Sophie Wallace / Emergency and Intensive Care Doctor
Everest ER: Tent City’s Medical Marvel
Sophie Wallace is a British doctor, now living in Australia. A keen mountaineer – she has worked in Africa, South America, Nepal and the Himalayas. Sophie was at Everest Basecamp when the April 18 avalanche struck, killing 16 Sherpas and wounding others. In this moving account, she describes how it was that day – the rescue attempts, the impressive medical response and the grimness of tending to those that were beyond help.
17 April 2014, Everest Basecamp, 5,364m
I didn’t sleep much on the Thursday night, as it happened. It was 17 April and I could hear lots of small avalanches going off all over the valley. They had happened all day too. Indeed, we would often see small avalanches in the higher peaks around Basecamp.
I remember a much louder rumble, just before drifting off to sleep again. However, I was soon reawakened. My radio was by my sleeping bag and it was alive with shouting and frantic communication in Nepali and Sherpa. I don’t think you need to speak a language to pick up the sound of panic.
Our Basecamp Manager came to my tent and asked if I was awake. As soon as that happened, I knew we were in trouble. This was around 0645 on 18 April. I was told initially that there had been an accident in the upper icefall, that one of our Sherpas was trapped and that they were sending a rescue party up.
I started getting some kit out ready to receive him – sending bottles of saline to the kitchen tent for warming, sorting our airway gear and drawing up drugs.
More information started to come in over the airwaves, the first from our climbing guide Ang Dorjee who has summited 17 times. He was translating on the radio and just said “three of our Sherpas gone”.
Gradually more and more numbers started to come through – “four dead”, “six missing”. The radio was so busy with information going up and down the mountain. It soon became clear that this was going to be a major rescue operation.
Rescue
There was no indication about number of survivors but we were being fed information about several awake and critically injured Sherpas who were in the process of being dug out. We decided to send a rescue party up from Basecamp on foot to find those at the bottom of the accident, and to helicopter a rescue team to the top of the accident site.
One of the climbers was a paramedic and had climbed Everest five times so she was the obvious choice to go above the icefall. I gathered a medical kit to send up with her: airways, bandages, morphine drawn up and warmed fluids. Then we arranged one of our dining tents into a field hospital to receive the walking wounded, planning to send anyone critically injured to the Rescue Association tent, as it had better facilities, monitoring and more doctors.
How did the accident happen?
A few days earlier, the Sherpas had started their runs through the icefall to establish Camps I and II above Basecamp. They climb overnight as the icefall moves too much during the warmth of the day. The route through the icefall was planned by the ‘Icefall Doctors’ – those responsible for fixing ropes and ladders over crevasses and up and down the huge leaning towers of ice known as seracs.
The avalanche I had heard the night before had taken out one of the horizontal ladders crossing a large crevasse. The Sherpas arrived to fix this ladder, which is almost at the top of the icefall. The place is known as the ‘popcorn’ field, because it moves so much like the top surface of popcorn in a popcorn machine at the cinema. They were fixing the ladder to ascend and some had managed to get up and beyond, but there was a queue of dozens of Sherpas at this ladder when the avalanche struck.
It came from about 300m above them on the Western Ridge and the impact of the snow on the towering seracs resulted in an absolute catastrophe. There were reports of Sherpas being blasted off the ladder and into the neighbouring crevasse. One cubic metre of ice weighs around one tonne, and these men were being buried under metres and metres of ice blocks the size of trucks, as well as snow from the avalanche. The total height of the disaster area from the lowest buried Sherpa to highest buried Sherpa over two hundred metres in vertical height up the mountain.
From those still alive, furiously digging out the bodies of their colleagues, and from the rescue teams heading up the mountain and in the helicopter, we were told that there were three critically injured, a few walking wounded and the rest were unfortunately going to be body retrievals.
The HRA
The HRA is the Himalayan Rescue Association, a not-for-profit organisation running a yearly clinic at Basecamp with volunteer Nepali and western doctors. The clinic has basic medical equipment including cardiac monitoring and airway kit, an ultrasound machine and resuscitation drugs.
Congregating at the clinic were all the doctors at Basecamp – most had heard about the disaster and come to volunteer. Alongside me were an emergency medicine registrar from Oxford (running the HRA clinic this year), a cardiologist from Quebec, a trauma surgeon from Europe, an orthopod from the US, an emergency medicine doctor from the US, another cardiologist from the US and an anaesthetist from Canada.
We managed to get everyone together and pool our skills to coordinate teams for each patient. Reports came from the mountain that the walking wounded were coming to us soon, so we allocated a scribe, and made wrist bands with patient numbers to keep track. The first five patients we had were fairly minor injuries –some scalp lacerations from falling ice, some chest bruising and minor limb injuries but everyone was fundamentally stable.
