The Mountains are Inherently Unpredictable and Unforgiving

Warning: Mountain Climbing requires special training and gear and is inherently dangerous.  

We have Skilled and Experienced Youth and Adult Climbers in our Troop.  If a climb is considered, a good amount of training must be completed prior to a summit attempt and only a select few Scouts and Adults will be able to attend.

If you are considering a Climb, consider taking a climbing course and using a Guide Service for your big adventure.

Do NOT Attempt Mountain Climbing without Properly Training for it or without Experienced Guides!

Medical Concerns for Mount Rainier

Mount Rainier has claimed more lives than any other mountain in the United States. While it isn't as technically demanding as the peaks of the Himalayas, it remains surprisingly dangerous. In fact, more people have died within this national park than on Mount Everest. Although the mountain's high fatality count is partly a result of the large number of visitors it attracts each year, climbing Mount Rainier is far riskier than most people realize.

Your team should have an adult medical lead with at least Wilderness First Responder training, and ideally an Expedition Medical Provider able to provide care beyond first aid.

Listed below is a list of several medical concerns that need to be considered and planned for.  References to practice guidelines for Hypothermia, Frostbite, High Altitude Illness and Avalanche Accidents are also included.  These references should be reviewed by all Adult Leads.

Both Hypothermia and High-Altitude Illness symptoms can be very subtle and difficult to identify early on.  That said, identifying and treating them early on can save the expedition or possibly a life.  The more eyes we have on our participants, the safer the group will be.

Hypothermia and Cold Injury

References:

• Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update

• Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2024 Update

• BICO card – excellent course that used to be free

Concern: Sudden weather changes and unplanned or prolonged stops increase the risk of hypothermia.  Early stages of hypothermia are not life threatening but will impact the victim’s ability to care for themselves.  This can slow travel and increase the risk of exposure, falling and other injuries.  Later stages of hypothermia are more problematic and will necessitate carrying out the victim and can threaten the safety of the rest of the group.

We have seen plenty of youth attend training with worn out or inadequate boots and clothing. 

Mitigation:

• Ensure all participants pack proper clothing 

  • Consider gear check prior to loading vehicles

• Ensure participants pack enough food

• Avoid overheating (sweating) and overcooling

• Frequent group checks and opportunities to quickly layer up or down

• Emergency Gear - Summit Gear should include:

  • 1 sleeping bag

  • 1 foam sleeping pad

  • 1 tarp

  • 1 stove (with fuel and pot)

  • Satellite Messenger

• Monitor Weather

  • Know when to turn around or hunker down

Heat Illness

Reference: 

• Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update

Traveling up a steep mountain in the middle of summer can be a whole lot hotter than you might think.  Add on extra clothing than you started your climb in, and you have a recipe for Heat Exhaustion.

Mitigation:

• Monitor group

• Observe for signs of Heat Illness

• Allow stops to adjust layers

• Ensure proper hydration

High Altitude Illness

References:

• Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update

• CDC Yellowbook - High-Altitude Travel and Altitude Illness 

Risk of High-Altitude Illness is mostly based on how high and fast you ascend and on Genetics.  Physical fitness and the drive to succeed will help you summit but will not protect you from becoming a victim.  You are either born for High Altitude, or you are not.  Most of us will be fine on Rainier, some will need more time to acclimate, and some people won’t be able to ascend safely without oxygen.

Ascending past 8,000 feet frequently leads to Acute Mountain Sickness (AMS), presenting as severe headaches, nausea, and shortness of breath.  High-Altitude Cerebral Edema (HACE) and High-Altitude Pulmonary Edema (HAPE) are less common but are life threatening and can also occur above 8,000 feet.  Ignored, AMS can progress to HACE.  Untreated, HAPE and HACE are fatal in 50% of cases and death can occur within 12 hours.  

Identifying High-Altitude Illness early on allows you a chance to prevent progression and save a life.

