Sanjaya Karki / Uniklinikum, Leipzig / Germany
Vincent O’Neill / The Tweed Hospital / NSW, Australia
In the aftermath of the earthquakes this year, we at Adventure Medic were dismayed at the quantity of media coverage given to Everest Basecamp and the plight of the mountaineers stuck at Camps 1 and 2 enroute to the summit. The needs of the rest of the country, in particular Gorkha, were far greater and, in our opinion, deserved much more widespread attention. However, as the dust settles, we turn back to the mountains. Dr Sanjaya Karki is a Nepali Emergency Physician who, along with Vince O’Neill, have been battling to establish a Helicopter Emergency Service in the country. In this article, they describe the avalanches triggered by the earthquakes and explains why they believe Nepali HEMS to be a national priority.
‘If you’ve read descriptions of being at the mercy of tumbling snow, you’ve probably figured out that avoidance is the only intelligent approach to avalanches. And a major part of avoidance is making good avalanche predictions. Prediction remains as much art as science’
Professor Edward LaChapelle of the University of Washington, a godfather of avalanche research.
Avalanches
An avalanche, in simple terms, is a snow slip. The deadliest avalanche ever recorded may have occurred more than 2,200 years ago, when Hannibal attempted to march the Carthaginian army across the Alps to conquer Rome with a contingent of three-dozen war elephants at his side. It is thought that roughly 20,000 of his soldiers and 2000 horses were killed by the tumbling snow.
Avalanches are natural processes, comprising three basic phases in three respective zones. An avalanche is triggered when the mechanical stability of a mass of snow is suddenly lost as a break occurs, usually at the area of the slope where the snowpack is most fragile (the starting zone). Next, the mass of snow that has suddenly dislodged flows down the slope with gravity, creating the path of the avalanche. The flow depends on the contours of the slope and the characteristics of the snow mass. Finally, the snow and associated rocks, vegetation and other debris moving with the avalanche eventually come to rest in what is termed in the runout zone.
Deforestation, seismic activity and heavy snowfall are all potent risk factors for avalanches. Earthquakes are an obvious trigger. In general, the risk of an avalanche occurring is at its highest around 24 hours after a snowfall of 12 inches or more. A slope requires a huge volume of snow to produce a significant avalanche, so clearly the winter months are when risk is highest. Most avalanches occur from December to April in the Northern hemisphere, but avalanche fatalities have been recorded in all months of the year. (For more information on avalanches, please see our detailed article from this winter.)
Avalanches on Everest
25 April 2015 is a date that will never be forgotten in Nepal. A 7.9 magnitude earthquake caused the tragic, untimely deaths of more than 8500 people. Many perished in landslips and avalanches triggered by the quake. On Mount Everest alone, 19 people lost their lives.
Sadly, this took place following a year of disasters for the Himalayan kingdom. On 14 October 2014, the effects of Cyclone Hudhud reached Nepal’s Annapurna region – destination for 60% of the country’s trekking and mountaineering visitors – causing severe snowstorms and avalanches that killed 43 people. Months earlier, on 18 April 2014, Nepal suffered the great loss of 16 Sherpa to another avalanche on Mount Everest.
Approximately 359 foreign climbers and 350 local Nepali guides were attempting Everest this year. At any point during peak climbing season, more than 1500 people can inhabit Everest base camp, including climbers, Sherpa guides, porters and other staff. In April, the best month for climbing, more than 1000 people were on or beside Everest when the earthquake struck.
Though the epicenter was approximately 220 kilometers away, the high mountains were shaken hard. Witnesses said the avalanche began on Mount Pumori. Pumori, in Sherpa language is an unmarried daughter, and some climbers refer to it as the ‘Daughter of Everest’. It is a 22,966 ft mountain just a few miles from Base Camp.
The snow then swept through part of the Khumbu Icefall (5500 m – 6100 m) at the head of the Khumbu Glacier. In the Icefall, the melting ice creates passages through the terrain which are constantly moving and shifting. It can move six feet in just a single day and takes about twelve hours to cross. Its dangers are well documented. In 1921, George Mallory turned away from the Icefall stating it was next to impossible to pass through. Safe passage depends on the work of the ‘Icefall Doctors’, a team of highly experienced Sherpas who bridge the crevasses by aluminum ladders and ropes.
On the day of the quake, many of the climbers were at Camp 2 (6500 meters) above the Icefall – they and those at Camp 1 were cut off from Base Camp as the work of the Icefall Doctors was destroyed. Short of food and fuel for warmth but safe, the climbers were subsequently evacuated by helicopter.
Base Camp
From the Icefall, the avalanche swept into South Base Camp. Tons of ice and rock tumbled down, creating a large air blast. Alex Gavan, a climber at Base Camp tweeted “large areas of base camp look like after a nuclear blast. Great desolation. High uncertainty among people.” All nineteen of those who died were in South Base Camp when the snow struck. Among them, Marissa Eve Girawong of Madison Mountaineering, known to many in the expedition community from the Diploma in Mountain Medicine.
The doctors of the Himalayan Rescue Association, and others on the mountain, managed to treat 73 wounded and evacuate them to Kathmandu or Lukla within five hours. One doctor, Rachel Tullet, did so despite suffering a fractured patella and large leg laceration of her own.
The need for HEMS
Helicopters were in hugely high demand following the earthquake and avalanches. Commercial helicopters were used to taxi the injured, but they were not equipped to provide medical care. In Nepal, we need to shift our focus as we rebuild to establish proper helicopter ambulance services. The same landscape responsible for our country’s unparalleled beauty also ensures that landslides, avalanches, floods and earthquakes are a constant and grave threat. Access and evacuation by road will always be a challenge. A HEMS service, capable of providing acute treatment on scene as well as in transit, would be of profound benefit to all who live in or visit the Nepali Himalayas. We must replace the current confusion of medical evacuation with an organised, centrally coordinated medevac service for the remote hill and mountain environments of the country.
Our Sherpa, pioneers of mountain climbing, known in legend as snow leopards in human form, maintain very close ties to the mountains of Nepal. They possess deep local knowledge of the Himalayas and expert skills in navigation and rescue in these mountains. Their skills must be formally incorporated into any future HEMS service if it is to be effective.
The effects of the earthquakes and avalanches of recent years will take a long time to heal. They will happen again. As we recover, we must make development of high-quality emergency medical services and HEMS a national priority. Such services will save many lives, but we fear many more will be lost before these goals are realised.
Cardiff Fundraiser
We’d like to remind readers of the fundraising evening for Nepal on Friday 10 July in Cardiff hosted by the IPPG and the Kendal Mountain Film Festival. It’s going to be a great evening for a very worthy cause.
Photos: NASA / Wikimedia Commons