Once they had had their treatment, wounds closed up and analgesia they were escorted to our dining tent-cum-field hospital for observation. I left it in charge of a team of first aiders with field experience, and two of our doctors.
The critically ill
By this time, the choppers were circling over the icefield and we had reports that the critical patients were ready to be sent down. It was difficult to know the order in which patients were going to arrive as there were three patients in three different areas. Two were close to a zone that could be cleared for the chopper to land. The other patient was too far down walls of ice and had to be ‘long-lined’, suspended from the bottom of the helicopter and lowered down to us.
We knew that amongst them was a head injury, a confirmed pelvic injury and internal bleeding, and a probable pelvic and thigh fracture but we didn’t know which was which. We allocated a team to each patient.
The first had significant lower limb fractures, was freezing and had his climbing mask on, so we couldn’t see if his breath was fogging the mask, as we could with a clear mask that would indicate a patent airway. He was drowsy and cold having been trapped in ice for several hours. The orthopaedic team began stabilising and splinting while we gave him intravenous fluids, warm water bottles and wrapped him up in a sleeping bag on a spinal board. An ultrasound scan checked for internal bleeding and a nerve block helped manage his pain from the fractures.
The next patient who arrived was from our team, wearing one of our ‘Adventure Consultants’ collars, so that came as a shock. He looked awful with significant chest and back pain. Again he was also freezing cold with wet clothes from having been trapped in ice. He was also given warm IV fluids, warm water bottles and wrapped in a sleeping bag on the spinal board. We did an ultrasound but there was no sign of lung collapse or internal bleeding despite his mechanism of injury and significant levels of pain. His heart rate was 110 and oxygen saturations were 78% (scary low at sea level but at Basecamp most of us only had oxygen saturations of around 80-85% anyway).
Finally, our third and most critically unwell patient arrived. He was long-lined down to us, so the first we knew that he was on his way was when the downdraft of the chopper started to beat on the tent and our voices were drowned out. Our last bed was a camp bed in the middle of the clinic, so we put him there. He was drowsy with blood in his mouth and obvious facial injuries but he was awake enough to talk and answer questions.
The anaesthetist began looking after his airway and the head and facial injuries and we cut him out of his wet down suit, got a drip in, gave morphine and performed an abdominal ultrasound. He had bruising all across his lower abdomen from where the harness had stopped his fall, just like a seatbelt injury in a car crash. We managed to get him packaged up and out on the first chopper to Kathmandu, wrapped up in a sleeping bag with hot water in drinking bottles for warmth and on a spinal board. It goes against all the rules of retrieval in the western world to transfer an unstable trauma patient with no medical escort but we just needed to get them fast to hospital. They were 20 minutes from Lukla hospital and a further 25 minutes from Kathmandu. That was where they needed to be, not in a tent on a mountain.
The bodies
Possibly the most depressing sight of all is that of a young Sherpa being suspended 60m from the bottom of a helicopter, flown across the valley in full view of everyone at basecamp and lowered down onto a helipad to the makeshift mortuary. Twelve times. The lower helipad (there are three helipads at basecamp) was allocated to the bodies, as we knew there were going to be many and also that not all of them had yet been identified.
Just watching the lifeless bodies hanging from below the chopper, still with their helmets and crampons broke my heart. The bodies were lowered onto the helipad, then our job was to give each a number written on duct tape and stuck onto them, to document clothing and any obvious injuries and to confirm death. We initially thought that confirming death in profoundly hypothermic patients might pose some problems, but the extent of some of their injuries made it depressingly easy.
We received all bodies from the long-line onto a tarpaulin sheet and each was covered up. Then came the next step of getting climbing teams to identify everyone. The crowd was huge and it was so difficult to get teams in to identify people one at a time. We knew we couldn’t make mistakes and had to make sure each body was identified and returned to their teams and their families. Three of the dead were from our team, one of whom I had been getting to know. I didn’t realise it was him when I took off his buff to show our head guide so that was particularly upsetting.
Each body came with their face covered by the buff that we all used to keep the wind off our faces. All our team had been allocated matching “Adventure Consultants” buffs at the beginning of our trip so there was no doubt who was from our team. Some of them still had their climbing boots on, and crampons. Some were missing helmets and boots. Out of the three Sherpa we lost, one had a newborn baby girl, one had two young children and one looked after his three year old and five year old sisters after losing their parents.
Eventually, all their bodies were identified and wrapped up in individual tarpaulin bags ready for the chopper to take them down to the village. The chopper took them two at a time. Each time the chopper took off there was a huge downdraft, which risked blowing off all the tarpaulins and exposing the bodies. The only solution was to lie across all the dead when the helicopter was taking off.
