Safety Information for Kilimanjaro Travelers
Supplemental Emergency Oxygen On Mount Kilimanjaro
Our guides are well trained and experienced to administer supplemental emergency oxygen to sufferers from rare complications of Acute Mountain Sickness (AMS) who may develop High Altitude Cerebral Edema (HACE), a potentially fatal swelling of brain tissue as a result of poor acclimatization, resulting in confusion, paralysis and coma if unrelieved.
AMS is the way your body tells you to go back down the mountain (read more on how to avoid or minimize it). You have over-extended and over-welcomed yourself on the shinning mountain. Headache and nausea warn that your systems are shutting down and trekking any higher will put your life in danger. Most effects of altitude sickness can be dealt with by simply descending a few hundred feet to more comfortable conditions and resting, but HACE symptoms are not so easily relieved.
Evacuation is essential, since after effects can persist for days or weeks depending on their severity. Your body produces extra red blood corpuscles at altitude to enable your blood to carry more oxygen to the brain, but this process takes a few days and is halted as soon as more oxygen becomes available.
After using supplementary oxygen, you must not attempt to hike higher. Although it relieves breathing difficulty and oxygen starvation, it reverses acclimatization changes. Supplementary oxygen is routinely carried only for emergency treatment and not as an aid to climbers who wish to continue to the summit. It would be a very dangerous practice. There is no way of avoiding some discomfort on the mountain, even if everyone who climbed wore heated, pressurized kits and oxygen masks. And where would be the pleasure in your Kilimanjaro climb then? The best safety insurance on Kilimanjaro climb is our guides, who will monitor you for AMS and avoid potential complications by getting you off the mountain if your condition becomes threatening. We advise trekkers to take an extra day acclimatizing on Kilimanjaro to make summit success more likely and allow you to avoid the worst effects of Altitude Sickness.
Pulse Oximeter on Mount Kilimanjaro
A pulse oximeter is a tiny clip which fits over a finger, shining light into the tissue to measure the color of reflected light and estimate the amount of oxygen in the blood. It can subtly aid the diagnosis of altitude sickness on a Kilimanjaro climbing challenge. Oxygen is carried by red blood cells, the color determined by the percentage of oxygen they contain. Bright scarlet blood is oxygen rich as it leaves the lungs and becomes a dark, burgundy color when the oxygen is used up and replaced by carbon dioxide, which is exchanged for more oxygen when it goes back to the lungs. Altitude sickness occurs when less oxygen is obtained from the lungs and arterial blood is darker in hue. Acclimatization increases the number of red blood cells available, enabling more oxygen to be carried. The redness of the blood tells you the level of oxygen saturation, from which you can judge the amount available to the trekker. However, these readings are very difficult to assess and vary from one individual to another especially at a high altitude environment.
A high reading of SpO2 could indicate very good acclimatization, or that the person is hyperventilating from anxiety, or even that he has carbon monoxide poisoning! A lower reading could demonstrate anoxia, oxygen starvation, or it could show that a person is coping very well with altitude. A trained athlete with 65% oxygen saturation may be perfectly safe, whilst a less fit trekker could still be at risk for hypoxemia at 75%. The real purpose of a pulse oximeter is to correlate heartbeat and oxygen saturation in a clinical environment for someone suffering from sleep apnea, heart attack or failure, pneumonia, anaemia and asthma. On a climbing excursion on Kilimanjaro mountain, it makes more sense to rely on your AMS symptoms and your guide to decide if you can safely continue your climb, or if you should return to a lower elevation. We advise trekkers to take an extra day acclimatizing on Kilimanjaro to make summit success more likely and allow you to avoid the worst effects of Altitude Sickness.
About Diamox On Mount Kilimanjaro
Acetazolamide, or what is commonly sold under the trade name Diamox, is a drug that is used for various medical treatments – including glaucoma, sleep apnea, epilepsy and hypertension. It is also used to help mitigate the effects of altitude sickness.
Using Diamox on Kilimanjaro is a question you are going to face when you start your preparations to reach the Roof of Africa.
What is Diamox?
