Health and Safety on Mt. Kilimanjaro

Coronavirus (COVID-19)

Map Adventure Safari is fully compliant with the published  Standard Operating Procedures by Tanzania's Ministry of Natural Resources and Tourism. The two main goals of the new procedures are to ensure that tourists entering the country do not bring in COVID-19 and to prevent tourists from infection while in the country.

Extra precautions are taken when interacting with clients and when packing, transporting, and preparing food and equipment for climbers. Personal protective equipment is worn by staff and the number of staff interactions with clients is also limited.

Our clients should expect the following on their climb:

Tourists will be subjected to a temperature check on arrival at the airport, park gate, and hotels. Individuals showing signs or symptoms of COVID-19 on arrival in Tanzania will be directed to a medical team for further consultation.

The all-mountain crew will wear masks when they are in vehicles, at the park gate, and while they are at camp. Hotel staff will wear masks when interacting with clients.

All-mountain crew and hotel staff will maintain a distance of at least three feet (one meter) from clients. However, in dealing with a medical emergency, it may be necessary to be in closer proximity.

It is mandatory for all clients to wear a mask when traveling in vehicles and when in public places. Clients are required to supply their own masks. Medical masks and non-medical face coverings such as cloth masks, neck gaiter, and Buff are both sufficient.

Clients should carry hand sanitizer on their person at all times. Clients are required to supply their own hand sanitizer.

Acute Mountain Sickness (AMS)

The percentage of oxygen in the atmosphere at sea level is about 21%. As altitude increases, the percentage remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,600 m) there are roughly 40% fewer oxygen molecules per breath so the body must adjust to having less oxygen. Altitude sickness, known as AMS, is caused by the failure of the body to adapt quickly enough to the reduced oxygen at increased altitudes. Altitude sickness can occur in some people as low as 8,000 feet, but serious symptoms do not usually occur until over 12,000 feet.

Mountain medicine recognizes three altitude categories:

• High altitude: 4,900 to 11,500 ft (1,500 to 3,500 m)
• Very high altitude: 11,500 to 18,000 ft (3,500 to 5,500 m)
• Extreme altitude: 18,000 ft and above (5,500 m and above)

In the first category, high altitude, AMS, and decreased performance is common. In the second category, very high altitude, AMS, and decreased performance are expected. And in extreme altitude, humans can function only for short periods of time, with acclimatization. Mount Kilimanjaro's summit stands at 19,340 feet - in extreme altitude.

At over 10,000 feet (3,000 m), more than 75% of climbers will experience at least some form of mild AMS.

There are four factors related to AMS:

• High Altitude
• Fast Rate of Ascent
• High Degree of Extention
• Dehydration

The main cause of altitude sickness is going too high (altitude) too quickly (rate of ascent). Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatization and generally takes one to three days at any given altitude. Several changes take place in the body which enable it to cope with decreased oxygen:

• The depth of respiration increases
• The body produces more red blood cells to carry oxygen
• Pressure in pulmonary capillaries is increased, "forcing" blood into parts of the lung that are not normally used when breathing at sea level
• The body produces more of a particular enzyme that causes the release of oxygen from hemoglobin to the body tissues

Again, AMS is very common at high altitudes. It is difficult to determine who may be affected by altitude sickness since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Many people will experience mild AMS during the acclimatization process. The symptoms usually start 12 to 24 hours after arrival at altitude and will normally disappear within 48 hours. The symptoms of Mild AMS include:

• Headache
• Nausea & Dizziness
• Loss of appetite
• Fatigue
• Shortness of breath
• Disturbed sleep
• The general feeling of malaise

Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside as the body acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate.

While hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip.

The signs and symptoms of Moderate AMS include:

• Severe headache that is not relieved by medication
• Nausea and vomiting, increasing weakness and fatigue
• Shortness of breath
• Decreased coordination (ataxia)

Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. It is important to get the person to descend before the ataxia reaches the point where they cannot walk on their own (which would necessitate a stretcher evacuation). Descending only 1,000 feet (300 m) will result in some improvement, and 24 hours at the lower altitude will result in a significant improvement.

Continuing on to higher altitudes while experiencing moderate AMS can lead to death.

