A number of other limitations exist in our study. The method we used to select operators may have excluded several operators. Those without a website were clearly overlooked. So too were five operators who did not respond to our initial contact. However, we believe that a reply rate of 83% is representative. We did not actively seek out reasons for the operators’ decisions. Although many operators did provide unprompted explanations, these may not represent all of those who took part.

Nevertheless, we believe that the quotes cited here are representative of the vast majority of operators contacted. It was unclear from our investigations whose opinion drove operator policy and whether it was a company or guide choice on which medications to take. In our inquiries, we did not actively question what mandatory medical training Silmitasertib research buy was given to guides or what other medical kit was available to counter high altitude illness. In conclusion, this study reveals that a large number (48%) of commercial UK-based expedition operators do not provide drugs for the treatment of AMS, HACE, and HAPE on expeditions to Kilimanjaro, Aconcagua, and EBC. Although there is limited case law for deaths at high altitude it is not plainly documented how many minor injuries and trips are cut short for those injured and not,

PLX4032 in vivo leading to a disappointing expedition,

due to high altitude illnesses. With Bay 11-7085 commercial expeditions becoming increasingly popular, we believe that this has the potential to increase morbidity and mortality from high altitude illnesses. We recommend that a clear set of guidelines are established that provide trained individuals with the means to diagnose and treat high altitude illnesses safely and effectively. As these medications are proven to save lives, it is vital that they are present in expedition medical kits and available to all those who head to altitude. The response from one commercial operator is, we believe, worth following: I do indeed carry all three of those drugs that you mention and I also supply my clients and my staff with specific information on how to use them, when to use them and how to diagnose the difference between AMS, pulmonary and cerebral oedema. I consider this vital to my role as a provider of holidays to high altitude. I also ensure that my porters have access to these and other medicines necessary for any wilderness treks. D. H. is employed by a Commercial Expedition Company (Jagged Globe) as their medical advisor which involves educating the staff and advising clients on medical matters. He is also honorary medical Advisor to the British Mountaineering Counsel. The other authors state they have no conflicts of interest to declare.