21 Steps to Follow when Choosing an Expedition Company for Everest or other 8000m Peaks

21 Steps to Follow when Choosing an Expedition Company for Everest or other 8000m Peaks

The Fall season is upon us and it is the time when many plan their next big climb in the Himalayas. As I write this article, few major expeditions will be going to Nepal this year and it is still uncertain as to what next year will be like. But if you are optimistic about a turn-around with the pandemic, what follows are 21 key features that you should be looking at, in order to choose which expedition you will join next Spring for Everest North or Everest South. They are not in order of importance. 

1. Success rate: Be wary of ANY company that claims 100% success rate. I have no knowledge of a single company that has this. Success means you arrive at BC, you participate in the expedition, you summit, and you return to BC. Don’t shop for phony success rates and instead look for a credible safety record. Safety also means no frostbite, no permanent organ damage, no time in a KTM ICU, no cardiac stents, no fractures, etc. Don’t be afraid to ask or to hold your company accountable for answers on this most important subject.   

2. Flash (Rapid ascents) vs Normal ascents: The price differences are big but your chances for success are no better with either. There is very little difference once you are on the mountain between the two groups in how you are treated. You can rent your own hypoxic tent from Hypoxico, use it one month before flying into KTM, and you will be as ready as those who are paying 50-75K more than you are. Once you are on the mountain, you will all eat the same food, have similar tents, and have similar support. If you rent a Hypoxico tent, and track your O2 saturations daily, you will already have baseline saturations for different altitudes before you arrive at BC. Share these with your expedition doctor. Finally, Flash ascents can turn into Normal ascents if the weather does not cooperate. Last year on Everest North most flash groups spent almost one month on the mountain before they could summit.

3. Unlimited O2 vs “We’ll let you know how much O2 we’ll give you”: Both are red flags if you are offered these. You should have as much O2 available as your body will need. (You don’t have surgery where the anesthesiologist gives you too little or too much - you get the right amount depending on the circumstances!) Do the math.(Tank capacity/O2 flow in l/m = num hours/tank) Nobody has unlimited O2 at Everest. Beware of any drugs (Epo) or inert gases offered by any company to increase your hematocrit. These have many side effects which you may later regret. If an inert gas can, trigger the release of a hormone in your kidney, think of the many other things it can possibly do. A good ballpark figure to keep you perfectly safe on a climb is some 6-10 bottles (1200ml) of O2/climber for an entire expedition. If you are in terrific shape, you may only need 4. The trick is to dial your O2 flow at all times to keep your saturations at BC levels (80% +-2%) at all times during your climb, and you will most likely avoid HAPE or HACE and even frostbite. I recommend never going below 75% in order to avoid triggering pulmonary hypertension, HAPE, and/or HACE.

4. Free unlimited WiFi offer: On the North Side (China), if you buy a phone card with >50 GB of data in Lhasa, you will have all the wifi you want for some $50. With 5g now at BC and further up, expect even a better deal. This has nothing to do with your expedition. Bring your unlocked phone to either side, and buy Nepali and/or Chinese SIM cards locally. On the South side (Nepal) things are not as simple and although WiFi and 3g are available, they are unreliable above Namche. Ask the Sherpas for the best spots. A Thuraya sat-phone and/or Thuraya IP+ is the ideal way to go. The IP+ may be provided by your expedition. A sat-phone is never a bad idea anyway, just in case things go sour and you need to call for help from anywhere on the mountain. Last year communications with Thuraya on the Chinese side were intermittent. Thuraya did not rule out interference. 

5. Electrical outlets at BC: On the North Side (China) there is electricity at BC so expect your expedition, regardless of what you paid, to bring to your tent a multiple socket outlet. Power comes and goes and is not perfectly reliable, especially when there are high winds or a storm. Above BC, expect power from solar powered batteries. On the South side at BC (Nepal) you may not have the luxury of power inside your tent, but if you go to the dining tent/lounge, you will have power from batteries charged by solar panels or from generators. Above BC, it’s no different than on the North side.

6. Bed with Mattress vs Therma-Rest: At BC some expedition companies offer a bed inside a stand-up tent with its own mattress and even a desk and night table. I have found no difference in the quality of sleep I get whether I’m on one of these beds or my therma-rest. In fact, I tore my sleeping bag with one of these metal beds last year. (Bring patches for your sleeping bag or down suit.) Beds and other amenities are only available at BC and again, not a reason to choose one expedition company over another.

7. Lounge with Panoramic views of Everest: Some Western expedition companies, and even Nepali ones (to play catch-up?), offer a picture on their websites of “this could be you” on a cushy sofa with an Everest view, a glass of champagne in your hand, all while watching a Netflix movie. Not sure this is why you are going to Everest, and frankly, I rarely saw anybody in these lounges while at BC for any length of time. They’re usually cold!