Severe AMS results in an increase in the severity of the aforementioned symptoms including:

• Shortness of breath at rest
• Inability to walk
• Decreasing mental status
• Fluid build-up in the lungs

Severe AMS requires immediate descent of around 2,000 feet (600 m) to a lower altitude. There are two serious conditions associated with severe altitude sickness; High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. But, when they do occur, it is usually in people going too high too fast or going very high and staying there. In both cases the lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.

High Altitude Pulmonary Edema (HAPE)

HAPE results from fluid build up in the lungs. This fluid prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and death. Symptoms of HAPE include:

• Shortness of breath at rest
• Tightness in the chest
• Persistent cough bringing up white, watery, or frothy fluid
• Marked fatigue and weakness
• A feeling of impending suffocation at night
• Confusion, and irrational behavior

Confusion and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent of around 2,000 feet (600 m) is a necessary life-saving measure. Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.

High Altitude Cerebral Edema (HACE)

HACE is the result of the swelling of brain tissue from fluid leakage. Symptoms of HACE include:

• Headache
• Weakness
• Disorientation
• Loss of co-ordination
• Decreasing levels of consciousness
• Loss of memory
• Hallucinations & Psychotic behavior
• Coma

This condition is rapidly fatal unless the afflicted person experiences immediate descent. Anyone suffering from HACE must be evacuated to a medical facility for follow-up treatment.

Daily Health Checks

Our guides are all experienced in identifying altitude sickness and dealing with the problems it causes with climbers. They will constantly monitor your well-being on the climb by watching you and speaking with you. Twice daily, in the morning and evening, our guides will conduct health checks.

Pulse Oximeter

A pulse oximeter measures oxygen saturation - tthe oxygen level in your blood - and your pulse rate. The oximeter is placed on a climber's fingertip. The oximeter uses two beams of light that shine into small blood vessels and capillaries in your finger. The sensor reflects the amount of oxygen in the blood.

Oxygen saturation is a measurement of how much oxygen your blood is carrying as a percentage of the maximum it could carry. Normal blood oxygen levels at sea level are 95-100%.

As altitude increases, oxygen saturations decrease. Proper acclimatization generally brings oxygen saturations higher, which is why these figures typically rise when oxygen saturations are tested after resting overnight. On Kilimanjaro, oxygen saturations percentages are regularly in the '80s. There are no definitive saturation levels where a client can be declared absolutely safe or at risk. However, when oxygen saturation drops below 80%, we monitor that climber very closely.

Lake Louise Scoring System

Additionally, our guides will administer the Lake Louise Scoring System (LLSS) to help determine whether you have any symptoms of altitude sickness and the severity. LLSS is a set of questions designed to assess adults for symptoms of AMS. It is important that you be open, active, and honest when answering these questions and with your guide overall. If you do not feel well, do not try to pretend you are fine. Do not mask your symptoms and say you feel OK. Only with accurate information can the guide best treat you.

Of course, there is always the chance that you will have to abandon your climb. In these situations, the guide will tell you to descend. It is not a suggestion or request, but an order. The guide's decision is final. Do not try to convince him with words, threats, or money to continue your climb. The guide wants you to succeed on your climb, but will not jeopardize your health. Respect the decision of the guide.

Acclimatization Guidelines

The following are recommended to achieving acclimatization:

• Pre-acclimatize prior to your trip by using a high-altitude training system.
• Ascend Slowly. Your guides will tell you, "Pole, pole" (slowly, slowly) throughout your climb. Because it takes time to acclimatize, your ascension should be slow. Taking rest days will help. Taking a day increases your chances of getting to the top by up to 30% and increases your chances of actually getting some enjoyment out of the experience by much more than that.
• Do not overexert yourself. Mild exercise may help altitude acclimatization, but strenuous activity may promote HAPE.
• Take slow deliberate deep breaths.
• Climb high, sleep low. Climb to a higher altitude during the day, then sleep at a lower altitude at night. Most routes comply with this principle and additional acclimatization hikes can be incorporated into your itinerary.
• Eat enough food and drink enough water while on your climb. It is recommended that you drink from four to five liters of fluid per day. Also, eat a high-calorie diet while at altitude, even if your appetite is diminished.
• Use FDA-approved drug Diamox for prevention and treatment of AMS.
• Avoid tobacco, alcohol, and other depressant drugs including, barbiturates, tranquilizers, sleeping pills, and opiates. These further decrease the respiratory drive during sleep resulting in a worsening of altitude sickness.
• If you begin to show symptoms of moderate altitude sickness, don't go higher until symptoms decrease. If symptoms increase, descend.

