Nepalese Mountain Rescue Development Project

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.

One of the key successes of the course was networking. A round table discussion with politicians, local authorities, and officials was held in Thamel, Kathmandu, on May 31, 2013, on the perspectives of a mountain rescue service in Nepal. Despite efforts from different organizations, there is no organized rescue or disaster management system in Nepal. Medical emergencies/urgencies still rely on transport by private vehicles or helicopters with no or minimal medical care. The National Ambulance Services (NAS) is the first initiative to fill this gap, though it is operating only within the Kathmandu valley. Moreover, Nepal lacks a common three-digit phone number such as 911 in the United States. There is consensus that a coordinated network should be established, for example, via a central dispatch center and emergency number supported by subcenters in different parts of the country, and that trained doctors, paramedics, and mountain guides capable of handling SAR operations and disaster situations are needed.

Most of the helicopter rescues still take place in the Khumbu region, making the Pasang Lhamu Nicole Niquille PLNN Hospital in Lukla an ideal staring point to establish the first link in a mountain rescue chain. In December 2013, a pilot project of the Lukla Helicopter Medical Assistance (LUHMA) took place in Bung, a Rai village in a very remote part of the Solukhumbu. This was an initiative of two Swiss partner organizations, the Fondation Nicole Niquille FNN Charmey and Alpine Rescue Foundation ARF Zermatt. 774 patients attended a 2-day medical camp organized by staff from the Lukla hospital in collaboration with the District Health Officer of the Solukhumbu and staff of the health post in Bung. This pilot project is in agreement with the aim of the Nepalese Mountain Rescue Development Project. The project phase between 2015 and 2017, in fact, aims to apply experience from pilot SAR stations in representative mountain areas of Nepal to develop SAR teams in cooperation with all institutions operating in ground and air care in Nepal (e.g., Alpine Rescue Foundation ARF Zermatt, Ecole Nationale de Ski et d'Alpinisme ENSA, Fondation Nicole Niquille FNN Charmey, Pasang Lhamu Nicole Niquille PLNN Hospital, Stanford University), under supervision of the major international societies (ISMM, ICAR, UIAA, WMS).

One important stage of these initiatives will be integrated into the X. World Congress on High Altitude Medicine and Physiology, held from May 25 to 31, 2014, in Bolzano, Italy (www.ismm2014.org). These final discussions will be indicative for the future development of a rescue service in Nepal. There is consensus among stakeholders in Nepal that training in mountain emergency medicine and an organized rescue service serving not only the more developed area of the Khumbu valley but also the remote areas of Nepal are overdue. It is obvious that foreign organizations will continue to offer their experience, but that these initiatives ultimately need competent decision-making by a network of Nepalese authorities, physicians, rescuers, and locals.