Diamox (aka Acetazolamide), as it is used for Acute Mountain Sickness (AMS), is a diuretic (i.e. it promotes the production of urine) and a prophylactic (i.e. is used as a preventative medicine – not a cure).
It is also a carbonic anhydrase inhibitor (ahem, what?). Essentially this means that it promotes the excretion, via urine, of bicarbonate – which is why it is useful for altitude sickness.
Diamox and altitude sickness
The excretion of bicarbonate increases the acidity of the blood, as bicarbonate is a conjugate base of carbonic acid. Increased acidity in the blood is equated by our bodies as increased CO2. The body responds to the imaginary excess CO2 by breathing deeper and faster to get rid of the CO2. Deeper, faster breathing increases the amount of oxygen received by the blood. This helps with the acclimatisation process and helps prevent the onset of AMS symptoms.
Obviously you should first consult your doctor to check whether Diamox is a suitable drug given your particular medical history. It is not suitable for pregnant women or anyone with kidney or liver disease issues (obviously these people shouldn’t be climbing Kilimanjaro in the first place)
We recommend taking Diamox for 2-3 days 2 weeks before departure to test whether you experience any side effects.
Typical side effects associated with Diamox are:
*Frequent urination – everyone experiences this when taking Diamox. It can result in the development of kidney stones so it is important that you drink loads of fluids whilst taking the medication.
*Numbness and tingling in the fingers, toes and face – Many people experience this side effect when taking Diamox. The sensation is a little discomforting but not dangerous
*Taste alterations (some foods might taste weird)
- *Nausea, vomiting and diarrhea – this is rare. These side effects should be identified during your test before departing for Kilimanjaro. Unfortunately these side effects are common with AMS and therefore can easily be misdiagnosed as AMS
- *Drowsiness and confusion is also possible – again these side effects can be confused with AMS
Typically Diamox comes in 250mg tablets. Most people take half a tablet in the morning and half in the evening. You should start taking tablets one day before arriving in Kilimanjaro and continue taking the same dosage for all ascent days. You can cease taking Diamox on descent.
Is Gamow Bag Necessary on Kilimanjaro?
A hyperbaric chamber is a sealable pressure vessel large enough for one adult to enter and stretch out, where he or she can be supplied with oxygen under pressure. The Portable Altitude Chamber, PAC, was designed to treat severe altitude sickness when immediate descent - the preferred treatment is not possible. It is inflated by a foot pump to simulate conditions of greater air pressure at lower altitude for sufferers from Acute Mountain Sickness, AMS. It is unwieldy to move, claustrophobic to experience and needs constant pumping to maintain pressure as it is not air snug.
The Gamow Bag is only recommended at very high altitudes such as on Everest, or staying at Crater Camp on Mount Kilimanjaro where fast and immediate descent is not feasible. But on climbing Mount Kilimanjaro it rarely takes more than an hour to find relief at lower levels except from Crater Camp, where the Gamow Bags should be standard equipment. One should never attempt to hike higher once symptoms arise on a Kilimanjaro trek as they can swiftly develop into High Altitude Pulmonary Edema, HAPE, where lungs are fluid congested and it is necessary to administer extra oxygen through a face mask. This is not possible in a Gamow bag. The other form of severe AMS is High Altitude Cerebral Edema, HACE, which manifests rapidly and is potentially fatal if descent is delayed. Symptoms are slurred speech, blindness, paralysis and coma. Rather than relying on a Gamow Bag on Kilimanjaro climbs, you can depend on our highly experienced guides to identify the severity of the problem and get you down fast and safely. We advise trekkers to take an extra day acclimatizing on Kilimanjaro to make summit success more likely and allow you to avoid the worst effects of Altitude Sickness.
About Malaria & Prevention
Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria.
- Malaria precautions are essential in all areas below 1800m, all year round.
- Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
- Check with your doctor or nurse about suitable antimalarial tablets.
- Atovaquone/proguanil OR Doxycycline (doxycyl 100) OR mefloquine is usually recommended.
- If you have been travelling in a malarious area and develop a fever seek medical attention promptly. Remember malaria can develop even up to one year after exposure.
