HAPE, HACE, FROSTBITE

Alaska, Mount McKinley

On May 22, 1991, Korean Kim Hongbim (32), who was camped at Denali Pass at 18,200 feet on the West Buttress Route on Mount McKinley, became seriously ill with severe AMS and high altitude pulmonary edema. Hongbim was lowered to the 17,200 foot camps by other climbers high on the mountain. On May 23, Hongbim was lowered down the Rescue Gully to 14,200 feet by the pararescue team of the 210th Air National Guard, assisted by rangers and other climbers at the 14,200 foot camp. On May 24, Hongbim was airlifted from 14,200 feet by an Air National Guard Pavehawk helicopter. He suffered from severe frostbite to both hands and pneumonia complicated by high altitude pulmonary edema. In a related incident on May 23, Geo Bong Kim (35) of the Korean Mokpo University Expedition, became seriously ill with high altitude cerebral edema while camped at 17,200 feet on the West Buttress. Kim was lowered down the Rescue Gully to 14,200 feet by members of his own expedition. On May 25, Kim’s condition remained critical and a ground evacuation was determined not feasible. He was airlifted from 14,200 feet by the NPS Lama helicopter.

Analysis

On May 14, Kim Hongbim and Lee Kyuhan landed in the southeast fork of the Kahilt- na to begin their climb of the West Buttress route. A short time after this (it is not know on exactly what day), Lee Kyuhan flew back out and left the area. Kim Hongbim continued on up the West Buttress and reached the 14,200 foot level in three to four days. According to members of the Mokpo University Expedition, Kim reached Denali Pass (18,200 feet) sometime around the 19th. For some unknown reason he stayed there for at least three nights using the tent that had been abandoned by the Koreans who had been rescued the week before. Kim deteriorated during this time and refused attempts by others to persuade him to descend. By the 21st he was vomiting and unable to eat. Rescue efforts began on May 22 and continued through May 24 and involved many people and several different expeditions.

Although unusual, the time of four to five days to Denali Pass is not unheard of in today’s “lightweight and fast” alpine style of climbing. Both factors, however, must be present for this equation to work. Slowing down, hanging out and camping at altitudes that one is unacclimatized to for extended periods of time can be a very dangerous proposition. Furthermore, failure to recognize symptoms of AMS and the beginnings of HACE and HAPE by the solo climber, and then choosing to do nothing about it, is usually a fatal error. Perhaps “summit fever” was the driving force that led to this accident and subsequent rescue, but the question of why so long a stay at Denali Pass when the 17,200 foot camp and, for that matter, the 14,200 foot camp are such a short distance away remains unanswered.

It is unfortunate that Kim Hongbim suffered such frostbite to his hands (most probably) while being lowered down the rescue gully during that long night. The amount of tension through his chest harness, the extended exposure to extremely adverse weather conditions, and the language barrier which severely hampered communications were all contributing factors.

In the situation in the related incident with Geo Bong Kim, we again see a clear example of an individual ignoring the obvious warning signs of AMS and then a continued, extended stay at an altitude to which he is unacclimatized. This can, and usually does, result in further physiological changes that can be fatal. The Mokpo University group took a relatively slow rate of ascent to reach the 17,200 foot camp. For some reason, however, Mr. Geo Bong Kim was not yet ready to tolerate that altitude and should have descended. (Source: Reynold Jackson, Mountaineering Ranger, Denali National Park)

Medical Analysis

The timely actions of generous climbers saved the life of Mr. Kim Hongbim. The rapidity of his ascent, his symptoms and vital signs were classic for pulmonary and cerebral edema; he was also dehydrated. With ideal circumstances, the patient would have been lowered with his arms inside the bag, no tension on his chest, and on supplemental oxygen. Chemical heating devices can also help prevent frostbite in these climbers who are already compromised. Use of intravenous fluids in high altitude pulmonary edema is problematic. Untreated HAPE could be made worse by aggressive fluid administration. A victim on oxygen or after descent has lower pulmonary artery pressure and less pulmonary leak, and can therefore handle fluids more safely. Kim Hongbim had a difficult hospital course, ended up losing all his fingers, and nearly died from complications. This could have been avoided had sufficient pressure been applied or the initiative taken by other climbers to force him down (even if he had to

be carried down) from his high camp at 18,200 feet, where he was steadily deteriorating. One can assume that brain hypoxia had impaired his judgment; he needed help, probably even the first night at Denali Pass. Although a solo climber who can’t speak English is very difficult to evaluate, a simple heel-to-toe walking test at any time during those three days probably would have been abnormal (positive for ataxia) and therefore indicated immediate descent.

Despite a reasonable rate of ascent, climber Geo Bong Kim developed pulmonary and cerebral edema at the 17,200 foot level. Edema of his face and headache were early warning signs that were apparently ignored. Oxygen was not available at the camp, and this victim nearly died. Fortunately, his group was able to lower him, without physical exertion on his part. At the hospital, x-rays confirmed pulmonary edema and magnetic resonance imaging also revealed edema of the brain. Unless one is training for a Himalayan climb or doing a traverse of the mountain, camping above 17,200 feet is to be strongly discouraged. (Source: Dr. Peter Hackett)