HAPE, HACE, AND AMS

Wyoming, Grand Teton National Park

While signs and symptoms of AMS are not unusual in the Tetons, it is rare to see HAPE or HACE. During the summer of 2001, four significant altitude- related cases were seen. One was a 14 year old boy scout from Sugar City, ID, who had climbed the Middle and South Tetons from the South Fork of Cascade Canyon on July 24. At 1900, Ranger Jim Springer encountered the group at their campsite in the South Fork. The scout was complaining of headache, nausea, ataxia, and chest pain. Springer was able to hear gurgling in the boy’s chest and surmised that it was HAPE. Springer hiked the boy to lower elevation, and his condition improved as they got lower. They spent the night at the patrol cabin at 8,500 feet, and the gurgling was absent at that elevation.

Two brothers, Mike (24) and Joe (19) Baker, flew in from Pennsylvania on August 17 and immediately set out for a day climb of the Grand Teton. Rangers Jernigan, McConnell, and Vidak were told by a guide that two climbers were having difficulty. One had vomited above the rappel, and they appeared weak. The rangers found the brothers at the Upper Saddle. Joe was curled up on the ground with headache and other AMS symptoms. Mike seemed in worse shape with nausea and weakness. They were escorted to the Lower Saddle where their blood pressures were found to be low. Joe improved with lower elevation, food, and rest. After contacting medical control, Mike was administered two liters of I.V fluids. Their condition improved enough to hike them out to the trailhead.

Caltha Crowe (54) and her husband from Connecticut were backpacking into Hanging Canyon, also on August 17, when she began projectile vomiting. Her husband thought her problem was overheating, so he sat her in the creek. Rangers Jernigan and Larson were flown to their location and felt that the woman should be rapidly evacuated. She was flown with Jernigan to Lupine Meadows, where she was transferred into an ambulance. On the way to town, her condition rapidly deteriorated. She nearly died in the ER. She was diagnosed with HAPE. Her treatment was complicated by the hypothermia resulting from sitting in the stream.

On September 4, Seth Uptain (24) and Todd Lamppa (28) from Casper, WY, set out to attempt a “light and fast” ascent of the East Ridge of the Grand Teton. They camped the night of September 2 at Surprise Lake and began climbing early the next morning. By 1800, they had reached the upper part of the mountain above the Second Tower at about 13,100 feet. Uptain began feeling increasingly ill with a terrible headache and difficulty breathing. They decided to stop for the night since Uptain was having trouble with balance as well as gaining altitude. They set up their tent. Uptain’s condition worsened during the night, and at 0430, Lamppa called park Dispatch with a cell phone to report that Uptain couldn’t stand and that his lungs gurgled noticeably.

Rangers Bywater and Johnson set out from the Lower Saddle with med gear and arrived at 0740. Uptain reported that he had HAPE the previous winter on a ski trip to 11,000 feet. His lungs were wet, but there was no gurgling heard without a stethoscope. He was ataxic. A screamer suit ride to Lupine Meadows was conducted, since the winds at the Lower Saddle weren’t good for landing there. When Uptain arrived at the ambulance, he couldn’t stand, but he refused transport to the hospital since he didn’t have health insurance and he had recovered after three days last winter. An I.V. was started, and he was convinced to go to the hospital. By the time he arrived at the ER, his gurgling chest was quite apparent. He again tried to deny treatment due to costs. After some treatment, he left the hospital.

Analysis

These cases show that it is possible to have serious altitude problems with moderate elevation gains if one is susceptible. They also should reinforce that climbers should listen to their bodies. It is better to go downhill if your condition is GOING downhill rather Othan pushing until you can’t help yourself. At least two of these people would have died if others hadn’t intervened and got them to help at lower elevation. It should also be obvious that climbers need to understand what “light and fast” means. As for health insurance and/or the cost of treatment, one must be aware of the consequences. (Source: Dan Burgette, SAR Ranger, Grand Teton National Park and Jed Williamson)