We would like to thank Drs Welch and Symmons for taking the time to consider our article and share their recent experience on Kilimanjaro.
The authors highlight the limited knowledge among guides and poor availability of equipment on Kilimanjaro, as consistent with our findings, and quite rightly point out limitations within our study and the need for a more in-depth analysis of the medical care that commercial operators are providing. We do indeed aim to advance our previous work by carrying out more detailed surveys with high-altitude commercial operators to look at this, in particular the use of supplemental oxygen.
Like Drs Welch and Symmons, we also welcome a discussion of the potential solutions for treating life-threatening high-altitude illnesses. The prevention of illness is always better than treatment, and thus we agree that the greater education of porters, guides, and tourists and ensuring that adequate preparations are in place are essential and invaluable aims.
The Himalayan Rescue Association and International Porter Protection Group (IPPG) play an important role in manning small aid posts at various sites on the Himalayas staffed with experienced voluntary doctors during peak trekking season to provide treatment. They also provide detailed information on mountain safety and prevention of high-altitude illnesses to trekking companies and individuals in order to help eradicate avoidable illness, injury, and death. A similar organized medical rescue service on other mountains would indeed improve the care of those falling ill on popular mountain expeditions. However, the setting up of these facilities may conversely cause commercial operators to abdicate responsibility of preventing and managing high-altitude illness.
In the prevention of high-altitude illnesses, the most reliable and simple method is by instigating longer periods of acclimatization (as described in Ref. ). The Wilderness Medical Society consensus guidelines recommend that once above 3,000 m individuals should not increase their sleeping elevation by more than 500 m per day and include a rest day every 3 to 4 days. On Kilimanjaro clients pay for each day they are on the mountain. This encourages many commercial operators to ignore the need for acclimatization and ascend too quickly. Therefore, one approach that has often been cited is to introduce a single multiday entry fee to the park and therefore reduce the financial incentive to spend as short a time as possible on the mountain.