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HACE - High Altitude Cerebral Edema

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  • John Ladd
    Two helicopter evacuations have been noted in recent days by Facebook PCT Class of 2012 group. I mentioned the first one only on Sidebar since it was
    Message 1 of 1 , Jun 19, 2012
      Two helicopter evacuations have been noted in recent days by Facebook PCT Class of 2012 group. I mentioned the first one only on Sidebar since it was dehydration (rarely a serious JMT problem), but this one may be a risk ewe can share - and sounds like HACE (High Altitude Cerebral Edema)

      Extracts from the FB thread:

      Jordan B..
      Hello All - to anyone who was hiking with my mother Kimberlie D...  a few days ago and had to call the helicopter, I want to say thank you so much. You probably saved her life. She's in a hospital in Fresno now, expected to be there for at least a week, but recovering slowly. Again, thank you thank you thank you to all the hikers that were there for her. Message me privately if you were close with her and would like more updates on her condition.
      Bl H,,,  Not to violate privacy, but was it something that others should be alert to? A trail danger? Something others should watch for and avoid?
      Jordan ...  No, it was her own body reacting to trail stress and elevation change
      Blake D...  I understand if people dont want explain more but I would love to learn from this. Was it altitude sickness? If so what kind? And how high up was she? I understand if this is too much of an invasion but I would love to learn from it.
      Jordan ...  The doctors don't quite know yet...she has some brain swelling that needs to go down before they can really see what happened. I'm sure as her condition gets better she'll be back on facebook :)

      About HACE, see



      Definitely an emergency requiring prompt evacuation.  Not common if you follow the traditional rule of limiting each night's campsite to no more than 1000-1300 feet above the prior nights (after you get above 8000 feet). It's important to know how to recognize the symptoms in your fellow backpackers (it's hard to recognize in yourself)

      HACE indications extracted from first article above

      1) height gain in the last few days, AND several of the following:
      2) severe headache (not relieved by usually-effective meds) 
      3) Diminished physical coordination - Clumsiness and/or difficulty (or asks for help) with simple tasks such as tying their shoelaces or packing up
      4) Difficulty doing (or refuse to do!) the finger-nose test or heel-to-toe walking
      5) Staggering, falling over. 
      6) Level of consciousness low and/or declining: Early on, loss of mental abilities such as memory or mental arithmetic. Later on, they become confused, drowsy, semiconscious, unconscious 
      7) Other (often absent) symptoms :
       Nausea and/or vomiting, which may be severe and persistent
       Changes in behaviour (uncooperative, aggressive or apathetic, “Leave me alone”, etc)
       Hallucinations, blurred or double vision, seeing haloes around objects, fits 

      Suggested tests from the first source:

      "Failure or difficulty doing any one of these tests means the victim has HACE. If the victim refuses to cooperate, assume they are suffering from HACE. If in doubt about the victim’s performance of the tests, compare with a healthy person. Be prepared to repeat these tests to monitor progress.

      • Finger-nose test. With eyes closed, the victim repeatedly and rapidly alternates between touching the  tip  of  their  nose  with  an  index  finger,  then  extending  this  arm  to  point  into  the  distance (useful test if the victim is in a sleeping bag or cannot stand up).

      • Heel-to-toe walking test. The victim is asked to take 10 very small steps in a straight line, placing the heel of one foot in front of the toes of the other foot as they go. Reasonably flat ground is necessary  and  the  victim  should  not be helped, but be  prepared  to  catch  the  victim if  they  fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.

      • Standing  test. The  victim  stands,  feet  together  and  arms  folded  across  their  chest,  and  then closes their eyes (the victim should not be helped, but be prepared to catch the victim if they fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.

      • Mental  tests are  used  to  assess  level  of  consciousness.  You  must  take  into  consideration  preexisting verbal/arithmetic skills and culture; it is a decline in ability over time that is significant. Examples of tests include: “Spell your name backwards”, “Take 3 from 50 and keep taking 3 from the result”, or ask their birth date, about recent news events, etc."

      Important to get this person help immediately. Don't hesitate to use the Spot 911 button and ask fellow hikers if they have Sat Phones or something like the Spot Connect so the SAR people understand how serious the problem is. Have someone trail-run to the nearest Ranger Station.  This is BAD news and requires immediate attention.  If the victim is mobile or can be readily carried, head the quickest way downhill unless it would interfere with SAR evacuation.

      The first link above also has useful information on recognizing the more common and almost as serious HAPE (High Altitude Pulmonary Edema) as well as AMS (Acute Mountain Sickness)

      More on this in our Links area

      Click on Safety, health and first aid

      then click on Altitude and Hypothermia Issues
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