- If travelling to high risk malarious areas, remote from medical facilities, carrying emergency malaria standby treatment may be considered.
Common Simple Problems During Your Kilimanjaro Trekking
A common outdoor complaint, headaches have three general courses: 1) dehydration, 2) muscular tension, and 3) a vascular disorder. Most headaches respond to rest, hydration, massage and over-the-counter painkillers, e.g. ibuprofen. Beware of the headache that comes on suddenly, is unrelieved by rest and medication, and it not like any other headache you have ever had.
Lean the patient forward and pinch the meaty part of the nose firmly shut. Hold it for 10 to 15 minutes. If bleeding persists, a squirt of a nose spray, such as Afrin, may help stop the bleeding. If the bleeding still persists, pack the nostrils gently with gauze soaked with antibiotic ointment or a spray such as Afrin. It is possible for noses to bleed from the back, and blood runs down the throat.
Six to twelve hours after overexposure to the sun’s radiation, the patient complains of pain and swelling in the eye with a feeling like an “eye full of sand”. The cornea of the eye has been sunburned. Sunburned eyes are usually very sensitive to light. Rinses with cool water will clean the eye and ease the pain. Cool compresses may be applied for pain. A small amount of antibiotic ointment may be applied several times a day for two to three days. Ointments made for the eye are best. The patient’s eyes may need to be covered for 24 hours. Snow blindness almost always resolves harmlessly in 24 to 48 hours. Prolonged discomfort is reason to see a physician. The problem can be prevented by water; sunglasses should fit well and have side-shields to block reflected UV light.
The immediate response to overexposure to ultraviolet light is burned skin aging and degenerative skin disorders such as a cancer. First aid for sunburn includes cooling the skin, applying a moisturizer, ibuprofen for pain and inflammation, and staying out of direct sunlight. If blisters form, a doctor should be consulted. Prevention of sunburn includes hats with brims and tightly-woven clothing, sun blocks such as zinc oxide, and sunscreens with a high sun protection factor-SPF 15 or more. Be aware: You can burn on cloudy days, sunlight is most harmful between the hours of 10AM and 3PM, sunlight is most harmful between the hours of 10am and 3pm, and large amounts of UV light are reflected by snow and water.
The backcountry is home to a multitude of diarrhea-causing life forms: protozoa, bacteria, viruses. They will produce, generally speaking, one of two kinds of diarrhea:
1). Non-invasive diarrhea, with microbial colonies on upper small intestine walls, leading to abdominal cramping, nausea, vomiting, and massive amounts of water, filled with salt and potassium, rushing out of the bowels. 2). Invasive diarrhea, sometimes called dysentery, with bacteria attacking the lower small intestine and colon, causing inflammation, bloody bowel movements, fever, abdominal cramping, and painful release of loose stools.
Whatever the cause, dehydration is the immediate problem with diarrhea. Mild diarrhea can be treated with water or diluted fruit juices or diluted sports drinks. Persistent diarrhea requires more aggressive replacement of electrolytes lost in the stool. Oral dehydration solutions are best for treating serious diarrhea. You can get by, usually, adding one tsp. salt and eight tsp. sugar to a liter of water. The patient should drink about one-fourth of this solution every hour, along with all the water he or she will tolerate. Rice, grains, bananas, potatoes are OK to eat. Fats, dairy products, caffeine and alcohol should be avoided.
Over-the-counter medications for watery diarrhea are available. Prescription medications include Lomotil. Dysentery should be treated with antibiotics, not medicinal plugs.
Water is easily and quickly lost from the body in the outdoors through sweating, urination, defecation, breathings, and diarrhea. Even mild dehydration causes loss of energy, loss of mental acuity, and loss of fun. Mild dehydration shows up as thirst, dry mouth and dark urine. Moderate dehydration adds very dry mouth, reduction of the amount of dark urine, a rapid weak pulse, and remarkable dizziness when the patient stands up. Severe dehydration very very dry mouth, lack of urine, and chock. Treatment of dehydration is explained above (see Diarrhea). Prevention is this: Drink half-liter every morning. Drink a quarter-liter every 15 to 20 minutes during periods of exercise. Drink enough to keep you urine clear.