For the first time in Nepal, disparate practices for altitude sickness aid have been consolidated into a single document, which is mandatory for medical posts on tourist routes. The new standards were adopted under the Public Health Service Act of 2018. For travelers, this means more predictable assistance at high altitudes, but also stricter requirements for their own acclimatization.
The document divides altitude sickness into three diagnoses. Acute Mountain Sickness (AMS) manifests within the first two days after ascent with headache, nausea, weakness, and sleep disturbances. High-Altitude Pulmonary Edema (HAPE) is a severe condition with shortness of breath at rest, a cough with frothy or bloody sputum, and bluish skin. High-Altitude Cerebral Edema (HACE) involves severe headache, loss of balance, confusion, and loss of consciousness. A specific course of action is prescribed for each condition.
Ascent Rules: Slower Than You Think
The standards codify rules that were previously followed mainly by instructors. Above 2,500 meters, the altitude gain between overnight stays should not exceed 300–500 meters. After every kilometer of ascent, it is recommended to spend two nights at the same altitude. The "climb high, sleep low" principle is cited as preferable.
Travelers are instructed to drink 3–4 liters of fluid per day, eat a high-carbohydrate diet, and abstain from alcohol and tobacco at high altitudes. At the first symptoms of illness, they should inform their companions and stop ascending.
Descent as the Main Cure
The document names descent as the most effective treatment method. If rest does not help, the person must be brought down 500–1,000 meters. Oxygen or a portable hyperbaric chamber—a Gamow bag, in which pressure is artificially increased—can be used during this process.
For a mild form of mountain sickness (AMS), rest and acetazolamide are sufficient; continuing the ascent is not permitted. For pulmonary edema (HAPE), oxygen, nifedipine, a Gamow bag, descent, and urgent evacuation are required. For cerebral edema (HACE), oxygen, dexamethasone, a Gamow bag, descent, and emergency evacuation are necessary.
What Medical Posts Must Now Have
According to the new standards, medical facilities in high-altitude areas are required to have a supply of oxygen cylinders or concentrators, Gamow bags, pulse oximeters to measure blood oxygen levels, blood pressure monitors, stethoscopes, thermometers, nebulizers for inhalation, electrocardiographs, and a set of emergency medications, including acetazolamide, dexamethasone, and nifedipine.
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