in or around the brain. Typically, symptoms and signs of AMS become worse, and HACE develops. However, someone with HAPE may also develop HACE.

Symptoms and Signs

  • Severe headache often feels worse when lying down and are 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 waking up, coma, death

Tests for HACE

  • Heel-to-toe walking test: The victim is asked to take ten tiny 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 and then extending this arm to point into the distance (a proper test if the victim is in a sleeping bag).
  • Mental arithmetic test: Give the victim a mental arithmetic test, e.g., subtract seven 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 shows excess wobbling or falling over in the two first tests (be prepared to catch the victim if they fall over!), assume they suffer from HACE. If there is doubt about the victim's performance compared with a healthy individual, Be prepared to keep repeating these tests.

How to Treat ( Guideline)

  • Descend immediately (rapid descent will begin to reverse the symptoms). Descend as low as possible, at least 1000m /3280 ft. If necessary, descend at night or in bad weather. Carry the victim if possible, as the exertion of walking can worsen the illness.
  • Suppose descent is not immediately possible (e.g., dangerous terrain or weather, not enough helpers, or while waiting for a helicopter). In that case, Oxygen or using 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) Using a pressure bag (roughly the equivalent of 2 to 4 L of oxygen/min).
    NB: If Oxygen and a pressure bag are available, give the Oxygen while the bag is 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 three days of treatment by tailing off the dose slowly (give the last three doses 12 hours)
    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 falling unconscious, give them rescue breathing before they stop breathing.

HAPE (High Altitude Pulmonary Edema)

HAPE symptoms are due to fluid accumulation in or around the lungs. It may appear independently without any initial signs of AMS (in about 50% of cases) or develop simultaneously as AMS. HAPE can easily be mistaken for a chest infection or asthma; if in doubt, it is treated for both.

Possible Signs and Symptoms

  • Reduced physical performance (tiredness, severe fatigue) and a dry cough are often the earliest signs of HAPE 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 gentle 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 become wet with frothy sputum and bloodstained (pink or rust-colored). This is a severe sign.
  • Wet sounds in the lungs when breathing deeply (place your ear on the bare skin of the victim's back below the shoulder blades; compare with a healthy person). Note: There may be NO wet sounds in even quite severe HAPE, which is called dry HAPE.
  • There may be mild fever up to 38.5 C, a sense of inner cold, and 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:

  • 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 unavailable and the victim is warm and well-hydrated. Give the tablets' modified release (MR) form (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 it 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: Supplementary Oxygen or 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, and Polaramine.
  • Dental Clove oil
  • Instruments: Thermometer, tweezers, scissors.
  • Dressing and wound: cotton buds and roll, square and sterile gauze, triangular, adhesive, and elastic bandages.