VII. Precautions for Team Leaders at High Altitude

(1) Since you plan to be a team leader, while being confident in your capabilities, you must also be fully prepared to endure hardship and make sacrifices. As a leader of high-altitude activities, you bear greater pressure and responsibility than on activities at lower altitudes. This is because you not only face more complex situations and handle both anticipated and unexpected issues, but also endure the torment of altitude sickness yourself.

(2) All judgments and decisions should prioritize safety. Throughout the trip, when major issues arise, you should inform everyone of the situation, background, available options, and possible consequences, and seek their opinions fully. Based on collective input, the team leader should have the authority to make final decisions, and the guiding principle of those decisions must be “safety first.”

(3) On a regular basis, you should focus on accumulating knowledge related to outdoor activities, high-altitude travel, medical emergencies, and local plateau customs. Try to gain as much direct and indirect experience as possible, and then do targeted intensive preparation before departure. This knowledge and experience may come in handy at any time.

(4) Carefully study the itinerary, choose the best route, and develop a scientific and reasonable plan. Depending on how you are ascending to high altitude, design appropriate daily schedules, routes, speeds, and campsites accordingly, taking into account as many potential emergencies and countermeasures as possible.


(5) A reasonable altitude gradient is very important for acclimatization. For the overall itinerary, unless there are special requirements, generally try to choose routes that “go up gradually and return steeply, ascend slowly and descend quickly.” For specific daily plans, when arranging campsites above 3,000 meters, try to ensure that each night’s sleeping elevation is about 300 meters higher than the previous day, and under no circumstances exceed 600 meters (the lower, the better).
Unless absolutely necessary, even if it means waking up earlier or arriving later, try to avoid staying overnight at high altitudes, as it can lead to many unnecessary discomforts, troubles, and even dangers.
Plans often fail to keep up with changes, so adjustments must be made in a timely manner based on actual conditions.

(6) Provide necessary education to team members on safety, discipline, local customs, religion, environmental protection, and altitude sickness knowledge, and remind and require everyone to follow these guidelines throughout the trip.

(7) Make thorough preparations before departure. Often, something that seems ordinary inland may become urgently needed at high altitude and impossible to find. However, items that you are certain can be purchased at high altitude (such as basic food) and non-essential items can be left behind.

(8) Try to help team members overcome nervousness and alleviate altitude sickness. Based on practical experience in recent years, organizing everyone to sing songs when altitude sickness is about to set in has proven effective—it helps relax emotions, shift attention, and increase lung capacity.

(9) Implement all necessary safety measures. Pay close attention to the condition of team members, remind inexperienced ones to adjust clothing, drink water, take medication, apply sun protection, and restrict behaviors that could lead to negative outcomes (such as showering, washing hair, or getting into conflicts with locals).

When arranging accommodations, pair those with high-altitude experience with newcomers and those suffering more severely from altitude sickness, so they can observe and care for one another.

If team members show significant or severe symptoms, or if there are severe weather conditions such as heavy snow or strong winds, or other special circumstances, the team leader should conduct night patrols and address any issues promptly. A few years ago in Siguniang Mountain, there was an incident where snow blocked a tent’s ventilation opening, nearly suffocating a team member. Night patrols could have prevented this.

(10) Once any team member shows abnormal signs, respond decisively and promptly—seek medical help or provide self-aid. Never be negligent, and under no circumstances leave an individual showing abnormal symptoms alone. Arrange for an experienced person to accompany them and maintain communication.

(11) High-altitude regions often have many ethnic minorities with diverse and sometimes rugged customs, beliefs, and traditions. The entire team should respect local customs and religions and practice patience. In case of conflict, the team leader should strive to control the situation and prevent escalation.



VIII. Handling Emergencies at High Altitude

Friends who have been to high-altitude areas or snowy mountains—if you’ve seen someone develop pulmonary edema from a simple cold within just a few hours, or heard a Tibetan driver calmly mention how another traveler died of altitude sickness somewhere—often find themselves shocked at how fragile life becomes there, how ordinary death seems, and how close life and death truly are.

High altitude is indeed different from the plains. Any seemingly minor oversight or carelessness could cost a life. Therefore, extreme caution is essential, and you cannot rely solely on the health and disease judgment standards used at lower altitudes.

At high altitudes, the most life-threatening conditions are high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE). These two types of altitude sickness develop rapidly and have high fatality rates, so they warrant serious attention and vigilance. The emergencies mentioned here mainly refer to these two.


To deal with HAPE and HACE, I summarize the approach in 20 words: “Take proactive prevention, stay observant, identify early, treat promptly, and descend quickly.”

“Proactive prevention” and “stay observant” have been mentioned earlier. Now let’s talk about “identify early,” focusing on the main symptoms of HAPE and HACE:



(1) High-Altitude Pulmonary Edema

Usually occurs 24–96 hours after a rapid ascent above 2,500 meters. Major triggers include cold, fatigue, and weakened immunity leading to respiratory infections, which cause fluid buildup in the lungs. The fluid in the lungs hinders effective oxygen exchange, reducing blood oxygen levels and causing systemic tissue hypoxia. In severe cases, brain hypoxia leads to gradual confusion, unconsciousness, and even death.

