State of emergency evacuation in Nepal

Short answer – it is largely driven by profit motive, long answer below.

In October, I was leading a camping trip in the Kanchenjunga region of eastern Nepal. During an acclimatisation trek near Ghunsa our client experienced a sudden onset of arrhythmia (irregular heartbeat). Following consultations with two doctors, including HAL’s remote trip doctor, Dr. Pranav, we decided to urgently evacuate our client to a hospital in Kathmandu.

I called the client’s insurance company in Israel to let them know of what happen, and to get a clearance from heli-evac. When the call connected they could only speak Hebrew. This presented a significant communication barrier. Thankfully, Daniel was feeling okay to talk and explain to them about his situation. After getting a clearance from the insurance co I initiated the rescue on Oct 31st, and spoke with the representative from the helicopter company on the why/how/when of rescue. To which he replied – this is a holiday season (it was Tihar) and Kanchenjunga is in a restricted area. He was implying it will take time because of approval requirements from multiple agencies; District Administrative Office (DAO), Home Ministry, Ministry of Defence and Civil Aviation Authority of Nepal (CAAN) When a patient is in distress and does not know when his medical condition might deteriorate, all they want to hear is – I will do everything I can to get you out of there, and here is the tentative timeline. 

We were only evacuated on Nov 2, after two days. After leaving Ghunsa, our helicopter made a detour to Lukla to pick up other stranded trekkers, which was unexpected and concerning. Then it hit me – Nepal does not have a dedicated medical evacuation service, rather a money driven air transportation service, where heli companies put money and profit above people’s lives.

Recent events, such as the incident involving helicopter blockades at Manaslu, highlight the challenges faced by Nepali citizens in accessing timely medical evacuations in remote areas. 

Another issue is of some Nepali adventurers not having enough coverage (in most cases no coverage at all) for heli evacuation in case of emergencies. This was seen first hand in Kanchenjunga where a local Nepali had to pay Rs. 8,00,000 (USD 5,894) to be airlifted to Kathmandu. He was suspected of Appendicitis. 

HAL is trying to elevate the safety standard in Nepal through its Himalayan Outdoor Safety Initiative (HOSI). HOSI provides orientation on outdoor safety protocols for guides and trekkers, organizes educational initiatives (Wilderness First Aid training) and supports the explorers with lending library of satellite communication devices.

To improve medical evacuation services in Nepal, the following suggestions are proposed:

1. Given the profit-driven nature of the private sector, the government should play a crucial role in establishing a dedicated air emergency rescue service. This service should be coordinated with government hospitals and private providers.
2. A strong and independent mountaineering association, such as the Nepal Mountaineering Association, should play a key role in advocating for improved medical evacuation services. This includes lobbying the government to streamline procedures for helicopter evacuations in restricted areas.

If you are in Kathmandu on 14 Dec, come say hi to Vivek at Nepal Adventure Expo and learn how HOSI can help you plan your next adventure.