8. All-you-can-eat Goodies: Depending on the expedition you are with, you will have access at all times to exotic candy-bars, cookies, potato-chips (pringles), soda, ham, and even wine. Access to these is for everybody. Be careful about catching any sort of virus from somebody else if these have been touched by unsanitized hands. Personally, my appetite is quite diminished at altitude, and it’s not this type of food that I want to eat there anyway. Eat what the Sherpas eat at all times, and you will be more than fine. The Sherpa breakfast is my favorite - a high calorie meal with lots of potatoes, tsampa, vegetables and black tea. 

9. Kitchen at BC and above: These are run mostly by Nepalis on both sides of the mountain. Expect pretty much the same food on both sides. I have been treated to some outstanding meals on the day of arrival at BC, but don’t expect to be eating better because you paid a hefty expedition fee. Everybody sits down at the same table, and all will eat plenty of rice, lentils and chapatis. If your expedition outfit offers espresso machines as a perk, these are only at BC, and they will most likely freeze at night and won’t work until mid-day. Your kitchen crew should follow practices that prevent contamination from viruses, and this will become a major challenge for future seasons. Ask about how dishes are washed, how utensils are cleansed and dried. I would bring my own fork and spoon (or SPORK) to avoid pitfalls with these. Smorgasbord type service in the dining tent should not be practiced anymore. Visit the kitchen tent at BC on day one to see what new practices are in place.

10. Respiratory Infections and Social Distancing: No company up until now has taken this seriously and entire groups end up with a bad flu often coming from a single climber with a virus that he/she brought from home or their plane ride. Expect claims from every expedition now as to how they will control this. This alone may make or break your summit dreams. Look for a well thought out plan, and perhaps an infection control expert as part of the expedition. Ask about isolation of anybody with a cough or fever until a COVID test is available. Common isolation practices for respiratory infections used in hospitals are not part of expeditions yet.

11. Pulse Oximetry: A pulse oximeter is a medical device which can be used no differently than how your mom used a thermometer at home when you were a kid, or it can be used intelligently by a medical specialist.  Beware of cheap pulse oximeters - most display false data when the saturation is below 80%. Use only FDA approved devices. Pulse oximetry can predict HAPE or HACE long before it happens, and can be used to help manage it. Steroids for HACE have very little support in the medical literature, and in fact, they are no longer used in Neuro ICUs for cerebral edema. Don’t rely on these if you get into trouble. (Mannitol is what is used today to treat cerebral edema - but you need a central line.) The best way to prevent HACE or HAPE is to avoid its main trigger which is of course hypoxia, most insidious at night when you are sleeping flat on your back.    

12. Gear: These days, the gear you need to take is pretty standard. Follow standard recommendations since these vary little from one company to another. One interesting suggestion from one company is heated socks for summit day. Not a bad idea and it’s cheap insurance for your toes. Ask about which brand of oxygen equipment your expedition company uses. I would recommend the Summit Oxygen Elite System from the UK. Make sure you can dial your ideal oxygen flow from your chest. Bring the lightest crampons and the lightest and warmest boots. Keep your climbing gear light and leave your gadgets at BC.

13. Hydration above BC: Although all expeditions will remind you to drink and stay properly hydrated, nobody really tracks whether your intake is enough. Be prepared to do your own math at all times since this is extremely important. I like the NCAA guidelines: 2-3 hours before a climb, 16oz (1 bottle). 15 minutes before, 8 oz. During the climb, 2-3 large gulps every 15 minutes. After exertion 1-1.5 bottles for every pound lost. Add electrolytes to your water bottle (powders available on Amazon). Good hydration means a good cardiac output, which means good blood flow to the brain. Dehydration also makes you prone to blood clots in your already thickened blood from a high hematocrit. A stroke can ruin your day above 7000m. I personally take one Advil per day at altitude to keep me slightly anti-coagulated. Ditto for the long plane rides. Keep your urine light yellow. Don’t let the water freeze while inside your backpack.

14. Food above ABC: Most expeditions do not make a big deal of this and just offer you noodle soup above 7000m. You will have less appetite, you may have nausea, but on summit day you will need a high caloric intake way beyond what is provided by these soups. Don’t skimp on this detail. I carry smoothies that I buy on Amazon and that are 280 calories per pouch. You can carry these in the inner pockets of your down suit. These will also help counter low blood sugar which I am sure is an issue for many on long summit days. They will also provide a little hydration. Carry four pouches on summit day. While at BC, spend time with the Sherpas and try to eat as much as they do.