Rainier/Emmons Glacier Elevations:

• White River Campground is at 4,400 ft

• Glacier Basin is around 5,900 feet

• Camp Curtis is around 8,685 feet

• Camp Schurman is around 9,500 feet

• Mount Rainier's summit is at 14,410 feet

Rainier/Disappointment Cleaver Elevations:

• Paradise is at 5,400 feet

• Camp Muir is at 10,188 feet

• Ingraham Flats camp on Mount Rainier 11,100 feet (up to 11,400 depending on snow conditions)

• Mount Rainier's summit is at 14,410 feet

Mount Baker/Easton Glacier Elevations:

• Park Butte Trailhead 3,360 feet

• Sandy Camp sits at an elevation of 5,800 - 5,900 feet 

• High camps north of Baker Pass at 6,000 - 6,800 feet

• Mount Baker Summit 10,778 feet

Notes

*Assumes starting altitude <1,200 m (<4,000 ft)

Abbreviations: HACE, high-altitude cerebral edema; HAPE, high-altitude pulmonary edema; AMS, acute mountain sickness.

Recommendations for each category in Table are as follows:

• Low Risk: Acetazolamide prophylaxis is not indicated. The traveler should carry over-the-counter analgesics for headache and have acetazolamide to speed acclimatization as necessary or to treat early AMS.

• Medium Risk: Acetazolamide prophylaxis would be beneficial; consider its use. Have the traveler carry acetazolamide for prevention or treatment of AMS and consider prescribing dexamethasone for emergency use.

• High Risk: Strongly encourage acetazolamide prophylaxis, and have the traveler carry dexamethasone for emergency use.

High Altitude Illness Mitigation:

• Medical provider on team

• Leaders review High Altitude Illness Guidelines

• Observe participants for changes in breathing and mentation

• HALT ascent if signs of AMS

• Descend if signs of neurological (HACE) or breathing (HAPE) problems

  • Persistent vomiting

  • Wet/rattling coughs

  • Confusion

  • Stumbling 

    • aka ataxia 

    • Bad sign!

    • Delays in evacuation will require carry out and is potentially fatal

• Consideration for use of Acetazolamide (brand name Diamox) to hasten acclimation

  • Talk to travel med provider prior to trip

  • Generally started the night before ascent

  • Adults: 125 mg every 12 h 

  • Peds: 1.25 mg·kg−1·dose−1 (maximum, 125 mg·dose−1) every 12 h

• Carry medication for treatment of HACE and HAPE

Staged Ascent

• Studies suggest that a 2 day stay at 3,000m ( 9,800’) is effective at preventing AMS to 4,300 m (14,100’)

  • Longer stays suggested by other studies

• This is often shortened for Rainier

  • Shorter timeline due to easy access to mountain

    • Summit often completed in 2 days

    • Although common – a 2-day plan is NOT the safest approach

  • Rational

    • HACE and HAPE are rare

    • If develop HACE or HAPE, you are hopefully already descending

    • You can get more clients up the mountain with a shorter timeline

  • Risk - Delays due to storm or injury can result in lethal High Altitude Illness

Example Individual High Altitude Med Pack

Must be prescribed by a medical provider prior to trip

• Acetazolamide 125mg x 12

• Dexamethasone 4mg x 12

• Nifedipine 30mg x 6

• Ibuprofen 600mg x 12

Dehydration

Reference: 

• Wilderness Medical Society Clinical Practice Guidelines for Water Disinfection for Wilderness, International Travel, and Austere Situations

Dehydration leads to losses in performance.  Moderate dehydration increases the risk of heat and cold injuries and can stop the group in its tracks.  Severe dehydration or dehydration combined with HACE is life threatening.

You lose more water than you think on the mountain

• Lost through breathing

  • Drier air

  • Faster breathing due to decrease in oxygen pressure

• Increased urination

  • Your body dumps bicarbonate in urine to help body with high altitude acclimation – this makes you pee a lot

  • Possible increase in urination due to cold

• Lower thirst response at high altitude

We have witnessed youth NOT refilling water bottles with snowmelt and only relying on the water brought with them from home.  2 liters is NOT enough water to safely summit Rainier.  Proper hydration will require a water resupply plan. 

