UKC

When climbing in places with no mountain rescue, we know we have to be able to get ourselves down off the wall and out to the nearest road. But what then, when you cannot just call an ambulance, and the nearest decent hospital may be hundreds of miles away, maybe in another country?

I’m thinking especially of places like Hampi, Taghia, Tsaranoro – that may be seen as just slightly exotic rock climbing rather than serious expeditions.

I’d like to talk about what insurance people have – especially if you’ve ever had to use it – and what emergency planning people do.

Please see my thread on our experiences in Madagascar with the Austrian Alpine Club insurance for the background to this question.

https://www.ukclimbing.com/forums/destinations/austrian_alpine_club_insuran...

With the AAC it turned out you have to organise and pay for emergency transport to hospital yourself, which I had not realised. But, we then had great problems getting reimbursed because we had organised and paid for it ourselves.

With BMC insurance, you are also expected to organise and pay for this yourself.      (I asked, and this was made quite clear. And no particular reassurance was forthcoming that it would be reimbursed, just a general reference to the terms and conditions.)

We paid out over 16 thousand euros in total, including 12 thousand for an hour and a half international air ambulance. (This was without any helicopter rescue – the first part was done by stretcher at low cost.) We had enough credit cards available to pay for this – a lot of people might not.

But more of a problem is the organisation. We had a vague plan, but not a detailed one, partly because we fondly imagined the insurance company’s “assistance” would step in once down off the wall.

Even when you realise they won’t, detailed planning is difficult because there are so many possible scenarios. And when it happens, you are having to make judgements about the seriousness of injuries that you’re not medically qualified to take.

I will certainly be doing a LOT more research before future trips. And we will be better prepared, in particular with a satellite phone.

But the insurance issue seems to be a thorny one.

Thanks for pointing all this out--seems something well worth thinking through before big trips, and I'll do that in the future thanks to your post! Glad your insurance situation was resolved, and best of luck to your partner about the infection.

As I've commented on your other thread, I'll keep this succinct, but in short, the key things I/we are clear on for all our expeds:

1) Location of med facilities, and their capability - this is worth checking when you're in country if at all possible - put aside a couple of days at the start to recce the likely hospitals/clinics you'll use, see what they have (anti venoms, RIG (rabies treatment), Malaria treatment, diagnostic equipment?). On the recce, time your journeys - knowing how long it will take you, what the roads are like, traffic (best to ask a local), is all useful info to have.

2) Your own medical equipment and knowledge - REC 2 (the 16 hour outdoor first aid course) isn't really sufficient for more remote areas in the developing world. Level 4 (Expedition) is another 16 hour course that focusses on exped med skills and likely injuries/illnesses. It will also help you put together an appropriate med kit.

3) Telemedical support -  most travel insurance policies come with med support in the form of a number you can call for medical advice. Test the service before you go - how long would you expect to be on hold for? Do you speak to a doctor straight away or are there screening questions? Do you need your policy number or do you have a pin to put in? You may also be able to get your GP to prescribe some meds for the trip (such as broad spectrum antibiotics), and it's good to get a doctor's opinion before actually using these. 

4) Repatriation - are there flying doctors? Again, do you need an account? Can you pay for separate cover for this or is it only on demand? Nearest airfield? 

5) Mapping of the area - I like to print out maps from Open street maps, mark them up, and laminate them - if you're undergoing a prolonged medevac, you don't want to be relying solely on tech. Ideally you'll have GPS which has medical facilities, airfields, and other key locations marked, and that will never run out of battery... but that isn't always realistic! 

6) Emergency contacts - People who you can rely on back home to help you in any ways remotely. They should have copies of your maps, plans, and you should keep them updated throughout your trip where possible. 

Not all of this is possible for everyone on every trip, but off the top of my head as a brain dump on things that will help if the defecation hits the oscillation, it's a start. 

Anyone have any other pre-trip tips?

Looking at the Tyrol Air Ambulance website they seem to have a tie up with "Assistance Plus" in Madagascar who apparently have 50 employees and arranged 105 outbound medical evacuations last year.  I couldn't see much info on the Europ Assistance website,  but Madagascar is not on a short list of random countries that they appear to operate in.   

