FROSTBITE, INADEQUATE EQUIPMENT, INEXPERIENCE

Alaska, Mount McKinley

On May 9, 1988, three members of the “Denali Flight 88 Expedition,” Jond Chrosto- phe, Serge Tuaz, and Eric Alamichel (20) left from the 5400 meter camp on the West Buttress route on Denali at 0800 bound for the summit. Jond and Eric carried skis up the route. Eric left camp with cold feet and one hour later felt nothing. He thought his feet were alright then. Jond stopped to rewarm his feet for ten minutes before reaching Denali Pass. Eric and Serge did not report any problems with their feet at this time. Christophe was wearing plastic double ski boots with full insulated overboots. Alamichel was wearing Koflach plastic double boots with wool felt inner boots and no gaiters. Tuaz was wearing Koflach plastic double boots with aveolite inner boots and single gaiters.

The party reached the summit at 1500. Summit conditions were 20 degrees C, 80 kph wind, sunny, and partly cloudy. Jond and Eric skied down from the summit via Denali Pass, arriving at the 5400 meter camp between 1700 and 1800. Four hours later Eric complained of a problem with his feet. Jond warmed Eric s feet in warm water in a cooking pot. Clear blebs formed on the front of both feet and toes, the great toe of the right foot being the worst.

The party remained at the 5400 meter camp on May 10. On May 11, they moved to 4450 meters on the West Buttress route. Eric wore three pairs of socks inside of his plastic boot shells for the descent. His feet were too swollen to fit inside his inner boots. Upon examination at the Medical Research Camp, Dr. Peter Hackett felt that the feet had been re-frozen, particularly the right great toe. Hackett re-warmed and dressed both feet and requested an air evacuation, which was not attempted until May 13 due to bad weather.

Lowell Thomas Jr. of Talkeetna Air Taxi made one landing at 4450 meters to pick up an injured member of another climbing party. He then attempted a second land- ing to pick up Alamichel, but aborted it due to dangerous, windy conditions. The entire party then skied down to Kahiltna Basecamp at 2240 meters, arriving at 2100. On May 14, Alamichel was picked up at Kahiltna Basecamp and flown to Talkeetna, then driven to Providence Hospital. (Source: Clifford Beaver, Ranger, Denali National Park)

Analysis

Alamichel said he left camp cold and an hour later felt nothing in his feet. He interpreted this to mean everything was alright when in fact this is a final warning of deep frostbite and action should be taken to reverse the damage immediately.

He reported wearing boots that were too tight, had wool felt inner boots that tend to accumulate moisture, and was wearing no gaiters. He had climbing bibbs that snapped down around his boot cuffs. (Source: Clifford Beaver, Ranger, Denali National Park)

Analysis

In retrospect, the frostbite victim should have decended to 4300 meters as soon as frostbite was recognized, if that was at all possible. The toes could then have been thawed without any danger of refreezing. Thawing toes at the higher camps was appropriate, since they would have thawed spontaneously anyway in a sleeping bag that night. However, adequate precautions were not taken on the descent two days later to prevent refreezing. The skin temperature measured upon immediate entry into the medical hut was -2 degrees C. Although an air evacuation was called for because this appeared to be a freeze-thaw-refreeze injury, and theoretically more subject to damage from trauma, there appeared to be no further damage due to his descent on skis. This reinforces our experience that patients with frostbite can most often evacuate themselves from the mountain. (Source: Dr. Peter Hackett, Director, Denali Medical Research Project)