Continuing Medical Education


Wilderness Medicine Educational Conference:

Nepal Mountaineering
Himalayan Summits: Gokyo Peak, Kala Pattar and Island Peak


An offering of: Wilderness Medical Society.
Logistics and guiding by Andes Mountain Guides.
With support from thge Everest ER.
Date: April 10, to May 4, 2011

This accredited curriculum's highlights include pathophysiology, treatment and prioritization of care for a variety of medical problems commonly encountered in wilderness environments and settings remote from hospital/ definitive care. Physicians and allied health care providers who counsel patients traveling to remote areas will be interested in the topics covered during this unique CME event. Curriculum includes altitude safety, altitude risk reduction, recent recommendations on altitude-related illnesses prophylaxis, rescue strategies and ethics, as well as real Everest war stories- uncovering what it really takes to deliver health care in the high mountain environment. This will be achieved through didactic lectures, small-group discussions and hands-on training.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Andes Mountain Guides. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians.

The Wilderness Medical Society designates this educational activity for a maximum of 17 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity

This expedition will take us into the heart of the Himalayas: the Khumbu region. After leaving Kathmandu, we’ll make our way to Gokyo Peak (17,600 ft), which is our first objective. It lies along the stunning Dudh Kosi River. Later we'll cross the pass towards the Chola Khola valley, in Order to approach the Khumbu Glacier and our next two goals, Kala Pattar (18,300 ft) and Everest Base camp. After leaving the starting point to the top of the world, we’ll get to Chhukhung and then to Island Peak high camp, from where we’ll attempt our last summit at 20,200 ft. Throughout the trip we’ll be immersed into the Nepali culture, hiking through green valleys, tough rocky terrain and immense glaciers, always with amazing Himalayan peaks on our sight: from Everest to Lhotse, Nuptse, Cho Oyo and Ama Dablam, an incredible experience on this classic climbing and hiking mecca.


Himalayan Summits Trip Details

  • Length: 25 days
  • Climber/guide ratio: 4:1
  • Capacity: 15
  • Cost: US $4,950.00
  • Additional CME Cost: $720.00 (19 hours AMA/PRA Category 1 CME credits)
  • Additional Non-Physician Wilderness Medical Education Cost: $250.00 (Wilderness Education Diploma from The Everest ER and Andes Mountain Guides)
  • Departure dates: 4/10/2011
Included
  • Certified Mountain Guides
  • 4* Hotel accommodations in Kathmandu with breakfast
  • All meals while in the mountain
  • Climbing permits and park fees
  • All Restaurant meals in Kathmandu
  • Camping and cooking gear for the group
  • Satellite phone service, emergency oxygen
  • Porters and pack animals
  • Private ground transportation throughout the trip
  • Airfare Kathmandu- Lukla
  • 24/7 US phone assistance before and during the trip
  • Real time online dispatches of the expedition
  • AMG cap and T-shirt
Not included
  • International airfare
  • Meals not listed in the itinerary
  • Restaurant drinks
  • Personal equipment (see Himalayan Summits Equipment List)
  • Personal insurance
  • Personal expenses
  • Rescue costs and extra expenses caused by abandoning the expedition.

Himalayan Summits Expedition Itinerary



Day 1

4/10/2011		 Kathmandu. We’ll be waiting for you at Kathmandu’s airport to help with baggage customs etc. We will then transfer to the hotel for checking in shower, rest, snack. At night we’ll have an introductory meeting and a welcome dinner.
Day 2

4/11/2011		 Kathmandu. We’ll arrange permits, deal with last minute details, check gear, and visit the bustling city of Kathmandu. Hotel night.

ALTITUDE ILLNESS: Acute Mountain Sickness ADVANCES IN PREVENTION AND TREATMENT Pathophysiology, diagnosis, and treatment of altitude illness Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the initial assessment and management of AMS.

TRAVELER'S DIARRHEA, GIARDIASIS & OTHER WATERBORNE WILDERNESS INFECTIONS Pathophysiology, diagnosis, treatment, and prevention of waterborne infections Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the diagnosis, treatment and prevention of traveler’s diarrhea and common waterborne infections.
Day 3

4/12/2011		 Phakding. We’ll take a short flight to Lukla, the beginning of our trek. After meeting our local staff members, we’ll hiking for 2-3 hours to Phakding, along the Dudh Kosi River.
Day 4

4/13/2011		 Namche Bazaar. Following the Dudh Kosi, we’ll approach Namche Bazaar. Namche is the gateway to the Solo Khumbu region, and is a traditional trading outpost for Nepalese and Sherpa traders. We will stay in Namche for the next two-night giving us a chance to acclimatize and explore the local culture. Lodge night.

ALTITUDE ILLNESS: High Altitude Pulmonary Edema(HAPE) and High Altitude Cerebral Edema (HACE): ADVANCES IN DIAGNOSIS AND TREATMENT Pathophysiology, diagnosis, and treatment of HAPE and HACE Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the initial assessment and management of severe high-altitude illness.

