Ultimate Kilimanjaro® - The #1 Guide Service on Mount Kilimanjaro

Is Climbing Kilimanjaro Safe?

If you only read one page on our site, this should be it.

Climbing Kilimanjaro is probably one of the most dangerous things you will ever do. Every year, approximately 1,000 people are evacuated from the mountain, and approximately 10 deaths are reported. The actual number of deaths is believed to be two to three times higher. The main cause of death is altitude sickness. Everyone climbing Mount Kilimanjaro should be familiar with the symptoms of altitude sickness. And everyone climbing Kilimanjaro should choose an operator like Ultimate Kilimanjaro® that has the proper safety systems in place.

Ultimate Kilimanjaro®'s Safety Precautions:

  • Our guides are highly experienced in preventing, detecting, and treating altitude sickness because they handle over 1,000 climbers per year.
  • Our guides conduct twice daily health checks using a pulse oximeter to monitor your oxygen saturation and pulse rate.
  • Our guides administer the Lake Louise Scoring System (LLSS) to help determine whether you have symptoms of altitude sickness and their severity.
  • Our guides are certified Wilderness First Responders (WFR). They have the tools to make critical medical and evacuation decisions on location.
  • Our staff carries bottled oxygen on all climbs and can administer it to quickly treat climbers with moderate and serious altitude sickness.
  • Our staff carries a portable stretcher at all times to evacuate climbers who need to descend but are unable to walk on their own.
  • Our staff has the ability to initiate helicopter evacuation through Kilimanjaro Search and Rescue (SAR), a helicopter rescue operation.
  • Our staff carries a first aid kit to treat minor scrapes, cuts and blisters.

The abovelisted measures ensure that Ultimate Kilimanjaro® guides and staff are prepared to keep our climbers safe and have the ability to treat climbers who become ill or injured. Your health and well being is our first priority.

“Read this before booking a Kilimanjaro climb. It might seriously save your life!”

"This review is designed for anyone who has made the decision to climb Kilimanjaro but has not yet chosen a guide company.

Let me start off by saying you should definitely find out if your guide company carries bottled oxygen on the climbs and if the guides perform daily health checks on you during the climb. Think that stuff doesn't matter? Think you would never need any medical assistance on the mountain? Think again.

I recently went on a 9 day climb of Kilimanjaro with Ultimate Kilimanjaro and found out the hard way that altitude sickness truly can strike anyone at any time regardless of fitness level or previous experience at altitude. I had read that prior to my trip but I honestly didn't think it could happen to me.

A brief background on me, I am 31 year old male who regularly hikes 7-10 mile trails that feature large changes in elevation in rocky terrain and I go the the gym 4 days per week for at least one hour each session. I have climbed three 14ers in Colorado and have been above 10,000 feet while hiking and snowboarding at least 50 times in my life. I had never felt any symptoms of altitude sickness during any of those previous trips to altitude.

Starting on day 4, the guides had been watching me very closely because I started to score poorly on my daily health checks. However, something severe hit me on day 5 of my Kili climb that required the guides to give me bottled oxygen and take me down the mountain. I am still not sure exactly what happened to me but I am certain without the quick diagnosis and response from my Ultimate Kilimanjaro guides that I very well could have gone into a coma or worse.

So please stop and ask yourself, if altitude sickness hits you on Kili, do you really want to be with a guide company that hasn't been monitoring your health and doesn't have bottled oxygen? A few hours can mean the difference between living and dying."

Review from TravelingHiker678 on Trip Advisor

WARNING: Most Kilimanjaro operators do not have safety measures in place. They are simply not prepared for emergencies. While it is true that most operators employ guides with many years of experience on Mount Kilimanjaro, that does not necessarily mean they actually know how to handle serious altitude sickness cases. Consider the following excerpt from the Journal of Travel Medicine:

"There needs to be greater awareness of the dangers of HACE, AMS, and HAPE."

On a recent university trip to Mount Kilimanjaro, our group of postgraduate nurses and doctors from across Australia were astonished at the high number of untreated, symptomatic high-altitude cerebral edema (HACE) cases observed.