Altitude Medication

Diamox (generic name acetazolamide) is an F.D.A. approved drug for the prevention and treatment of AMS. The medication acidifies the blood, which causes an increase in respiration, thus accelerating acclimatization.

Diamox does not disguise symptoms of altitude sickness, it prevents it. Studies have shown that Diamox at a dose of 250 mg every eight to twelve hours before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS).

The medicine should be continued until you are below the altitude where symptoms became bothersome. Side effects of acetazolamide include tingling or numbness in the fingers, toes, and face, taste alterations, excessive urination; and rarely, blurring of vision. These go away when the medicine is stopped. It is a personal choice of the climber whether or not to take Diamox as a preventative measure against AMS.

Map Adventure Safari neither advocates nor discourages the use of Diamox. Ibuprofen can be used to relieve altitude-induced headaches.

Mountain Rescue

-Bottled Oxygen

We carry bottled oxygen on all of our climbs as a precaution and additional safety measure. The oxygen canister is for use only in emergency situations. It is NOT used to assist clients who have not adequately acclimatized on their own to climb higher. The most immediate treatment for moderate and serious altitude sickness is descent. With Kilimanjaro's routes, it is always possible to descend and descend quickly. Therefore, oxygen is used strictly to treat a stricken climber, when necessary, in conjunction with descent, to treat those with moderate and severe altitude sickness.

We are aware that some operators market the use of supplementary personal oxygen systems as a means to eliminate the symptoms of AMS. To administer oxygen in this manner and for this purpose is dangerous because it is a temporary treatment of altitude sickness. Upon the cessation of the use of oxygen, the client will be at an even higher altitude without proper acclimatization.

99% of the companies on Kilimanjaro do NOT offer supplementary oxygen - because it is potentially dangerous, wholly unnecessary and against the spirit of climbing Kilimanjaro. The challenge of the mountain lies within the fact that the summit is at a high elevation, where climbers must adapt to lower oxygen levels at altitude. Using supplementary oxygen is akin to putting the mountain at sea level, where nearly everyone can summit.

-Portable Stretcher

Large, one-wheeled rescue stretchers are found on Mount Kilimanjaro but they are only available on certain routes of the park. That means that if a climber is unable to walk due to severe altitude sickness or a leg injury that compromises mobility, getting that climber down the mountain could pose difficult challenges for Kilimanjaro operators when these stretchers aren't nearby. Usually, it means assisting the injured climber by carrying him or her on one's back.

At Map Adventure Safari, we carry a portable stretcher on northern routes in case of emergencies when a climber is unable to walk on their own and the trekking party is some distance away from the park's stretchers.

Our portable stretchers are compact, strong, and lightweight. The device can be used to evacuate an injured climber quickly off the mountain. To use, the subject is secured to the stretcher using straps. Then porters hold on to the handgrips to usher the climber to safety.

Kilimanjaro Search and Rescue

We are partnered with Kilimanjaro Search and Rescue (SAR), a helicopter rescue operation that conducts modern, efficient rescue services on Kilimanjaro. Airbus AS 350 B3 helicopters waits nearby at Moshi Airport. Once a distress call is received, rescue procedures are activated within five minutes. Expert pilots, highly trained rescue doctors and emergency flight technicians are exceptionally qualified and prepared for all emergencies on the mountain.

Kilimanjaro SAR manages a medical clinic that focuses on high altitude-related illnesses, mountain medicine, and trauma. It is staffed 24 hours a day by physicians, nurses, and assistants offering the best possible treatment. This group is advised by a unique Clinical Advisory Team made up of top-level medical and high altitude professionals.

Note that: this service is only available to clients who have the required travel insurance. Clients must be covered to trek at high altitudes up to 6,000 meters to qualify for Kilimanjaro SAR rescue. Your travel insurance will be verified by our staff before the trek.