The main symptoms of high-altitude pulmonary edema include: initially resembling acute altitude sickness—reduced exercise capacity, fatigue, difficulty breathing even at rest, headache, chest tightness, palpitations, and dry cough. As the condition worsens, there is severe breathing difficulty, cyanosis of the lips and face, chest pain, inability to lie flat, persistent coughing, and coughing up thin, frothy sputum that starts as white or light yellow and later turns pink. If you place your ear against the patient’s chest wall, you may hear bubbly sounds in the lungs (medically called “rales”). The patient may become restless and, in severe cases, gradually lose consciousness. Without intervention, the patient may fall into a coma or die within hours.


(2) High-Altitude Cerebral Edema

High-altitude cerebral edema mostly occurs after a rapid ascent above 4,300 meters. The primary cause is hypoxia-induced increased cerebral blood flow, elevated intracranial pressure, and brain edema, along with increased brain volume, which compresses brain tissue, disrupts cellular metabolism, impairs function, and eventually leads to unconsciousness and death. Its characteristics include: frequent occurrence at night, rapid onset; low incidence but high fatality rate.

The main symptoms of high-altitude cerebral edema include: initial signs of confusion, lethargy, fatigue, and impaired motor coordination (visual cues: the patient staggers, walks unsteadily, appears intoxicated; at more advanced stages, tying shoelaces or handling small objects becomes difficult, and they cannot accurately point to their facial features with a finger); as the condition progresses, there is severe headache, projectile vomiting, slowed reactions, reduced cognitive ability (visual cues: errors in simple arithmetic), memory loss, drowsiness, gradual confusion and unconsciousness, and in some cases, convulsions. Severely comatose patients often suffer from concurrent brain hemorrhage, which can be life-threatening.

In addition to taking a series of protective measures on the plateau, you should also pay close attention to yourself and your teammates. If any of the aforementioned symptoms occur, communicate and report them promptly.

When dealing with suspected or confirmed cases of high-altitude pulmonary edema or cerebral edema, the first thing to do is to send the patient to the hospital immediately. Leave the rest to the doctors—they know what to do.

If you are in a place without medical facilities, as a non-professional, the approach to treating both types of altitude sickness is the same: immediately take three actions—administer high-flow oxygen, give two tablets of “Lasix” orally (for severe cases, inject dexamethasone intravenously at the same time), and descend as quickly as possible. For patients with cerebral edema, you can also apply a cold compress to the forehead to reduce intracranial pressure.

Never delay, and definitely don’t wait for rescue in place. Descending 600–1200 meters immediately is the most important and effective treatment— the faster, the better; the lower, the better. Once down, go to the hospital right away. Always remember, every second of delay reduces the patient’s chance of survival.

Although we hope you never encounter this situation, anything can happen on the plateau. It’s best to keep these tips in mind.


IX. Returning to Low Altitude

After you finish your journey and return from high altitude to the plains, you may experience fatigue, weakness, drowsiness, chest tightness, dizziness, increased hunger, diarrhea, and other symptoms. Depending on the duration of your high-altitude activity and the altitude reached, the severity and duration of these conditions vary, but they generally disappear on their own within 1–2 weeks. This is known as “low-altitude reaction,” commonly referred to as “oxygen intoxication.”

“Oxygen intoxication” is essentially “oxygen poisoning.” Like altitude sickness, it is also a normal physiological response of the human body. Although it is far less harmful than altitude sickness, if not taken seriously, it can still have adverse effects on the body.

To cope with “oxygen intoxication,” pay attention to the following aspects:

(1) Get plenty of rest

Traveling is already strenuous, and with “oxygen intoxication,” you’ll need even more rest upon returning to recover your condition and physical strength.

(2) Pay attention to your diet

Eat more antioxidant-rich foods, including vegetables and vitamins, and drink less alcohol.

Foods such as tomatoes, oranges, strawberries, soy products, and tea are rich in vitamin E, vitamin C, tea polyphenols, soy isoflavones, and other components that offer strong antioxidant effects, which are beneficial in preventing and treating “oxygen intoxication.”

Those with more severe symptoms may also take vitamin E supplements.

(3) Drink plenty of water

Drink about 2–3 liters of water daily.

(4) Be cautious with special work

If you are engaged in special work such as long-distance driving or working at heights, be extra cautious during the “oxygen intoxication” period to ensure safety.



Conclusion

After writing so many lengthy words, if they prove helpful to you in any way, then the author’s original intention has been fulfilled. If there’s anything inappropriate, feel free to point it out—better to be corrected than to mislead others or oneself.

Alright, are you ready? Set off for the plateau.

Once you truly step into the west, into the plateau, and face the majestic snow-capped mountains, vast grasslands, and beautiful alpine lakes, you will become enchanted by the blue skies, white clouds, mountains, rivers, and vegetation. You’ll find that your soul has found a happy home. Compared to such rich spiritual rewards, the cost of altitude sickness will seem trivial.

From then on, your heart may carry an extra bit of longing—you’ll fall in love with the plateau, miss the plateau, and return to that sacred land that captivates your soul again and again.

By that point, what does high altitude really matter to you?