Treating patients on Mount Everest and the West Coast

Practicing medicine during a pandemic — in an emergency department, no less — can be extremely challenging. But is it more challenging than practicing medicine on a mountain in Nepal at an altitude of more than 18,000 feet? Dr. Chris Ho can answer that question.

Dr. Ho, a board-certified emergency medicine doctor at Sharp Memorial Hospital, has cared for people in many locations beyond hospital walls. From an Alaskan tundra to inside a tent on Mount Everest, he has treated all sorts of ailments in a wide range of settings.

“Training in emergency medicine after medical school really translates well to opportunities to provide remote medicine,” he says. “It started when I was a resident and provided expedition support in the Juneau ice field with a group of geologists.”

But if you really look back into Dr. Ho’s past, his training likely began as a child camping, hiking and skiing with his family. Not to mention he was an Eagle Scout, the highest rank attainable in the Boy Scouts of America. And in college, he took advantage of every opportunity to do more adventurous things, including rock climbing and back-country skiing.

“I grew up in Northern California,” Dr. Ho says. “We’re really into the outdoors.”

Providing care from Juneau to Nepal
When Dr. Ho headed to Alaska during a summer break in his residency program, he was not only overland skiing, hiking, mountaineering and providing medical care, but also participating in just about every activity members of a geology expedition perform. He took turns cooking for team members, performing basic geological research, and setting up and breaking down camp.

“I’m no geologist,” Dr. Ho says. “But everyone has to pitch in. You’re mostly there for manual labor until someone needs medical care.”

After completing his residency, Dr. Ho took a volunteer role with the Himalayan Rescue Association Nepal to provide care at a clinic at the base of Mount Everest. However, it was not just the trekkers he found himself treating.

“Everest is very unforgiving. You’re dealing with high altitude sickness, hypothermia, frostbite, and general illness and injuries,” Dr. Ho says. “People get sick and die there every year. But the most care I provided was for Nepalese locals — the sherpas and porters who lived in the area and don’t have access to regular care.”

As for the trekkers, the cost to conquer Everest is so expensive, and training is so intense, that many groups had their own doctors with them in hopes of better ensuring their climbers’ success. What’s more, the base camp doctors were often unable to reach those needing care higher up the mountain. So, injured or ill climbers and their team had to deal with issues where they were or somehow make their way down to the medical tent at base camp.

“We did everything from treating diarrhea and giving people oxygen and IV fluids, to providing wound and hypothermia care,” Dr. Ho says. “If someone was very sick, we had to try to get them off the mountain, and that was done by helicopter, which is very expensive and difficult — and unfortunately, not always logistically possible.”

From mountain medicine to urban search and rescue
Later, when Dr. Ho moved to San Diego, began working full time and started a family, he stuck closer to home. “The days of going off on months-long, faraway adventures came to an end,” he says.

However, he has continued to teach wilderness medicine to volunteer groups and lecture on medical travel. He is also a Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force manager for the San Diego-based team.

Dr. Ho's extensive travels gave him first-hand experience that he now uses to teach wilderness medicine and lecture on medical travel.

The task force is deployed by FEMA to a disaster area to aid in structural collapse rescue or can be prepositioned when a major disaster threatens a community. Each team is equipped and ready to deploy within six hours and features specialists in medicine, hazardous materials, structural engineering, logistics, planning, and search and rescue.

“Our most common deployments are for earthquakes, hurricanes, wildfires and mudslides,” Dr. Ho says. “The San Diego team is mostly designed as an earthquake response team and can be sent to other states or even to other countries, if needed.”

Tips for your own wilderness trips
As for the local hiking hobbyists or wilderness wanderers he occasionally treats in his San Diego ER, Dr. Ho says most run into a few specific problems. These include dehydration, overestimating their skill level and getting lost.

“People are too reliant on their cellphones for navigation, and they often find themselves with no coverage or no power,” he says. “You have to have a way of navigating without your phone.”

Additionally, Dr. Ho recommends the following tips for safe outdoor adventuring:

Don’t go out alone. If you do, however, share your travel plans with someone and check in with them regularly. “Have a plan prepared in case you or someone in your group gets hurt or weather shifts dramatically,” he advises.

Bring enough water. According to Dr. Ho, “Often, it’s hotter than you assume it’s going to be, there is less shade than you expected, and you’re not as fit as you think you are.”

Be prepared. Bring first-aid materials appropriate to your level of first-aid knowledge. “You’re better off learning basic first aid than buying a big first-aid kit,” Dr. Ho says. “In the wilderness, medical knowledge is far more important than equipment or gear.”

Carry an EpiPen. If you or anyone in your group have any chance of an allergic reaction, you must have an EpiPen or generic version with you. “With an EpiPen at hand, there’s the opportunity for a lay person to save a life,” he says.

“Calculate what’s worth the space and weight in your bag, where you are going and who you are going with,” Dr. Ho says. “What I carry on an expedition or rescue will be very different than what someone with no knowledge or experience will carry. But we should all choose wisely.”