BACKCOUNTRY MEDICAL KITS Detailed discussion of medical supplies needed in remote environments Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the planning and provisioning of a backcountry medical kit.
Day 5

4/14/2011		 Namche Bazaar. WWe’ll take a rest day in town, enjoy incredible Himalayan views of Everest, Lhotse and Ama Dablam. We’ll also visit the local Sherpa Museum.

BACKCOUNTRY WATER DISINFECTION How to effectively purify and disinfect surface water. Participants may have the opportunity to test different water purifiers and learn about chemical and natural water purification techniques. Measurable objectives: Upon completion of this lecture participants should be able to list different methods of creating potable water from nonpotable water and delineate the pitfalls associated with each of the methods.

HYPOTHERMIA Pathophysiology, diagnosis and treatment of hypothermia Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the assessment, diagnosis and management of hypothermia.
Day 6

4/15/2011		 Phortse Tenga. We’ll trek for 4-5 hours, on a path not often traveled by westerners until we reach Phortse Tenga, our next stop, on our way to Gokyo.

FROSTBITE AND OTHER COLD INJURIES Pathophysiology, diagnosis and treatment of cold injury Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the prehospital and hospital assessment and management of frostbite.

LIGHTNING INJURIES Pathophysiology, diagnosis and treatment. Safety and avoidance. Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the assessment, management and prevention of lightning injuries.
Day 7

4/16/2011		 Machhermo. We'll start the day walking inside the forest for the first few hours. We’ll approach Tongba, where the trail starts climbing toward Gokyo. We'll pass Dole, and later Luza, and eventually amazing views of Machhermo and the green valley bellow will come into view. 5 hours trek.

AVALANCHE SAFETY AND RESCUE: Andes Mountain Guides expedition staff will conduct a brief review of avalanche safety.
Day 8

4/17/2011		 Gokyo. Leaving Machhermo early, we’ll trek until we reach the ridge where we’ll be able to see 8,000 meter giants as Cho Oyu, Cholatse and the Ngozumba glacier will fall out in front of us. After descending and passing a few amazing glacial lakes, we’ll arrive in the small village of Gokyo. 4 hours trek.

SIMULATED MOUNTAIN RESCUE: Andes Mountain Guides will demonstrate "packaging" a patient on the mountain, rigging for raising and lowering nonambulatory patients.
Day 9

4/18/2011		 Gokyo Peak. Today we’ll reach our first summit, Gokyo Peak, at 17,600 feet (5,500 meters). While climbing we will have amazing views of the glacier and the emerald lakes bellow which only slightly comparable with our views of Everest, Lhotse and Makalu. After some time on the summit we will descend back to the village and download the 500 pictures we all just took. 5-6 hours round trip.
Day 10

4/19/2011		 Leisyasa. Today we will leave Gokyo behind and trek to the herders/yakman outpost of Thagna. From Thagna we’ll cross the Ngozumba glacier and start trekking toward the Chola La pass. From the top of the pass we can retrace our trek and get great views of our previos days summit as views of Gokyo Peak and its neighbors abound. The mountains of the Rolwaling Himal are also visible from the pass. Its mostly downhill from the top of the Chola La as we start towards Leisyasa, our next stop. 7 hours trekking.
Day 11

4/20/2011		 Lebouche. From Leisyasa we follow the riverbed until reaching Dzonglha Kharka. Then we’ll start hiking up towards Awi Peak, at 17,200 ft. After enjoying the views, we’ll descend all the way to Lebouche, by the Khumbu Glacier. 5 hours.

HYPOTHERMIA Pathophysiology, diagnosis and treatment of hypothermia Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the assessment, diagnosis and management of hypothermia.
Day 12

4/21/2011		 Gorakshep- Kala Pattar. We’ll start the day hiking on the moraine and before long the Khumbu and Changri glaciers will come into view. After crossing the Changri glaciers, with incredible views of Kala Patar in the front of us, we’ll trek until we reach Gorakshep camp (3 hours). After lunch and a rest we’ll climb steep terrain until reaching the ridge and then the summit of Kala Pattar, 18,300 feet (5,700 meters). Incredible views of Everest and Nupse will great us at the summit and we will have some time to relax and enjoy our accomplishment before descending back to camp. 2-3 hours round trip.

PSYCHOLOGICAL ISSUES IN ADVENTURE TRAVEL Using adult attachment theory to predict psychological response to stressors inherent to adventure travel. Measurable objectives: Upon completion of this lecture participants should be able to explain and identify the four basic adult attachment styles and predict an individual’s response to the stressors inherent to adventure travel based upon their attachment styles. In addition participants should be able to describe interventions used for each attachment style.
Day 13

4/22/2011		 Everest Base Camp. Following the right bank of the Khumbu glacier, we’ll make our way through ice pinnacles to arrive at Everest Base Camp (EBC). We’ll have the opportunity to talk with some of the expeditions at EBC and be able to experience the expedition excitement that always exists at the base camp for the highest mountain in the world. We will have a private tour of the Everest ER from our friend Luanne Freer, the President of the HRA. After some time for photos and mingeling at EBC we’ll descend to Gorakshep or possibly the whole way to Lebouche. 5 - 7 hours trekking time.

