Important points to cosider while analyzing the deaths of climbers on Mt Everes !
Dear Editor,
I read the article “Mortality on Mount Everest, 1921-2006:
descriptive study” by Paul G Firth(1) et al with great interest. The
retrospective analysis of all the deaths in 1921-2006 is definitely a
commendable job but the descriptive study has failed to address some of
the extremely important points regarding the deaths of climbers, settings
and clinical consideration.
It is important to mention whether the death was more among those who
were making first attempt or subsequent attempts to Everest. How about the
medications used by the climbers? Some climbers might be using
dexamethasone(2).
The summit bid starts at midnight which may be one of the confounding
factors for the death while climbing and should be considered. Similarly,
crowded climbing and delaying in summit bid should also be considered as
delayed summiting has been correlated.
The ataxia, how was it considered? It is important to mention that
climbers are in crampon, roped and with oxygen cylinder and mask with all
gloves and clothing. The ataxia cannot be argued or labeled unless there
is Rhomberg’s or sharpened Rhomberg’s test done.
The most importantly, the authors have forgotten to consider ‘high
altitude deterioration’(3) as an important factor to cause death to such
extreme altitudes with the longer time of exposure. The authors go further
ahead and prematurely come to speculate that headache, nausea and vomiting
not being heralds of high altitude cerebral edema at extreme altitudes.
Thank You!
Dr Matiram Pun, Secretary of Mountain Medicine Society of Nepal
(MMSN)
References:
1. Firth PG et al. Mortality on Mount Everest, 1921-2006: descriptive
study. BMJ 2008;337:a2654
2. Schoene RB. Dexamethasone: By Safe Means, by Fair Means. High Alt Med
Bio 2005; 6 (4). 273-275
3. Ward M. High altitude deterioration. Proc R Soc Lond B Biol Sci. 1954
Dec 15;143(910):40-42.
Competing interests:
I had been in Everest Region and also to the Everest Base Camp in 2007 Spring and Fall both for the medical research. I worked as a Volunteer physician in Manang and Thorang Phedi Medical Aid Post of Himalayan Rescue Association of Nepal (HRA) in 2008 Spring.
Rapid Response:
Important points to cosider while analyzing the deaths of climbers on Mt Everes !
Dear Editor,
I read the article “Mortality on Mount Everest, 1921-2006:
descriptive study” by Paul G Firth(1) et al with great interest. The
retrospective analysis of all the deaths in 1921-2006 is definitely a
commendable job but the descriptive study has failed to address some of
the extremely important points regarding the deaths of climbers, settings
and clinical consideration.
It is important to mention whether the death was more among those who
were making first attempt or subsequent attempts to Everest. How about the
medications used by the climbers? Some climbers might be using
dexamethasone(2).
The summit bid starts at midnight which may be one of the confounding
factors for the death while climbing and should be considered. Similarly,
crowded climbing and delaying in summit bid should also be considered as
delayed summiting has been correlated.
The ataxia, how was it considered? It is important to mention that
climbers are in crampon, roped and with oxygen cylinder and mask with all
gloves and clothing. The ataxia cannot be argued or labeled unless there
is Rhomberg’s or sharpened Rhomberg’s test done.
The most importantly, the authors have forgotten to consider ‘high
altitude deterioration’(3) as an important factor to cause death to such
extreme altitudes with the longer time of exposure. The authors go further
ahead and prematurely come to speculate that headache, nausea and vomiting
not being heralds of high altitude cerebral edema at extreme altitudes.
Thank You!
Dr Matiram Pun, Secretary of Mountain Medicine Society of Nepal
(MMSN)
References:
1. Firth PG et al. Mortality on Mount Everest, 1921-2006: descriptive
study. BMJ 2008;337:a2654
2. Schoene RB. Dexamethasone: By Safe Means, by Fair Means. High Alt Med
Bio 2005; 6 (4). 273-275
3. Ward M. High altitude deterioration. Proc R Soc Lond B Biol Sci. 1954
Dec 15;143(910):40-42.
Competing interests:
I had been in Everest Region and also to the Everest Base Camp in 2007 Spring and Fall both for the medical research. I worked as a Volunteer physician in Manang and Thorang Phedi Medical Aid Post of Himalayan Rescue Association of Nepal (HRA) in 2008 Spring.
Competing interests: No competing interests