Four intermediate mountaineers ascended the South Fork of Big Pine Creek on August 30 to do some alpine climbing. They camped at Elinore Lake (about 11,000 feet), and on August 31 they headed up Scimitar Pass with the intention of climbing Mt. Sill. One of the team members, Robert Gertz (28), mentioned feeling like “there was ice in my lungs.” He reported no other symptoms. The group made it to about 13,200 feet and then turned around due to time constraints. That night they camped at Elinore Lake. Robert found it harder and harder to breathe as the night progressed and began coughing up brownish mucus.

After a sleepless night, team member Michael Colby hiked up to a high point where there was cell service and called 911. He informed the Inyo County Sheriff’s Office of Robert’s condition, and was told the party should help the patient descend and continue to monitor him. That day the group made it only two miles, and this took 10 hours as the patient’s condition deteriorated.

Inyo County Search and Rescue was called to action early on the morning of September 2. Robert had reached a critical stage and could no longer move without extreme and dangerous effort.

Two rescuers started out immediately and requested helicopter assistance due to the patient’s serious and worsening condition. A California Highway Patrol helicopter arrived soon afterward and searched for a landing zone while the rescue team, comprised of two Wilderness EMTs, assessed the patient. Robert was prone with his head elevated on a log. His blood pressure, heart rate, skin color, pupils, lung sounds, and level of consciousness were not alarming. However, he could not speak even a word without severe respiratory distress. No oxygen saturation measurement was obtained on scene. He was placed on 15 liters per minute of oxygen via a non-rebreather mask. Focus then shifted to the pending helicopter extraction.

The helicopter was able to land within 50 feet of the scene. Even so, in Robert’s weakened state it took him about 15 minutes to walk to the helicopter, pausing and even sitting down to rest every few steps. The effort of stepping up into the cockpit was colossal for the patient. He was immediately flown to a rendezvous with an ambulance on the valley floor. In the ambulance, after descending to 4,000 feet and with at least 45 minutes of high-flow oxygen, his O2 saturation was still around 60 percent. (Normal O2 saturation levels are above 90 percent.) Robert was transported to Northern Inyo Hospital, where he was diagnosed with severe high altitude pulmonary edema (HAPE) and given treatment. He has since made a full recovery.

Analysis

What’s striking about this accident is that, despite the team’s substantial preparation and knowledge, little could have been done to prevent it. The party was experienced and had been climbing conservatively. They began descending immediately after the onset of symptoms and called 911 nearly as quickly. The patient pushed himself to his physical limit trying to get down. When he hit that limit, his friends pushed themselves to theirs in the attempt to help him. By the time rescuers found the group, Robert and his partners had given up hope of getting him out unassisted. The patient’s pants were completely shredded from the waist to the knees from his struggle to descend over sharp talus after he could no longer walk. The rescue team and helicopter arrived just in time, and Robert’s friends were truly heroic in their efforts to assist him to a lower elevation. (Source: Edited from a report by Julie Vargo, Ariana Wylie, and Paul Rasmussen, Inyo County Sheriff’s Posse SAR.)

(Editor’s note: This narrative is presented to remind us that AMS, HAPE, and HACE can happen at relatively low elevations and can be difficult to alleviate.)