HACE AND HAPE

Alaska, Mount McKinley, West Buttress

On June 8, the “AAI-1 -Taylor” expedition arrived at base camp to start their ascent of the West Buttress. The team arrived at the 14,200-foot camp on the evening of June 14, which is very close to the recommended rate of ascent of 1,000 feet per day.

After the first night here, Taylor reported that Michael St. Denis (46) exhibited signs of fatigue and malaise. On May 16, St. Denis spent most of the day in his tent. Around 1730, Taylor noticed that St. Denis was becoming confused and less aware of his surroundings. Recognizing the deteriorating condition of his client, he decided to take St. Denis to the Ranger Camp for an assessment. St. Denis was diagnosed as suffering from both high altitude cerebral edema and high altitude pulmonary edema.

NPS Ranger Gordy Kito, in consultation with NPS volunteer physicians Dr. Jim Freeman and Dr. Jim Sprott, determined that due to the patient’s persistent ataxia, they would not attempt to walk St. Denis down the mountain, as it could take multiple days and that falling because of a loss of balance was inevitable.

St. Denis was evacuated from the 14,200-foot camp to Talkeetna at 1200 on June 18 via the Lama helicopter and then transported to Alaska Regional Hospital in Anchorage.

Analysis

The ability of the guide, Dylan Taylor, to recognize that his client was exhibiting the signs and symptoms of HACE and his quick actions to get him to the Ranger facilities where oxygen was available contributed to the favorable outcome of this incident. Although it is less likely for a climber to be afflicted with HAPE or HACE if they climb at the suggested rate of 1,000 feet per day, it is by no means a guarantee that a person will not suffer from altitude illness. The recommendation of 1,000 feet per day is only a guideline. Everyone will react differently to altitude, even those who have been to altitude previously. Each time someone goes to altitude there is a possibility that he or she will suffer from AMS, HAPE, and/or HACE regardless of past performance at altitude.

It is of some note that those who suffer from HACE may have persistent neurological manifestations that can last for days, weeks, and even months. The fact that these symptoms may persist for extended periods of time must be considered when determining whether or not individuals should be allowed to descend under their own power, with assistance from their team, and when it is appropriate to evacuate them by other means. (Source: Daryl Miller, South District Ranger)