HAPE, ALLOWED TO DESCEND ALONE, POSSIBLE CO POISONING
Alaska, Mount McKinley, West Buttress
The 2008 Ulsam McKinley Expedition, led by Jeong Sang Kim (34) flew onto the glacier on May 1 and climbed to the 14,200-foot camp in eight days. The expedition stayed at the camp waiting for better weather to ascend to the 17,200-foot high camp, and during this time had made at least one carry to the base of the fixed lines at 15,400 feet. The group then made their move to the high camp on May 15. However, Kim felt ill after arriving at the fixed lines and elected to descend while the rest of the expedition continued up. While he was descending solo, he was observed by the NPS patrol stationed at the camp. The patrol noted that he required multiple rest stops while descending and that he could not walk the remaining 200 meters of level ground into the 14,2 00-foot camp without sitting down twice to rest. The patrol ranger and primary medic contacted Kim, and after a brief physical exam discovered that he had an oxygen saturation of 51 percent, the normal for this altitude being approximately 84 to 89 percent. The one abnormality noted was that pulmonary rales were not found during auscultation. Kim was diagnosed as suffering from atypical High Altitude Pulmonary Edema (HAPE) and brought to the medical tent for treatment. While on low flow oxygen via nasal cannula, his oxygen saturation began to fall to the low 40’s. He was immediately placed on high flow oxygen with a non-rebreather mask. Following contact with medical control, he was then administered Diamox and Albuteral. The Incident Command system subsequently was activated and the park helicopter was placed on standby for an evacuation, but poor weather conditions prohibited any evacuation attempt that day. Kim remained in the care of NPS personnel throughout the night and was kept on oxygen. The rest of the Ulsam expedition returned to the 14,200-foot camp the following day and were informed about his condition. Another physical exam was performed to evaluate the possibility of Kim descending with the assistance of his fellow team members, but it was discovered that his saturation level would plummet shortly after being taken off oxygen and not performing any physical exertion. Based on these findings, Kim and another patient were evacuated from the 14,200-foot camp during the evening of May 16 by the NPS Lama helicopter. After being flown to Talkeetna, the two were transferred to a fixed-wing medical evacuation flight for transport to the Alaska Regional Hospital. Kim’s symptoms had resolved and he was released following his examination at the hospital.
Kim was fortunate in that the NPS staff suspected that there was something irregular occurring and undertook an investigation. There is a strong possibility that had he gone to sleep alone in his tent that evening, he could have died. Kim’s medical condition worsened even after being placed on low flow oxygen and necessitated aggressive medical treatment on the part of the NPS patrol to stabilize him. When I went to consult with the expedition leader, I discovered that while the group was cooking outside the tent, they were using a portable isobutane-style stove to heat the interior. They indicated that this was a normal practice and erroneously stated that since it was a single small stove, there wasn’t any danger from it. The expedition had maintained a prudent acclimatization schedule, but the practice of heating their dome tent with a stove put every member at risk of carbon monoxide poisoning and may have contributed to Kim developing HAPE. In addition, splitting the expedition and allowing an ill member to descend by himself could have resulted in Kim’s death by the simple fact that no one would have been aware that he was in respiratory distress. Furthermore, un-roped travel on glaciated terrain is not recommended because of the danger of falling into crevasses. (Source: John A. Loomis, Ranger, Denali National Park)