Nepalese Mountain Rescue Development Project

Abstract

On May 29, 1953, the Sherpa guide Tenzing Norgay and New Zealand’s Edmund Hillary summited Earth’s highest mountain. Sixty years later, an anniversary in Kathmandu brought together alpinists, government ministries, mountaineers, and locals; but somewhat contrary to the celebration, the press coverage was fixated on the question ‘‘How to fix the mess at the top of the world’’ ( Jenkins, 2013). The Federal Democratic Republic of Nepal is constituted geographically by expansive mountain, remote hilly areas, and plains. Nepal, with the world’s highest peaks in its backyard, is inevitably an attraction for trekkers, climbers, pilgrims, and researchers from all around the world. Local inhabitants also have to face the mountainous environment in their daily life. Different reports have investigated injuries and illness related to environmental, geographical, and logistical factors in inhabitants and visitors (Basnyat et al., 1999; 2000; Gaillard et al., 2004; Newcomb et al., 2011; Macinnis et al., 2013). The difficult terrain, extreme high altitude, and lack of an organized rescue system or trained search and rescue (SAR) services remain an open issue in Nepal. As early as 2008, the International Commission of Alpine Rescue (ICAR) had started discussing remote rescue operations and evacuations from extreme altitude. The Swiss helicopter company Air Zermatt provided evidence that rescue operations are technically possible up to altitudes above 7000 m, and Nepalese pilots and rescuers have received general training in collaboration with the Nepalese helicopter companies Fishtail and Simrik since 2009. However, rescue flights from these ranges are highly debated due to the inherent hazard for aircrafts, staff, and patients. Pilot Sabin Basnyat and rescuer Phurna Awale died in a helicopter accident at Ama Dablam in 2010, but the training project was continued, and three helicopter pilots and 15 rescuers attended a series of specialized rescue training in Nepal and Switzerland. At the International Mountain Summit in 2010 in Bressanone, Italy, experts discussed the ethical aspects of transport flights to and from base or higher camps that are not medically justified (Shan and Houston, 1989; Drew et al., 2011) and the potential discrimination against local people. This meeting led to a consensus statement on helicopter rescue at extreme altitude. The EURAC Institute of Mountain Emergency Medicine initiated a project in 2011 in collaboration with the Mountain Rescue Services of South Tyrol, International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Himalayan Rescue Association (HRA), and Mountain Medicine Society of Nepal (MMSN) to develop a core team of technically and medically trained mountain rescuers and physicians who together would strive for a system of mountain safety and rescue in the Nepalese Himalayas. The project was funded by the Government of the Autonomous Province of South Tyrol and the company SALEWA in Italy. After careful selection, ten Nepalese mountain rescuers and ten young physicians from different regions in Nepal were invited in 2012 to attend a 2-week course led by emergency medicine physicians of the ICAR MEDCOM and mountain rescue service of South Tyrol. The training programme was based on the internationally recognized UIAA/ICAR/ISMM Diploma in Mountain Emergency Medicine (http://www .theuiaa.org/mountain_medicine.html) with some aspects tailored to a Nepalese context. In 2013, the same group of technical and medical instructors travelled to Nepal to give a comprehensive 2-week course in mountain rescue techniques and medical treatment. The course included theoretical aspects of mountain medicine, rescue operations at Pasang Lhamu Mountaineering Foundation, and technical skills related to mountain rescue in the Nagarjun National Park. Particular attention was devoted to the perspective of a combined terrestrial and helicopter mountain rescue service in Nepal, highlighting the special aspects of ground and helicopter rescue at high altitude, and the importance of alert systems, dispatching, and a rescue chain in remote areas. Simulated scenarios were followed by in-field application of these scenarios so that participants could experience a range of plausible issues: meteorological challenges with an incoming monsoon, single and multiple victim scenarios, role allocation for a team leader, and medical/technical personnel (Strapazzon et al., 2011). The final training day involved a large-scale simulated rescue operation to test the group’s teamwork, decision-making, leadership, coordination, and communication skills in disaster/crisis management.