Extreme altitude and illness: How can medical sciences help us to achieve the Everest dream?

Since the first recorded summit of Everest in 1953, medical and technological advances have increased the mountain’s accessibility. This has resulted in a commercialisation of Everest expeditions and an underestimation of the challenges the mountain poses. A large proportion of climber mortality on Everest is attributable to controllable and often preventable human factors called subjective hazards, the most prominent being altitude illness. Arguably the biggest cause of death on Everest, altitude illness is a set of conditions resulting from the inability to acclimatise to the hypoxic environment at altitude. Increasing numbers of climbers on Everest are underprepared, meaning they are at increased risk of developing altitude illness and death. The aetiology of altitude illness is complex and multifactorial, however there are measures which can be taken to reduce susceptibility and treat the condition. Unfortunately due to its complex causation and unspecific symptoms, altitude illness is often hard to foresee and diagnose. Susceptibility to altitude illness is increased massively with a previous history of the illness, fast rate of ascent and certain genetic factors. Knowledge of the causation is being used to construct clinical tests, which can help predict summiting success and produce management plans for those suffering from the illness.This review identifies the importance of acclimatisation programmes and a slow rate of ascent in reducing the incidence and severity of altitude illness. In addition to examining current best practice for its prevention and treatment, it also aims to produce a conclusive approach to extreme altitude expeditions, by discussing the efficacy of possible screening tests and the best predictors for altitude illness.