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HAPE, Failure to Descend

On April 25,1985, a five member Japanese party, Tokyo Hakuryo Alaska Expedition, flew to the 2130 Kahiltna landing strip for their climb of the West Buttress of Mt. McKinley. On May 1, Yoshikatsu Sumimoto (37) began to suffer symptoms of High Altitude Pulminary Edema (HAPE) as they ascended to the 3900 meter camp. That evening he experienced gurgling in his lungs and difficulty with his breathing. By the morning of May 2, Sumimoto’s condition had deteriorated to where he had difficulty in standing and began coughing up bloody sputum. His party decided to take him down to the last camp at 3200 meters. At 1400 an American party, MOTA, encountered the Japanese where they recommended they descend to a cave and igloo at 2750 meters. At 1900 the MOTA party arrived at the 4350 meter camp and reported Sumimoto’s condition to rangers Roger Robinson and Bob Seibert.

Robinson and Seibert consulted Rob Roach of the Denali Medical Research Project where a CB radio, a portable 02 (E bottle) and Diamox was obtained to send back with the MOTA team. The MOTA party returned to 3300 meters at 2045 where they found the Japanese camped. Sumimoto was found by himself in a separate tent from the other four. Rick Maschek (of MOTA) found that Sumimoto had a pulse of 120, respirations of 28 and a temperature of 38°C. Maschek began administering 02 at one liter per minute and gave him one 500mg of Diamox. Maschek provided Sumimoto with liquids and was adamant with the rest of the party about providing him with additional liquids and keeping someone with him at all times. At 2200 Michael Nicklas (of MOTA) skied to the 3050 meter level of the Kahiltna where he attempted to reach Kahiltna Base Camp or the NPS via his CB radio. He made no contact. At 2315 Sumimoto’s pulse had improved to 108 with 24 respirations per minute. Early on May 3, at 0300, Sumimoto showed additional improvement with a pulse of 100. Maschek gave him another Diamox. By 0900, Sumimoto was feeling much better. He was able to sit up and had a pulse of 96-100. At some point in the night, the nasal cannula had frozen. Maschek put him back on oxygen that morning and reminded his partners to give him additional fluids. At 1000, Lowell Thomas, Jr., of Talkeetna Air Taxi flew over the area in an attempt to reach the Japanese party via CB radio. No contact could be made. Due to a cloud layer, Thomas made only one pass as he was uncertain of the party’s location. Later in the day, Sumimoto was able to ski unassisted back down to the Kahiltna Base Camp. No further aid was given. (Source: Rober Robinson, Mountaineering Ranger, Denali National Park))

Analysis

At the first sign of altitude sickness, especially when it became clear that Sumimoto’s lungs were involved, his party should have stopped ascending. When his condition deteriorated to the point that he could not walk a straight line without assistance, his group should have started down with him. Another indication for immediate descent is the combination of gurgling in the chest, cough, shortness of breath and a heart rate greater than 100 and breathing rate greater than 20. These are signs of life-threatening pulmonary edema. This man’s life was saved by the prudent action of the MOTA group, the NPS and the Medical Research Group. The oxygen provided enough improvement that he could proceed down on his own. Had he descended a mere 300-500 meters when first ill, he would have made a quick recovery and could have continued on two days later. The Diamox may have helped; its use in severe HAPE is still experimental, but it certainly did no harm. (Source: Dr. Peter Hackett, Denali Medical Research Group)