15. Guides - Western vs Nepali:. Again be wary of any racial or nationality distinctions of superiority. Twenty years ago there were few trained Nepali guides, but that is not the case anymore. In fact, Nepali guides go through a rigorous certification process these days, and in my opinion they have a quality that you will rarely find among Western ones - compassion. This said, Nepali run companies tend to have a lower guide to customer ratio and therefore the many more accidents we have seen recently with these outfits. But don’t blame the guides. Blame the logistics of some of these companies. At any rate, even in the most expensive outfits, your closest guides will be the Sherpas, with one Western guide for a group of 6-10. Paying $50-75K extra is rarely going to get you a private Western guide, and that guide may not be any better than a top Nepali one. What may differ with expensive companies is that on summit day, you will have two Sherpas assigned to you, carrying all that oxygen that will be wasted into the atmosphere when not used properly.

16. Country of Origin of your Expedition Company: No major differences here, except that the Nepali ones have had many more fatalities. They also have the most customers and practice the least amount of triaging - if you have a check, they’ll take you! You will be more at ease in an expedition run by a company from your own country or culture. I have often noticed, and this is most evident at the dining tents, that people sit in groups by nationalities. This sometimes becomes awkward, since communications must occur in several languages, with some lost in translation side effects.

17. Medical Personnel: In the 2019 I was the only MD on the North Side. I brought a full monitor with EKG capabilities, blood pressure, temperature, and SpO2. I also brought an ultrasound, and of course all the medications, lines, and airway equipment needed to manage HAPE, HACE or other less life-threatening emergencies. The South Side is better equipped and has a small ER. The ideal specialties for expeditions are either emergency room doctors or anesthesiologists. Look for board certification in their specialty. They need to be experts in reading EKG’s, the use of an ultrasound, starting central lines, especially on the North side where there are no hospitals nearby and no helicopters available for evacuations.

18. Accomodations in KTM and trek to BC: In KTM there are three hotels that I like and that will keep even the most demanding customers perfectly comfortable: a) The KTM Guest House b) Yak and Yeti and c) The Marriott Kathmandu.  All have great food, beautiful bedrooms, and most importantly great showers (for your return). If you are going to the North side, you will have nice hotels also in Lhasa and Shigatse. On the South side, you will be staying in teahouses for your trek to BC. These have few perks. The rooms are small with thin plywood walls between them and two narrow beds 3 feet apart. Toilets (squat type) are shared by probably 10 rooms. You can shower for an added $5, and you can upgrade (if available) to a room for yourself for another $5. Food is the same for everybody, no matter what you paid to your expedition company. I would expect that for next Spring the teahouses will implement something different for the dining areas regarding distancing, otherwise these will become Covid hotspots. Normally they are crowded, loud, and a cool place to meet many people from different parts of the world in a friendly atmosphere. But the world has changed...  

19. Hot Showers at BC: Another perk that is not all that it’s made up to be. Showering at BC can sometimes be an expedition in itself. I’ve had the situation where I was all soaped up beneath the shower head, the warm water was dripping slowly, only to have the pipes freeze and then get stuck with soap and shampoo all over my body and head in freezing temperatures! I’m not not sure this is a reason why I’d choose one expedition company over another - which most offer anyway. Not to be outdone, the Russian expeditions also offer massages at BC on the North Side, with professional masseuses! (Thanks Helena!)

20. Toilet Facilities at BC and above: Don’t expect the Ritz. Whether you pay $30K or $120K for your Everest attempt, all these boil down to a wobbly plastic chair on a blue barrel with freezing temperatures - or simply a hole in the ground with a small tent around you. Be extra careful about hand contamination in toilet tents, especially with the zippers. (Bring your hand sanitizer along.)  If you are high up on the mountain, always carry toilet paper in your backpack. Be careful when you release yourself from your jumar. (Sh*t happens!)  To date, I have not seen anybody using poop-bags on Everest on either side.

21. COVID-19 Plan: No mention of an expedition these days can go without touching upon this most delicate subject. How will your expedition company differentiate between the simple respiratory viruses that go around BC and a coronavirus infection? How will expeditions be preventing cross-contamination from other groups? Are the Russian parties a thing of the past (Or is Vodka better than Purell?) How will one diagnose a COVID infection? Can you be airlifted quickly to a good hospital in case you get one? (The Chinese side is still a few days away from any serious medical facility). Are there COVID tests available at BC with rapid results? (This last one I believe must be offered by both the Nepali and Chinese governments if they want to prevent some major mishaps.)

Although the list may be incomplete, I’ve tried to cover what I believe are the most important things one should look for when deciding which expedition to join. This alone is perhaps the single most important decision you will make if you want to climb Everest, and your life will depend on it. Shop carefully, be savvy, be safe.

Dr. Leo Montejo did his residency at Harvard in anesthesiology and critical care medicine and is a former professor at Stanford in this specialty. He is an extreme sports enthusiast and has participated in six Himalayan expeditions.