Emergencies and evacuations during trekking.
Obviously we hope this will not be necessary but it is important you have some information on what to expect in the event of an evacuation, and how Nepal Inside out will look after you in the event of sickness or an accident.
Which information to bring on trek
We ask you immediately after you booking to give us your insurance policy details, like the name of the insurance company, your policy number and the emergency telephone number. This information is kept in our office and given to your guide.
It is advisable to take a copy of your insurance policy and the emergency phone number with you on the trek. Let the other participants know where it is, so in case you are incapacitated, they can find this information.
Make sure everyone in the group and your Nepalese guide(s) are aware of any medical conditions or severe allergies you have. If you have an allergy, a medical condition, or you are using prescribed medicines, ensure that your fellow trekkers help with getting this necessary information to a medical person in the event of an emergency. Best is to keep the information with your insurance papers..
It is advisable to register at the consulate/embassy of your country in Nepal. In the event of a problem then the help of the local Consulate will be more efficient if they already have your details. Furthermore, we recommend you read about Nepal and find out the latest travel advice from the foreign department of your country.
Read here why we advise to take travel insurance with sufficient coverage.
If you have symptoms of altitude sickness
Most of the time if you feel the effects of altitude sickness it will be easy to turn round and go back down.
If you have multiple symptoms, then don`t make the mistake of `sleeping one night over it`. Cerebral or pulmonary oedema will develop fast and render someone incapacitated within hours.
If you are unsure if you should go down, then have a look at the symptoms in the `Pocket First Aid and Wilderness Medicine`, which your tour leader is carrying in the first aid kit. Listen to your body and observe your own movements and ask advice to the tour leader of your travel companions.
If you are obviously suffering from increasingly advanced symptoms during your walk up to the higher villages then it is important to head straight back down. It doesn`t matter if it`s day or night, it is essential that you go down and get qualified help. Our guide will arrange staff members to descend with you and assist you with finding a lodge for the night. You will never be left alone by our staff. Once your symptoms disappeared, you will have to make a decision to either go back up or to continue down. In most cases, it will be wise to descend.
Read here more about the symptoms of high altitude disease and how to prevent them.
If you have an accident
In case you have an accident and you are unable to walk by yourself then our staff will have various options. Firstly, they can provide a team of people to carry you down. Secondly, they can arrange a horse that takes you down, which costs about 100 USD per day. Or they can carry you to a nearby lodge and call for a helicopter to evacuate you back to Kathmandu.
At this point, it is important to remain calm. Our staff and other local people will do everything they can to help you. You should know that this is not the first time that an evacuation is being made, and that our staff members are trained to handle this situation. They will follow a clear procedure, with as priority that everyone is protected and warm.
In case of a helicopter evacuation
Most insurance companies prefer a direct phone call between a doctor and the policy holder to assess if a helicopter evacuation is necessary. This will take place by either a mobile phone or a satellite phone. If there is no communication possible from the area where you are then the guide will send someone or to the nearest place where there is a phone.
A case file will be opened at the insurance company, so this first phone call is a very important one. Don`t forget to ask for your reference number. If you are not able to communicate, it might be someone else from your group who speaks on your behalf. Don`t expect your local guide to speak to the insurance company, they often don`t have sufficient English to cope with the specifics.
You need to provide the following information to the insurance emergency number:
Your name and your address;
Your policy number and the company you booked your insurance through;
The start date of your trip;
Your exact location and the details of your illness or accident;
Your contact details, such a phone number where they can reach you.
In Nepal, the helicopter company rarely sends a helicopter if there is not an assured payment and contact with the insurance company. If the permission is given, all the financial transactions will be handled directly by your insurance company. Therefore there is a three way communication between the insurance company, the helicopter company and our guide (and office). In the event of an evacuation, your guide stays your main point of contact. If you are in a local clinic (which is run by the Himalayan Rescue Association) the medical staff will also be involved in the evacuation procedure.
Either way, a telephone call will be made to the helicopter company to ask for an evacuation. Your guide will also inform our office in Kathmandu. We are not in the possibility to make any payments for a helicopter rescue.
Once the helicopter is on its way then you will be told how long it will take before it reaches your location. However, sometimes it can take hours until they appear because helicopter pilots will not risk flying in dense clouds. If they cannot land nearby the hostel or clinic where you are lying in a bed, the pilot will land at the nearest safe spot he finds. This could mean that you will have to be carried to this spot.
The helicopter usually carries only one casualty, so do not expect that it to bring along a friend or relative. There are two ways of getting on board a helicopter. Either you will walk yourself, approaching from the side in full view of the pilot. Your guide (and some of the team) will have prepared your day backpack with some important items to take with you. These include your insurance papers, your wallet, your passport and flight tickets, spare clothes, some toiletries, your mobile phone, your camera and anything of value. Your main luggage stays with the group if the pilot does not want to take it in the helicopter. It will return to Kathmandu with the group, so you can take it with you on the plane home, or it will be sent at a later date by cargo.
The helicopter flies to the domestic airport of Kathmandu, where our staff will be waiting for you with a vehicle to take you to hospital, or if necessary there will be an ambulance. We take you to one of the best hospitals in Kathmandu: NICS International Clinic for altitude problems, Grande Hospital for general health/accidents etc…
Once you arrive in Kathmandu, the altitude symptoms will probably disappear fast, leaving you feeling rather weak, a bit shaky and probably coughing a lot. In the hospital they will do a number of tests to check your hydration levels, any fluid on the lungs and your blood pressure. If you are severely dehydrated then they may keep you in the hospital some nights. If the test are ok, they will send you home after a few hours of observation.
Back in your hotel room where you may take some rest, you will have the chance to phone home. You are welcome in our office for Skype calls and sending emails. The staff in our office will be able to help with changing your air ticket details, if it is allowed. Note however that travelling by air directly after an altitude-related illness is not recommended. It is always best to wait several days.
The Cost of Evacuation
The cost of a helicopter varies depending on where they have to fly to for doing the rescue operation. It can be anywhere between USD 3500 and USD 10.000 for evacuations. So it is very important that you check your insurance policy before the trekking, to see if it can cover this amount. The helicopter company may take your credit card details when you arrive in Kathmandu to cover a deposit, which can be up to 45% of the total amount.
The insurance company will follow your progress and communicate regularly with the medical staff at the hospital. In most cases they are going to pay for treatment directly to the hospital but it may occur that you have to pay yourself with your credit card and get it back from them afterwards.
We recommend that you inform your local consulate of your situation if it is serious. They can visit, advise and assist, but their powers are quite limited. They cannot intervene with airlines for example, in order to get you a quick flight out!
Repatriation to your home country
In the event of a serious illness or accident, you will not be able to enjoy the last days of your holiday since you have to spend it in a hospital. After this you may want to fly home. Speak to your doctor about flying before changing your flight date. Often it is better to take sufficient rest and to wait some days before flying. If it`s not too long, you might want to wait until your travel companions are back you’re your bag and fly home with them on the scheduled date.
Either way, always keep your insurance company informed. Make sure that all changes in your planning are noted on your case file. This will ease up things when you make your recuperation claim later on.
If you are too sick or injured to return home by yourself, the insurance company will arrange an air ambulance service with an allocated medical team to have direct contact with the hospital staff. An air ambulance service is a specially equipped private airplane used worldwide for this specific purpose.
Getting ill or injured can be quite a traumatic experience up in the mountains. From feeling `a bit tired and off` to being evacuated to Kathmandu, many people get surprised by how quickly it can happen. Avoid the situation by walking slowly and carefully on the trails. Take the number of days we recommend to ascend, your program is made to allow you enough acclimatization.