First aid at high altitude is absolutely essential for safety whilst trekking in the Himalayas and other mountain ranges exceeding 2,500–3,000 metres. Conditions at high altitude are unpredictable: lower oxygen levels, fluctuating temperatures, intense UV radiation and sudden changes in the weather mean that the body is forced to operate under extreme conditions.
That is why anyone planning a trek above 3,000–3,500 metres above sea level should be familiar with the principles of how to act, how to recognise the symptoms of altitude sickness, and the basics of first aid. In the mountains, this isn’t just theoretical knowledge — it’s a skill that can save your health, and sometimes your life.
Why is first aid at height so important?
At high altitudes, the body functions in conditions of oxygen deprivation, which disrupts:
- concentration,
- motor coordination,
- assessment of the situation,
- the functioning of the heart and respiratory system,
- cold resistance,
- emotional stability.
The biggest risk is that health problems develop gradually and are often downplayed.
That is why first aid at height must be based on:
- monitoring of symptoms,
- early response,
- decisions made with a cool head, not „on the basis of ambition”,
- an understanding of the basic principles of acclimatisation.
The main health risks at height
1. AMS – Acute Mountain Sickness (altitude sickness)
The most common condition. AMS can occur as early as 2,500–3,000 m.
Typical symptoms of AMS:
- headache (the most common symptom),
- nausea, vomiting,
- loss of appetite,
- fatigue that is „disproportionate” to the level of exertion,
- sleep disorders,
- dizziness,
- the sensation of „walking as if drunk”.
What should I do?
- do not go any higher until the symptoms have subsided,
- drink plenty of water (at least 3–4 litres a day),
- avoid alcohol,
- to rest,
- optional: ibuprofen or paracetamol for a headache,
- if symptoms persist after 24 hours → descend to an altitude of 300–500 metres.
2. HAPE – High-Altitude Pulmonary Oedema (pulmonary oedema)
This is a life-threatening condition — it requires immediate evacuation and medical assistance.
Symptoms of HAPE:
- severe shortness of breath,
- difficulty breathing, even at rest,
- a cough with frothy phlegm,
- blue lips and nails,
- a very fast heart rate,
- „wheezing” whilst breathing.
What should I do?
- Descend IMMEDIATELY to a lower altitude (at least 500–1000 m),
- administer oxygen, if available,
- avoid exertion,
- call for help immediately.
3. HACE – High-Altitude Cerebral Oedema (brain oedema)
The most serious form of altitude sickness.
Symptoms of HACE:
- severe balance disorders,
- confusion, aggression or apathy,
- slurred speech,
- hallucinations,
- uncontrolled movements,
- inability to walk in a straight line.
What should I do?
- Get down from the heights IMMEDIATELY,
- evacuate immediately (by helicopter or with local assistance),
- do not leave the patient alone,
- administer oxygen or dexamethasone tablets (if prescribed by a doctor before the trip).
Acclimatisation guidelines – the cornerstone of first aid at altitude
This isn’t just „extra knowledge”. It’s absolutely essential.
The 300–500 m rule
At altitudes above 3,000 metres, we sleep no more than 300–500 metres higher each night than we did the previous day.
The „climb high, sleep low” principle”
You can climb higher during the day, but you come back down to a lower altitude for the night.
Acclimatisation days
For every 800–1000 metres of elevation gain, there should be a day of rest and acclimatisation.
Consistent hydration
At high altitudes, water is a fuel:
- 3–4 litres a day is the minimum,
- water → electrolytes,
- We avoid alcohol and drink coffee in moderation.
Food
The body needs calories — lots of calories.
- carbohydrates,
- vegetable soups,
- rice, pasta, potatoes,
- hot meals, not cold ones.
A practical first-aid kit – what should every trekker carry?
On an expedition above 3,000 metres, a first-aid kit is just as important as your boots.
A first-aid kit should contain:
Essential medicines:
- ibuprofen,
- paracetamol,
- electrolytes,
- medicines for diarrhoea / food poisoning,
- bandages and plasters,
- disinfectants.
Medicines for altitude sickness (after consulting a doctor):
- acetazolamide (Diamox) – as a preventative measure or for mild symptoms of AMS,
- dexamethasone – for symptoms of HACE,
- nifedipine – for symptoms of HAPE.
Additional equipment:
- NRC film,
- antibacterial face masks,
- nitrile gloves,
- energy gels for emergencies.
How does Diamox work and when should it be used?
Diamox (acetazolamide) aids acclimatisation, but it is not a „miracle cure”. It helps the body adapt more quickly to low oxygen levels.
Directions for use (after consulting a doctor):
- as a preventative measure: 125 mg in the morning and in the evening,
- for symptoms of AMS: 250 mg every 12 hours.
Please note:
Diamox does NOT treat severe altitude sickness. In cases of HAPE/HACE, the only treatment is to descend.
The most common mistakes that cause health problems at height
- too fast a pace,
- no acclimatisation days,
- ignoring the early symptoms,
- dehydration,
- „the drive to the top”,
- sleeping too high,
- alcohol at high altitudes,
- no food, no energy.
Each of these errors significantly increases the risk of AMS, HAPE or HACE.
First aid at height — a step-by-step guide
1. Recognise the symptoms
Keep an eye on yourself and the group. Headache? Tiredness? Loss of appetite?
2. Stop the march
Never continue climbing if you have symptoms of AMS.
3. Rest and hydration
Drink 0.5–1 litre of water + electrolytes.
4. Assessment after 1–2 hours
If the symptoms subside → approx.
If they’re still going → don’t go any higher.
5. The decision to disembark
If the symptoms are getting worse, this is the only option.
6. Severe symptoms = cause for concern
Shortness of breath, loss of balance, slurred speech → immediate evacuation.
Summary
First aid at altitude is knowledge that must be clear, specific and put into practice immediately. In the Himalayas, there is no room for taking risks or ignoring the body’s warning signs.
Remember the three most important rules:
- always act early,
- Never continue climbing if you have symptoms of AMS,
- The only remedy for severe symptoms is to descend.
First aid at altitude not only improves safety — it also makes trekking more enjoyable, mindful and carried out with respect for your own body’s capabilities.