EXPEDITION MEDICINE How to plan to be a medic on expedition: common expedition problems and their treatment and evacuation strategies. Measurable objectives: Upon completion of this lecture participants should be able to describe controversial areas of expedition medicine, such as provisioning, responsibilities of health care providers to expedition members, and potential legal liability.
Day 14

4/23/2011		 Periche After a lazy morning, we’ll begin our descent along the Khumbu glacier, passing Tukla, until eventually reaching the lush green Pheriche Valley which we'll follow to the village of Pheriche. 3-4 hours trekking.

WILDERNESS OPTHALMOLOGY Pathophysiology, diagnosis and treatment of eye problems that occur in wildereness settings. Measurable objectives: Upon completion of this lecture participants should be able to explain and describe the wilderness assessment and management common opthamologic problems.
Day 15

4/24/2011		 Chhukhung. We'll trek until we reach Dingboche. At Dingboche we will be greeted by amazing views of Lhotse and Baruntse, as we move on toward the village of Chhukhung where Ama Dablam stand proud watch over the village. 3 hours trekking.

PSYCHOLOGICAL RESPONSE TO INJURY AND CRISIS (2-022 FAWM) Psychological reactions of victims of accidents and natural disasters and suggested responses for rescuers and caregivers. Measurable objectives: Upon completion of this lecture participants should be able to explain the four patterns of decompensation and reintegration, including methods rescuers and caregivers can use to contribute to the victim’s reintegration process and safeguard their own mental health. In addition participants should be able to explain qualities and personality structure of the wilderness leader or rescue crew leader that contribute to the reintegration process.

WILD ANIMAL ATTACKS Treatment and avoidance wild animal wounds / attacks Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the assessment, management and prevention of wild animal attacks.
Day 16

4/25/2011		 Pareshaya Gyab. We'll trek toward the headwaters of the Imja Khola river and the glacier which bares the same name. With Baruntse and Ama Dablan in our sights, we’ll climbing beside the Lhotse glacier until we arrive at Island Peak base camp,16,400 feet (5,100 meters). 3 hours trekking.

BITES AND STINGS Pathophysiology, diagnosis and treatment of common envenomations by insects and snakes. Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the initial assessment and management of bites and stings of hymenoptera and crotalid snakes in the wilderness setting. Includes wilderness management of anaphylaxis.
Day 17

4/26/2011		 Island Peak High Camp. We’ll move up the rocky slopes of Island Peak, on our way to advanced base camp. 2-3hours. We'll begin to get ready for our main objective and get a good nights rest.
Day 18

4/27/2011		 Island Peak. On the trail today we’ll see Makalu, and Cho Polu, eventually ascending fixed lines, to obtain the ridge. An easy climb follows along the snowy ridge and eventually to the summit of Island Peak, 20,200 feet (6,300 meters). After we enjoy the summit, take photos and bask in the glow of our accomplishments we will descend back to camp and then all the way to Chhukhung. 5 to 7 hours round trip.

MANAGEMENT OF FRACTURES & DISLOCATIONS Diagnosis and treatment of orthopedic injuries in the backcountry Measurable objectives: Upon completion of this lecture participants should be able to explain and describe priorities in the initial assessment and management of orthopedic injuries in a wilderness setting.
Days 19 to 22

4/28/2011		 Back to Lukla.We'll spend these days leisurely walking down the valley spending three nights at Pangpoche, Phortse and Namche, and eventually arriving back to Lukla.
Day 23

5/2/2011		 Lukla to Kathmandu. Flight to Kathmandu sightsee in Kathmandu or rest and relax the rest of the day.
Day 24

5/3/2011		 Kathmandu Extra day. We’ll use this day in case of delayed flights, weather considerations and/ or any other issue that could affect our schedule or to relax or tour Kathmandu.
Day 25

5/4/2011		 Flight Home. Although always a day of mixed emotions this is the end of the program. After hugs as the sharing of final stories we will say our goodbyes and depart for home.

Restaurant meals included: day 1, day 2, day 23, and day24.
Hotel includes breakfast.

Faculty
Luanne Freer, MD, FACEP, FAWM: Luanne is the Medical Director, Medcor at Yellowstone National Park and Midway Atoll NWR. She has been the Mt. Everest Base Camp Physician since 2003 and a Himalayan Rescue Association volunteer since 2002. She has taught Wilderness Medicine courses for physicians around the world for 12 years.


NOTE: FACULTY HAS SIGNED A DISCLOSURE FORM LISTING ANY COMMERCIAL SUPPORT.

Designation Statement:
The Wilderness Medical Society designates this educational activity for a maximum of 17 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Full disclosure statement:
Faculty member Dr. Freer has disclosed no real or apparent conflict of interest related to the content of this presentation.


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