• environmental medicine, expedition medicine
• environmental medicine, wilderness medicine
• major trauma management
• major incidents, training
• mountian rescue

Every spring, Everest Base Camp (5345 m) morphs from a remote, undulating glacier to a miniature city over 2 km² in size and housing over a thousand people in nearly 50 separate camp sites. During a 2–3 month-period, several hundred climbers will make an attempt on the summit of Mount Everest (8848 m) with the support of hundreds of dedicated Sherpas as high-altitude porters, base camp staff, mountain guides and pathfinders (the ‘Icefall Doctors’). During weeks of preparation, trains of yaks can be seen in the distance, ferrying up loads from the nearest seasonal settlement Gorak Shep—a desolate, dusty village a few hours away. Each team will then spend weeks acclimatising to the altitude, where there is less than half the oxygen available compared with at sea level.

To support these teams, the Himalayan Rescue Association (HRA) staffs a temporary clinic at Base Camp known as ‘Everest ER’ (figure 1). It is the highest emergency room in the world, and for the last 12 years has treated climbers and expedition staff alike. It is a non-profit organisation whose volunteers have, on many occasions, been involved in providing life-saving treatment. The clinic runs 24/7 and will see over 500 patients in a season, with anything from difficulty sleeping to life-threatening cerebral oedema or severe frostbite. Challenges include the subzero temperatures, limited equipment, low ambient oxygen levels and geographical isolation.

The 2014 season started no differently from any of the previous years. On 18 April—Good Friday—our team at the clinic had already been in place for 2 weeks and seen more than 100 patients when, at 06:45, a loud roar woke many of us at Base Camp from sleep. The sound of an avalanche is not uncommon in that area, but this was unusual in its protracted rumble and echoing …