The document discusses acclimatization to high altitudes and provides information on how the body adjusts as it gains altitude. It notes that as altitude increases, atmospheric pressure and oxygen levels decrease. The body starts acclimatizing as soon as a person gains altitude through processes like increased heart and breathing rates. It recommends ways for people to support their body's adjustment, such as staying hydrated, eating well, resting adequately, and pacing activity levels. It also discusses dehydration, hypothermia, and blister prevention.

1. Notes for Reference
Acclimatisation
As one gains altitude, there is lower and lower atmospheric pressure which results in lesser and lesser
oxygen available for breathing. Acclimatisation involves the body adjusting to this decreased lower
oxygen content in the thinner air.
The body starts this ‘adjusting process’ as soon as a person starts gaining altitude.
The person has to just support his/her body as it starts the adjusting process.
This adjustment by the body involves the following:
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Increased heart rate (pulse)
Increased respiratory rate
Lack of appetite
Mildly disturbed sleep
Breathlessness on activity (earlier than at sea level)
Slight oedema possible (face, hands, legs)
Mild lassitude
------------------------------------------------------------Headache – AMS starts!
The support that the person has to provide to his/her body:
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Hydrate adequately – keep sipping water, 4-5 litres/day
Eat well – appropriate diet, timely input
Manage layers appropriately – feel warm and comfortable! Sleep warm!
Rest appropriately and adequately
Get fresh air, especially when in camp – walk around in the evenings, keep tents ventilated
Pace yourself while hiking – walk while you can talk!
Monitor self and others –
General feeling
Shortness of breath at rest
Quality of urine
Food intake
Quality of sleep
Evening activity
Tent ventilation
Sleeping bag use
Hotspots while walking
Hygiene – personal and community
Prompt action to address signs and symptoms of AMS
In case of AMS, here is a checklist which might help a person understand what action is to be taken to
help patient recover:
1.
Water
How much water have you drunk?
How have you been drinking in the last few days? (Sipping or gulping huge quantities)
How much water has been passed out?
Was your urine clear or coloured?
2.
Food
What have you been eating?
How frequently? When was the last that you ate? What?
When was the last you pooped? Quality?
Do you experience nausea? Have you vomited?
Do you have any allergy?
3.
Layers
How are you feeling? Feeling warm?
Are your clothes dry?

2. Have you been sleeping warm?
4.
Pace
How has the pace been for you? Too fast? Too slow?
Are you feeling short of breath even at rest?
How were you feeling through the last few days’ of altitude gain?
5.
Fresh air
Have you been staying inside tents in the evenings? Evening walks?
Has your tent been ventilated adequately?
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Dehydration
Following extracts are taken from “The Wilderness First Responder” by Buck Tilton, director of Wilderness
Medicine Institute of NOLS, USA
Without water there would be no life – at least any life, as you know it.
Water puddles inside every one of your cells, and flows through the microscopic spaces between cells.
In water, oxygen and nutrients float to all parts of your body, and waste products are carried away.
When your kidneys remove waste from your body those wastes have to be dissolved in water. Digestion
and metabolism are water-based processes, and water is the primary lubricating element in your joints.
You even need water to breathe, your lungs requiring moisture to expedite the transfer of oxygen into
blood and carbon dioxide out of blood. Sweat, as mentioned, is mostly water. The water in your blood
carries heat from warmer body parts to cooler areas of your anatomy when you are exposed to cold.
In short, if you aren’t well hydrated, you won’t be able to stay healthy, maximize your performance, or
even maintain joy at being outdoors.
The water in your body, the fluid that keeps you alive and active, leaves you at an alarming rate.
Estimates vary widely, but an average person at rest on a normal day loses between two and three
litres of water. One to one-and-a-half litres rushes out as urine, and another one-tenth litre in
defecation. Moisture is lost from act of breathing, more than half a litre per day, and that rate increases
in dry winter air.
Then there’s sweat. The fluid lost in perspiration can climb to one to two litres per hour during periods of
strenuous exercise. Compared to watching TV all day, one hour of exercise may demand
approximately a 50 percent increase in the amount of water your body uses.
Your thirst mechanism, that feeling of ”Gosh, I need a drink of water”, doesn’t kick in until you’re about
one to one-and-a-half litres low. Down three to four litres can leave your endurance decreased to 50
percent and your oxygen uptake reduced close to 25 percent…
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The following are notes from The Wilderness Medicine Institute of The National Outdoor Leadership
School, U.S.A.
DEFINING HYPOTHERMIA
Why is it taught that hypothermia occurs whenever someone is shivering or their temperature drops by
a degree or two? I’ve read in several medical texts that the definition of hypothermia is a core body
temperature below 95F (35C). (A question from a student in a course I'm teaching)
Yes, if you read the medical literature on hypothermia it’s common to see a threshold for hypothermia
at 95F (35C). As a medical geek I like to probe the origins of stuff like this. The best I can figure this
norm was described by British researchers in the 1960’s and has become a commonly shared criterion.

3. It is fine and dandy for researchers or medical personnel with access to advanced life support to
anchor their work at this point, but it’s not the world in which we manage hypothermia. We don’t work
in rescue helicopters or emergency rooms with physicians, nurses and the benefits of medical
technology, or inside a controlled physiology laboratory. We have to manage cold people in the
wilderness.
We teach people to recognize hypothermia from subtle and early clues such as impaired ability to
perform complex tasks, fine motor shivering, apathy, confused and sluggish thinking, slurred speech,
stumbling, and "the umbles" (patient grumbles, fumbles and stumbles). We do this because we know it’s
much easier to stay warm than to warm a cold person.
Compared to the scientist our definition of hypothermia is loose. We call people hypothermic who are
probably only stressed by the cold, or are cold and unhappy, or who are simply having trouble coping
with the environmental conditions. I’d imagine if we could measure the temperature of our
“hypothermic” students we would find it only decreased a degree or two, if at all.
It doesn’t matter that our patient’s temperature may be higher than a clinical definition. It’s not
important in the field to know the patient’s temperature. What’s important is to be self-aware of your
physical state and vigilant of how your companions are faring in the cold. What’s important is acting
early and aggressively to stay warm, rather than needing to rewarm to cold person. We can treat this
early stage of hypothermia, these cold stressed people in the wilderness. A hypothermia wrap, a good
meal and some warm fluids often are just what the doctor ordered. What we can’t afford to miss,
because it’s much harder to manage in the field, is real hypothermia.
Responsibility of outdoors people: to recognise early signs and symptoms of ‘mild’ hypothermia, and
immediately take steps to prevent this stage from developing into ‘moderate’ hypothermia and
‘severe’ hypothermia.
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Blisters
Best prevented than treated! And easily prevented. Here is a cryptic description of the phenomenon
called blisters.
Blister is a heat (friction) injury – caused by the rubbing of the shoe against the skin. Following steps
taken will prevent blisters:
1.
Shoes snugly fitting and well-broken in (snugly: not so loose and not so tight).
2.
Two pairs of socks – nylon inner and thicker material outer. Socks should be well fitting and not
prone to creasing.
3.
Keeping the feet as dry as possible. Change socks regularly. Dry used socks in the sun or with
body heat (inside the sleeping bag at night).
4.
Be aware of a ‘hot spot’ developing on a foot – this could fast blossom into a glorious blister. A
simple padding on a hot spot transfers the friction on that pad instead of your skin. One just has
to overcome laziness to get that pad in. The pad can be a medical tape.