On our descent, we noticed 10 people who appeared to be suffering from HACE, with clear evidence of altered consciousness and ataxia. Many were only able to walk with the physical support of two porters. Trekking guides we spoke to note that in a normal day between base camp at Barafu (4,673 m) and Uhuru Peak (5,895 m), they see between 10 and 15 cases of trekkers with HACE symptoms being encouraged to climb higher to summit or being assisted down in the late afternoon.

Although some of the guides do carry oxygen, the trekking guides we spoke to were not trained in how and when to use this equipment. This guide had to be shown by our team how to use the oxygen bottle and mask. The trekker’s symptoms were relieved upon using the bottled oxygen and he continued his descent down to Millennium Camp (3,810 m). Left at 5,000 m, with no additional oxygen, his ataxia and altered consciousness would have resulted in a very slow descent and possible death.

Another guide accompanying a trekker with HACE did have an oxygen cylinder, but had no tubing with which to administer oxygen.

Among tour companies and trekkers there needs to be greater awareness of the dangers of HACE, AMS, and HAPE. Early identification of the symptoms followed up with the treatment could possibly reduce the number of deaths each year on Mount Kilimanjaro.

Paul Gordon John Welch* and
David Andrew Dyke Symmons+
*Medical Education Unit and +Emergency Department
The Townsville Hospital

Journal of Travel Medicine

Here is an email we received from a doctor who witnessed an emergency on the mountain and described what happened.

"I am a physician specializing in pulmonary and critical care medicine."

I recently climbed Kilimanjaro (not with your company). I was called to assist a client that traveled with some budget company and had developed High Altitude Pulmonary Edema (HAPE) at Barranco Camp. It was a bit shocking that the ranger station had only one (essentially empty) bottle of oxygen available.

The reason for this e-mail is that I was very impressed with one of your guides who was very competent and helpful in a situation where others were not. He provided a bottle of oxygen and assisted in organizing a descent. I know that giving out his oxygen may go against your policy to provide optimal care to your own clients and sometimes you may have trouble securing back-up or even getting your own bottle back. However, he recognized the serious nature of the client’s condition and did the right thing! I want to take this opportunity and thank your guide and your company for assisting in the rescue of this client.

Ultimate Kilimanjaro really lives up to its billing and I will certainly recommend you to anyone that is interested in climbing Mount Kilimanjaro. Once again, thanks to your guide and Ultimate Kilimanjaro for your help and professionalism!

All the best,
Dr. Darius Seidler, MD
Pulmonary and Critical Care
Dartmouth Hitchcock Medical Center

We present the above scenarios not to scare you, but to inform you. Because anyone who contemplates climbing Kilimanjaro must understand the risks. While the dangers associated with high altitude trekking can never be completely eliminated, they absolutely can be minimized by a competent, professional operator. And we are not exaggerating when we say that we here at Ultimate Kilimanjaro® would be comfortable sending our own friends, family and loved ones on Kilimanjaro with less than a dozen active companies.

Acute Mountain Sickness (AMS)

The percentage of oxygen in the atmosphere at sea level is about 21%. As altitude increases, the percentage remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,600 m) there are roughly 40% fewer oxygen molecules per breath so the body must adjust to having less oxygen. Altitude sickness, known as AMS, is caused by the failure of the body to adapt quickly enough to the reduced oxygen at increased altitudes. Altitude sickness can occur in some people as low as 8,000 feet, but serious symptoms do not usually occur until over 12,000 feet.

Mountain medicine recognizes three altitude categories:

In the first category, high altitude, AMS and decreased performance is common. In the second category, very high altitude, AMS and decreased performance are expected. And in extreme altitude, humans can function only for short periods of time, with acclimatization. Mount Kilimanjaro's summit stands at 19,340 feet - in extreme altitude.

At over 10,000 feet (3,000 m), more than 75% of climbers will experience at least some form of mild AMS.