Mitigation:

• 1 stove per 2-3 participants

  • Allows for adequate melting of snow

  • Don’t forget fuel, pot, and platform (3mm plywood is fine)

• 2 bottles of water

  • One should be Nalgene (maybe Tritan) to allow of hot/boiling water

  • Many bottles will warp and leach out chemicals if filled with hot water

• Discuss and ensure proper hydration with participants

Water Purification:

• Great debate on the best way to approach this on the mountain

  • May need a different plan for glacier and for lower camp

    • Melt/boil at high altitude

    • Filter at low altitude

  • Best Recommendation: Boil ALL Water

• Snowmelt

  • Many people drink snowmelt without issue

  • Avoid areas where people walk/camp/use the bathroom

    • Use just enough fuel in stove to melt snow – minimize fuel used

    • Find and collect water that is naturally melting in the sun

    • Leave water in black garbage bag during the day

  • Some risk of illness

    • Giardia is the main threat – some opt to risk becoming ill and hope symptoms will start AFTER end of adventure

    • Melted water on glacier less likely to cause illness

    • Melted water at lower elevations more risky

• Boiling Water

  • Kills everything in water

  • Safe to drink

  • Uses a lot of fuel

  • Needs to be cooled before placing in most bottles

    • You must have at least one heat resistant water bottle

      • Standard Nalgene bottles (Tritan Renew plastic) can safely handle hot and boiling water

        • Nalgene Ultralite bottles (High-Density Polyethylene (HDPE)) are rated to hold boiling water

          • These soften with heat

          • Need to wait 2-3 minutes to cool down before putting on cap - otherwise steam will pop off lid

          • Hikers reports that boiling water added to these tastes like plastic

          • NOT recommended over Standards Nalgene bottles

      • Double walled metal canteen

        • Single walled canteens work too, but are too hot to hold when filled with boiling hot water

• Filter

  • Filters out Giardia and Cryptosporidium and bacteria

  • Does not filter out viruses – generally not an issue here

  • Great for treating water in lower altitudes

  • Filters will freeze solid if they get cold enough

    • Can’t filter water if filter is frozen

    • Ice will permanently damage filter filaments

  • NOTE: do NOT run boiling hot water through filter

    • This will likely damage the filter

    • It is a waste of fuel – instead, filter snowmelt or warm water only

  • Can be used at higher attitudes in the summer

    • Can hasten water treatment and conserve fuel

    • Warm filtered water can be used to fill regular water bottles without having to wait for it to cool

    • Must keep filter in ziplock bag in sleeping bag at night to protect from freezing

• Chemical Treatment

  • NOT very effective against Giardia, especially when water is cold

    • Should NOT be a major issue on glacier

    • Problematic at lower camps

  • NOT effective against Cryptosporidium

    • Should NOT be a major issue on glacier

    • Problematic from water sources with waterfowl or human bathing/swimming

  • Can treat bacteria and viruses from snowmelt

  • Wait time required to be effective

    • Need to double wait time with cold water – plan for an hour for bacteria and viruses

    • Wait time for Giardia and Cryptosporidium is unrealistic

  • Allows you to adequately treat most water on glacier without using up too much fuel

  • Chemical Tab Examples:

    • Katadyn Micropur  

      • Chlorine Dioxide (ClO₂)

    • Aquatabs

      • Sodium Dichloroisocyanurate (NaDCC)

      • Better Value

• SteriPen

  • Uses UV light

  • Supposed to treat Protozoa (Giardia), Bacteria and Viruses

  • Requires use of internal batteries

    • Extreme cold and wind drain batteries incredibly fast

  • Expensive and most people don't have these

  • Bulb can shatter

  • NOTE: some glaciers can have a lot of silt and clay mixed in it (Glacial Flour) - which will decrease penetration and efficacy of UV light

Solar Radiation Injuries - Sunburns and Snowblindness 

Seattle people are often not optimized for full sunlight at altitude.  Snow can reflect 90% of sunlight back at you.  Sunglasses reflect light back at your nose.  Few are ready for a double dose of solar radiation.

