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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Risk versus Reward


Much has been written about the sixteen tragic deaths that occurred on Mt. Everest in 1996, including the excellent book Into Thin Air, by John Krakauer. in the most recent climbing year (2006), it appears that there were at least 15 deaths. Unlike 1996, in which 8 climbers died during one tragic storm, there was no single catastrophic event to account for all of these tragedies.

In wilderness medicine, we learn too often about the consequences of encounters with extreme environments. Man’s demise comes not only from sudden, unforeseeable events, like falling into a crevasse, but from more insidious and predictable medical difficulties, such as severe altitude illness. High altitude cerebral edema (excess fluid in the brain) and pulmonary edema (excess fluid in the lungs) are the nemeses of fit and experienced mountaineers, and all too common in inexperienced and under-qualified climbers. These days, it is not enough to climb Mt. Everest – one now seeks to climb for a record or distinction – most number of climbs, fastest climb without oxygen, oldest climber, youngest climber, first amputee climber, first climber from Montana who is a member of the Republican Party and who has graduated from Princeton – you get the picture. It is hard to fathom, but there are persons making summit attempts who have never before climbed another significant peak. In the guiding community, it is no secret that clients are sometimes literally hauled up the mountain for substantial sums of money. The result is, at least in part, that approximately 1 in 20 persons who climb to reach the summit of Mt. Everest perish during the attempt.

Adventurous men and women are entitled to be risk takers, but there is a boundary beyond which risk becomes foolish and perhaps unacceptable. Perhaps we hear too often, “No risk, no reward. No bet, no blue chips. No guts, no glory.” From a strictly medical perspective, it makes no sense to take people who are ill-equipped to encounter hardship at sea level in a controllable urban environment, and put them in a fight for their lives in extreme sub-zero temperatures at altitudes where one cannot survive for long without supplemental oxygen. Furthermore, many of the ill and wounded have never climbed even close to the altitudes at which they encounter misfortune on Mt. Everest. I believe in personal choice, but not when it will unnecessarily lead to limbs and lives lost.

If the climbing community and officials in Nepal and Tibet allow the routes up Mt. Everest to become highways open to anyone with the ability to afford a permit, not with any proven and relevant climbing experience, we can look forward to setting at least one new record on a regular basis – raising the number of persons maimed and killed in the attempt. Ocean divers must be educated, trained, and certified in order to be able to rent scuba tanks. Is it time to promote something comparable for persons who wish to climb extreme peaks?

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photo by Mathias Schar
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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