I assume that if TAA were involved they would have organised and paid for the rescue?

Perhaps climbers need to check the capability of the emergency assistance company that their insurance uses, for the country they are visiting.

Can't edit so will add:

6) In-country support - if you have a contact in-country that you can rely on, talk them through your medevac plans. See if they have any suggestions, or can help you refine your plan. Ensure they have your contact details, and perhaps ask them to supply weather updates if they will be hard for you to get. If appropriate, you could give them the contact details of your home support, allowing others to co-ordinate logistics while you concentrate on more immediate issues.

Thanks for that useful stuff, joshtee.

Maybe one to add is communications - try to find out in advance whether there is mobile coverage where you are going and which provider has the best coverage; then you know which local sim to get when you arrive. And if no coverage, get a sat phone.

Another one is don't underestimate your own stupidity when under extreme stress! When fight-or-flight mode kicks in, you get tunnel vision. I have realised that at one point when we couldn't make a phone call, we had available both a basic dumbphone with a charge on it but a sim which wouldn't pick up the local network, and a smartphone with a local sim but the battery had died. And it never occurred to us to try putting the local sim in the working phone!!!

Good point about comms - something that if you can't confirm in advance, is good to do in the first few days/recce. 

I work with an awesome paramedic who's favourite saying is 'when someone is in a high stress situation, they're operating as the stupid version of them'. So true - really good point to make. Hard to mitigate against beyond rehearsing, or playing 'worst case scenario' and talking through situations throughout your trip.

J

The AAC are terrible in anyplace other than Europe. Yes they are cheaper than e.g. the BMC but they are incompetent and difficult to deal with when the shit hits the fan.

When I've travel to unusual places I use Campbell Irvine (http://www.campbellirvinedirect.com)

Over the last ten years I've used them for travel to Afghanistan, Sudan, South Sudan, Uzbekistan, Kyrgyzstan, Siberia and Chad. I used them once in South Sudan after a vehicle accident resulted in a wide open 8" gash in my leg with lots of blood, visible muscle damage and opportunity for infection. I also had a couple of broken fingers. There was zero mobile reception, but we had a satphone so could contact them and they leapt into action, and it was an excellent service with zero hassle and no refusal to pay. It's not cheap, but it's certainly cheaper than the £12k that the AAC cost you in Madagascar. My last trip was to Afghanistan and that cost around £800 for 6 weeks. Well worth it.

They don't appear to cover climbing or mountaineering.

I can think of nowhere worse to have a serious injury than South Sudan. Bit of a thread hijack, but did you do any climbing when you visited? There is some cragging just outside Juba that is quite acceptable. 

Good point. I'm not much of a mountaineer. In fact I am not one so that wasn't an issue for me. I tend to go exploring and trekking in these places rather than climbing so my suggestion might not be all that useful. It might be worth giving them a ring and chatting through the options or getting a recommedation from them for somewhere else to go. When I was in e.g. Afghanistan it was for a long walk through the Wakhan and Hindu Kush (in the footsteps of Eric Newby etc) so I wasn't considered to be doing anything unusual.

Yes, I'd heard about a few crags around Juba but only really explored Jebel Kujur which hadn't been developed at that point. It now has a load of bolted routes mainly done by a guy called Andy Chambers.

The best climbing in the area was actually in the Taka Mountains on the outskirts of Kassala in Sudan. Big walls with big vultures, and an enormous boulder field beneath it which we spent about ten days exploring in between drinking ginger coffee and hiding from the sun.

Yes I've done a bunch of those, didn't meet Andy but another British guy called Steve was very active when I was there a few years ago. 

This area looks incredible! But also incredibly hot. 

It was silly hot. We usually got up at 4am to get to the crag by maybe 530 after the buses started to run. We'd climb until maybe noon and then retire to have some coffee and snacks in the "honeymoon cafe". By about 2pm the rock would be just about too hot to hang onto, and that isn't much of an exaggeration. We measured the temp in the full sun at 2pm as 49C, and that was in late January. It's a beautiful place, and climbing to the col to watch the sun come up over Eritrea was magical.

Has anyone looked into Global Rescue cover?