There are four factors related to AMS:

The main cause of altitude sickness is going too high (altitude) too quickly (rate of ascent). Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatization and generally takes one to three days at any given altitude. Several changes take place in the body which enable it to cope with decreased oxygen:

Again, AMS is very common at high altitude. It is difficult to determine who may be affected by altitude sickness since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Many people will experience mild AMS during the acclimatization process. The symptoms usually start 12 to 24 hours after arrival at altitude and will normally disappear within 48 hours. The symptoms of Mild AMS include:

  • Headache
  • Nausea & Dizziness
  • Loss of appetite
  • Fatigue
  • Shortness of breath
  • Disturbed sleep
  • General feeling of malaise

Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside as the body acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate.

While hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip.

The signs and symptoms of Moderate AMS include:

  • Severe headache that is not relieved by medication
  • Nausea and vomiting, increasing weakness and fatigue
  • Shortness of breath
  • Decreased coordination (ataxia)

Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. It is important to get the person to descend before the ataxia reaches the point where they cannot walk on their own (which would necessitate a stretcher evacuation). Descending only 1,000 feet (300 m) will result in some improvement, and 24 hours at the lower altitude will result in a significant improvement.

Continuing on to higher altitude while experiencing moderate AMS can lead to death.

Severe AMS results in an increase in the severity of the aforementioned symptoms including:

  • Shortness of breath at rest
  • Inability to walk
  • Decreasing mental status
  • Fluid build-up in the lungs

Severe AMS requires immediate descent of around 2,000 feet (600 m) to a lower altitude. There are two serious conditions associated with severe altitude sickness; High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. But, when they do occur, it is usually in people going too high too fast or going very high and staying there. In both cases the lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.

High Altitude Pulmonary Edema (HAPE)

HAPE results from fluid build up in the lungs. This fluid prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and death. Symptoms of HAPE include:

  • Shortness of breath at rest
  • Tightness in the chest
  • Persistent cough bringing up white, watery, or frothy fluid
  • Marked fatigue and weakness
  • A feeling of impending suffocation at night
  • Confusion, and irrational behavior

Confusion, and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent of around 2,000 feet (600 m) is a necessary life-saving measure. Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.

High Altitude Cerebral Edema (HACE)

HACE is the result of the swelling of brain tissue from fluid leakage. Symptoms of HACE include:

  • Headache
  • Weakness
  • Disorientation
  • Loss of co-ordination
  • Decreasing levels of consciousness
  • Loss of memory
  • Hallucinations & Psychotic behavior
  • Coma

This condition is rapidly fatal unless the afflicted person experiences immediate descent. Anyone suffering from HACE must be evacuated to a medical facility for follow-up treatment.

(Also see Why Does Acute Mountain Sickness (AMS) Occur?).

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Daily Health Checks

Our guides are all experienced in identifying altitude sickness and dealing with the problems it causes with climbers. They will constantly monitor your well-being on the climb by watching you and speaking with you. Twice daily, in the morning and evening, our guides will conduct health checks.

pulse oximeterPulse Oximeter

A pulse oximeter measures oxygen saturation - tthe oxygen level in your blood - and your pulse rate. The oximeter is placed on a climber's fingertip. The oximeter uses two beams of light that shine into small blood vessels and capillaries in your finger. The sensor reflects the amount of oxygen in the blood.

Oxygen saturation is a measurement of how much oxygen your blood is carrying as a percentage of the maximum it could carry. Normal blood oxygen levels at sea level are 95-100%.

As altitude increases, oxygen saturations decrease. Proper acclimatization generally brings oxygen saturations higher, which is why these figures typically rise when oxygen saturations are tested after resting overnight. On Kilimanjaro, oxygen saturations percentages are regularly in the 80's. There are no definitive saturation levels where a client can be declared absolutely safe or at risk. However, when oxygen saturation drops below 80%, we monitor that climber very closely.

