Emergencies and Rescue on a Nepal Trek: An Honest Plan

Nobody likes to think about emergencies before a holiday. But in the mountains, the best way to stay calm is to know what would happen if something went wrong, and to know that someone has a plan.

I’m Rujan, a licensed trekking guide in Nepal since 2018. This guide explains how emergencies are prevented, what we do if one happens, how helicopter rescue really works, and how to protect yourself from the fake rescue scams that have hurt Nepal’s name.

Most emergencies are prevented, not rescued

The most important rescue is the one that never happens. Almost every serious problem I have seen on the trail began as something small that was ignored: a headache, a cough, a sore ankle, a day of not eating.

This is how I prevent most emergencies:

• A slow pace and real rest days. Going up too fast is the main cause of trouble at altitude. Read my guide to altitude sickness in Nepal.
• A daily check. Every morning and evening I ask how you feel: your head, your breathing, your sleep, your appetite. Please tell me the truth. A hidden headache can become a real problem.
• Small groups. I walk with up to four people, so I can see every face and hear every breath on the climbs.
• Weather and season. We plan around the weather, and we wait when the mountain says wait.
• The right gear. Warm layers, good boots and a first-aid kit. See my Nepal trekking packing list.

What counts as an emergency on a trek?

Most problems on a trek are not emergencies: tired legs, blisters, a mild headache that goes with rest. We deal with them calmly.

These are emergencies, and we act at once:

• Altitude sickness that gets worse, or doesn’t improve with rest.
• Brain swelling (HACE): confusion, strange behaviour, stumbling, very sleepy.
• Fluid in the lungs (HAPE): out of breath at rest, a cough that doesn’t stop, a gurgling chest.
• A serious injury, such as a fall, a broken bone or a deep cut.
• Serious illness: a high fever, severe vomiting or diarrhoea with dehydration, chest pain.
• Being caught by dangerous weather, snow or storms on a high pass.

Step one: the best treatment is often down

For altitude problems, going down is the best treatment there is. Often only a few hundred metres lower, people feel much better within hours.

So the first answer to an emergency at altitude is usually not a helicopter. It is to stop going up, and to walk down, slowly, with help, even at night if needed. On every trek I know where the lower villages are. The Safety plan you can download from each trek page shows, for every night above 3,000 m, exactly where we go down to.

If someone cannot walk, there are other ways down before a helicopter: a horse, or local porters who carry a person down in a basket on their back, as people in the mountains have done for generations.

Step two: getting help

Medical help on the trail. In the main seasons, the Himalayan Rescue Association runs aid posts with volunteer doctors in a few places on the most popular treks, such as Pheriche on the way to Everest and Manang on the Annapurna Circuit. They give advice and treatment for altitude sickness and other problems. Some villages also have small health posts.

Phones and messages. Mobile signal on the trails comes and goes. Lodges often have phones or WiFi. On remote treks, a satellite messenger can be a good idea. See my guide to SIM cards, WiFi and charging.

Emergency numbers in Nepal:

Keep your insurer’s 24-hour emergency number with you as well. It is the number that matters most for a rescue. The Safety plan has a line for it.

Step three: helicopter rescue, honestly

A helicopter is for real emergencies: when walking down is not possible, not fast enough, or not safe. This is how it works:

1. We call your insurer. For you to be reimbursed, the insurer usually has to agree to the rescue before it happens, or very soon after. They may want to speak to you, your guide or a doctor.
2. The insurer arranges the helicopter, or approves the one we arrange.
3. The helicopter flies when it can. Helicopters in the mountains fly only in daylight and reasonable weather. In cloud, wind or at night, they cannot come. This is why walking down is always the first plan.
4. You are flown to Kathmandu, or to a lower town, where hospitals used to treating travellers can look after you.

The cost: a rescue flight in the mountains costs several thousand US dollars, sometimes much more. Without the right insurance, you pay it yourself. Your insurance must cover trekking at the altitude of your trek and helicopter rescue. Read my guide to travel insurance for trekking in Nepal.

Fake helicopter rescues: how to protect yourself

I have to be honest about this, because it has hurt Nepal and the people who work honestly here.

In the past, some people in the trekking industry pushed walkers into helicopter rescues they did not need, sometimes by exaggerating mild symptoms, so that someone could claim large sums from insurance companies. The government of Nepal has investigated these scams. Most guides and companies are honest, but you should know how to protect yourself:

• A helicopter is only for a real emergency. A mild headache, tiredness or a sore knee is not a reason to fly.
• Never let anyone push you into a rescue you don’t need, and never agree to pretend to be ill.
• If you are unsure, call your insurer yourself before you agree to anything.
• Ask what is wrong, and why walking down isn’t possible. A good guide will explain it clearly.

When you walk with me, the helicopter is the last answer, never the first. My job is to bring you down safely, and if a helicopter is truly needed, to make sure it is done honestly, through your insurer.

What to prepare before you go

• Travel insurance that covers trekking at your altitude and helicopter rescue. Bring the policy number and the 24-hour emergency number.
• Tell your guide about any health conditions or medicines. It stays between us.
• Download the Safety plan from your trek’s page, fill in the lines by hand, and keep it at the top of your bag.
• Leave your plan with someone at home: your route, your dates and your guide’s contact.
• A small personal first-aid kit, and your own medicines in their original packets.

Frequently Asked Questions

What happens if I get altitude sickness on a trek?
We stop going up. If it’s mild, we rest at the same height until it passes. If it gets worse, we go down, which is the best treatment. A helicopter is only for real emergencies, when walking down isn’t possible or not safe.

How much does a helicopter rescue cost in Nepal?
Several thousand US dollars, sometimes much more. Your travel insurance must cover helicopter rescue at the altitude of your trek.

Can a helicopter always come?
No. Helicopters fly only in daylight and reasonable weather. That’s why walking down is always the first plan.

What are fake helicopter rescues?
In the past, some people pushed trekkers into rescues they didn’t need, to claim money from insurance. The government has investigated these scams. Never let anyone push you into a rescue, and call your insurer yourself if you’re unsure.

What are the emergency numbers in Nepal?
Police 100, Tourist Police 1144 (English spoken), Ambulance 102 and Fire 101. Also keep your insurer’s 24-hour emergency number with you.

Calm Comes From a Plan

Emergencies in the mountains are rare when you walk slowly, listen to your body and travel with someone who is watching. And when something does happen, a calm, honest plan makes all the difference.

If you have questions about safety on a particular trek, write to me. I will tell you honestly what to expect.

Write to me →

Have more questions? Read my trekking FAQ or browse all my Nepal travel guides.

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