Back in camp
At last, the helicopter made its final trip and I started walking back to camp with the other doctors. On the way were two of our clients, coming towards us with tea and chocolates. I didn’t realise that it was already 3pm – we had been full steam ahead since 0630. They poured me a cup of tea and I just burst into tears. I hadn’t realised how exhausted I was but I hadn’t eaten or drunk anything since the night before. I had been rushing between the HRA clinic, our camp and the helipad, all at 5400m altitude.
When we got back to camp, I had to change my top as I had blood on my clothes from moving the bodies. There was still more to discuss as four dead remained on the mountain. The location of one was known – he had been identified from one of his legs sticking out above the ice, upside down on a fixed line. They had tried to get him out during the day but could only move the one leg, the other was too deeply buried. They had had to abandon retrieval on the day of the accident because it was getting too warm and too dangerous for people to linger in the icefall.
The following morning, a large rescue team was sent up once more via helicopter to the accident site to try to retrieve his body and to look for the other three. Some were saying they had seen packs in the ice but they were unable to find a body attached to them. Despite the best efforts of the rescue team in a dangerous environment, those three were never found. Nobody knew where they were, or how deeply they were buried.
Reflections
The arrangement and allocation of resources for the rescue and retrieval was impressive. The team consisted of a mixture of Nepali and Western guides. Together, they were the rescue team, diggers, coordinators high up the mountain, coordinators at Basecamp and on the helipad, and managed ropes, choppers and shovels. The mutual respect between the western and Nepali guides, for their climbing skills, compassion and professionalism was evident for all to see. Guides from all teams on the mountain united to get the job done as safely and respectfully as possible. There have been reports in the media of problems and friction escalating at Basecamp but in all honesty, having remained at Basecamp with our team for another two weeks after the accident, I saw no aggression at all.
The climbing season this year on Everest came to a premature end. Many of the teams who lost Sherpas were large organisations, which normally contribute hugely to the preparation of the mountain for climbing. Many of the Sherpas who were involved in the accident and the rescue were not prepared to go through the icefall again, primarily out of respect for the souls of the friends and brothers they lost that day. I think many also didn’t want to see the blood and personal items at the accident scene again.
As more began pulling out it had a cascade effect on the rest of the climbing teams, and eventually everyone realised that to continue to climb would not only be disrespectful to the decision the Sherpas had made, but also impractical. The lack of support remaining on the mountain would also put even more people at an unacceptable level of risk.
An accident like this clearly demonstrates what the Sherpas have to go through as part of their job. They make multiple journeys through the icefall, carrying heavy gear to set up the higher camps for the climbing clients. Typically, they might do this up to twenty times per season, compared to six for clients. They have high accident and mortality rates and are considered to have one of the most dangerous jobs in the world.
Despite this, the government payout in the event of their death is pitiful and barely covers their funeral expenses. After pressure from a number of organisations including the Juniper Fund this year’s life insurance payout was more than doubled to approximately 10,000 USD, in addition to payments from the ministry of tourism, the Nepal Mountaineering Association and the Expedition Operators Association of around 1,650 USD.
The Sherpas are well-respected by those who have had the honour of climbing with them, and just like other experienced climbers they know the risks of the icefall. Nevertheless their working conditions and insurance must improve. All companies must buy the minimum mandatory level of insurance for their employees. Adventure Consultants purchased the highest level of insurance and also matched the government payout for each family, and will provide ongoing assistance to the dependents of those who are gone. However, many other families have been left unsupported with small children.
The events of 18 April will have a lasting effect on the climbing world. It is still unclear what will happen on Everest next season, in particular whether proposals to minimise the number of passes through the icefall will be upheld. Everest will continue to seduce climbers and without the climbing industry Nepal has little else to generate income in that region. The Sherpa people depend on the mountain for their economy. Indeed, a Sherpa can earn over six times the average annual national income in just three months. In many cases, they are experienced, respected climbers making an informed choice about their job. They are not exploited. All of us know the danger of the icefall. However, that is of no comfort to the sixteen families and twenty-eight children who lost someone that day.
The Sherpas who lost their lives were: Mingma Nuru Sherpa, Dorji Sherpa, Ang Tshiri Sherpa, Nima Sherpa, Phurba Ongyal Sherpa, Lakpa Tenjing Sherpa, Chiring Ongchu Sherpa, Dorjee Khatri, Then Dorjee Sherpa, Phur Temba Sherpa, Pasang Karma Sherpa, Asman Tamang, Tenzing Chottar Sherpa, Ankaji Sherpa, Pem Tenji Sherpa and Ash Bahadur Gurung.
To help the families of Sherpas killed in the mountains all over Nepal, not just those from April 18th, please visit the Juniper Fund. They have a financial programme that gives assistance, spread over a four year period, helping families to get back on their feet and to manage education and living expenses. The Juniper Fund also continues to campaign for better working conditions and insurance for Sherpas and to educate clients about the working conditions of those who will be helping them climb.