Proper protection from sun is needed:

• Long sleeve shirts and pants

  • Sun hoodies are nice

• Glacier glasses

  • Snow blindness is painful and can stop the group

  • Ideally Category 4 lenses (< 8-12% visible light) and side shields

  • Group should bring extra set in case one gets lost

  • Emergency ones can be made from duct tape

• Sunscreen (SPF 50)

  • Badger Adventure Sport Mineral Sunscreen (SPF 50)

    • REI

    • Fred Myers

  • All Good Sunscreen Butter (SPF 50+)

    • Fred Myers

  • Thinksport Clear Zinc Sunscreen (SPF 50)

    • REI

    • Costco

  • Sun Bum Mineral Face Stick (SPF 50)

    • REI

    • Costco

• Lip Balm (SPF 30+)

  • Badger SPF 15 Mineral Sunscreen Lip Balm

    • REI

  • Aquaphor Lip Repair + Protect SPF 30

  • Sun Bum SPF 30 Lip Balm

• Nose shields are not a bad idea

Climbing Associated Injuries

Falls and other injuries are always a possibility.  Hypothermia, Altitude Illness, Dehydration, and Exhaustion all increase the risk of falls.  Avoiding these will also help you avoid falls and other injuries. 

Rock falls are a major cause of injuries to climbers, especially at Disappointment Cleaver on Mount Rainier.  

In the past, a participant didn’t bring crampons.  This makes glacier travel too dangerous and will result in the team canceling the trip or sending that participant home. 

Mitigation:

• Safe climbing practices

• Appropriate Safety Gear

  • Helmets

  • Climbing gear

  • Alpine axe and possibly poles

  • Crampons

  • Gaiters

• Medical Training

  • Wilderness First Aid - with High Altitude Illness Module

  • Expedition Provider - WFR or higher

• First Aid Kits

• Consider use of gaiters to reduce risk of injury when crampons are used

  • They also protect your expensive pants from being cut open

Avalanche

Reference: 

• Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update

Mitigation:

• Avalanche training

• Review guidelines in case the worst happens

Exhaustion

Each of our participants moves optimally at a different speed and forcing slower participants to move at a faster rate may be counterproductive.  Over pacing climbers can lead to the need for more frequent and long rest breaks as well as exhaustion.  A slower pace is often faster and more sustainable than a rapid pace.

Exhaustion is often confused with High Altitude Illnesses.  High Altitude Illnesses often necessitate descent and evacuation from the mountain.  Both Exhaustion and High Altitude Illnesses increase risk of injury.  Avoiding Exhaustion may prevent an avoidable injury or unnecessary end to the trip.

In the past, we have seen participants not bring food and others unable to keep up with the group due to differences in conditioning.  

Pace:

• The group must set a pace that works for the entire team

  • Group should move together to reduce risk that one group becomes isolated 

• If a participant is unable to maintain a reasonable pace, they threaten the safety of the entire team

  • Slow paces and excessive breaks will result in increased exposure on the mountain and increased risk to the entire team

  • Risk of injury increases as climbers reach exhaustion 

• In the past, Climbing Guides would often set intense paces

  • This was the norm

  • Led to exhaustion related injuries

• In 2022, and AMGA became the standard for guides

  • A consistent and sustainable pace is the new norm

  • Focus on target heart rate and not on shear speed

• RMI and AAI set a pace at 1000 feet of elevation gain per hour

  • Faster than this is taxing on many

  • Slower than this increased exposure on the mountain and makes each section that much longer to complete

Mitigation:

• Ensure participants pack appropriate amounts of food and water

  • Meals and snacks are vital for performance

  • Proper hydration is vital for performance

• Monitor pace

  • Not too fast – monitor group

  • Not too slow – avoid getting cold or expending extra energy moving painfully slow

• Inspect gear carried – avoid unnecessary weight

• Distribute weight appropriately

  • Some can carry more than others

• Monitor group

• Drink and snack at breaks

Sanitation

Climbers have gotten sick at camp due to poor sanitation.  Nausea and vomiting are also signs of High-Altitude Illness, which confuses how to treat sick climbers.  

Participants should bring and know how to use blue bags.  This helps protect the water others will drink later.

What to bring

• Ziplock freezer bag and possibly a poop tube

• Blue bag kit

• Paper Towels

  • Hold up MUCH better the TP

• Hand sanitizer