Lake Louise Scoring System

Additionally, our guides will administer the Lake Louise Scoring System (LLSS) to help determine whether you have any symptoms of altitude sickness and the severity. LLSS is a set of questions designed to assess adults for symptoms of AMS. It is important that you be open, active and honest when answering these questions and with your guide overall. If you do not feel well, do not try to pretend you are fine. Do not mask your symptoms and say you feel OK. Only with accurate information can the guide best treat you.

Of course, there is always the chance that you will have to abandon your climb. In these situations, the guide will tell you to descend. It is not a suggestion or request, but an order. The guide's decision is final. Do not try to convince him with words, threats or money to continue your climb. The guide wants you to succeed on your climb, but will not jeopardize your health. Respect the decision of the guide.

Acclimatization Guidelines

The following are recommended to achieving acclimatization:

  • Pre-acclimatize prior to your trip by using a high altitude training system.
  • Ascend Slowly. Your guides will tell you, "Pole, pole" (slowly, slowly) throughout your climb. Because it takes time to acclimatize, your ascension should be slow. Taking rest days will help. Taking a day increases your chances of getting to the top by up to 30% and increases your chances of actually getting some enjoyment out of the experience by much more than that.
  • Do not overexert yourself. Mild exercise may help altitude acclimatization, but strenuous activity may promote HAPE.
  • Take slow deliberate deep breaths.
  • Climb high, sleep low. Climb to a higher altitude during the day, then sleep at a lower altitude at night. Most routes comply with this principle and additional acclimatization hikes can be incorporated into your itinerary.
  • Eat enough food and drink enough water while on your climb. It is recommended that you drink from four to five liters of fluid per day. Also, eat a high calorie diet while at altitude, even if your appetite is diminished.
  • Use FDA approved drug Diamox for prevention and treatment of AMS.
  • Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillizers, sleeping pills and opiates. These further decrease the respiratory drive during sleep resulting in a worsening of altitude sickness.
  • If you begin to show symptoms of moderate altitude sickness, don't go higher until symptoms decrease. If symptoms increase, descend.

(Also see Are You Afraid of High Altitude? How to Approach Mount Kilimanjaro's Biggest Obstacle and Who's Responsible for Your Safety on Mount Kilimanjaro? You Are).
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Altitude Medication

Diamox (generic name acetazolamide) is an F.D.A. approved drug for the prevention and treatment of AMS. The medication acidifies the blood, which causes an increase in respiration, thus accelerating acclimatization.

Diamox does not disguise symptoms of altitude sickness, it prevents it. Studies have shown that Diamox at a dose of 250 mg every eight to twelve hours before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS).

The medicine should be continued until you are below the altitude where symptoms became bothersome. Side effects of acetazolamide include tingling or numbness in the fingers, toes and face, taste alterations, excessive urination; and rarely, blurring of vision. These go away when the medicine is stopped. It is a personal choice of the climber whether or not to take Diamox as a preventative measure against AMS.

Ultimate Kilimanjaro® neither advocates nor discourages the use of Diamox (see Diamox: Does it Mask AMS?).

Ibuprofen can be used to relieve altitude induced headaches.

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Mountain Rescue

Bottled Oxygen

We carry bottled oxygen on all of our climbs as a precaution and additional safety measure. The oxygen cannister is for use only in emergency situations. It is NOT used to assist clients who have not adequately acclimatized on their own to climb higher. The most immediate treatment for moderate and serious altitude sickness is descent. With Kilimanjaro's routes, it is always possible to descend, and descend quickly. Therefore, oxygen is used strictly to treat a stricken climber, when necessary, in conjunction with descent, to treat those with moderate and severe altitude sickness.

We are aware that some operators market the use of supplementary personal oxygen systems as a means to eliminate the symptoms of AMS. To administer oxygen in this manner and for this purpose is dangerous because it is a temporary treatment of altitude sickness. Upon the cessation of the use of oxygen, the client will be at an even higher altitude without proper acclimatization.

99% of the companies on Kilimanjaro do NOT offer supplementary oxygen - because it is potentially dangerous, wholly unnecessary and against the spirit of climbing Kilimanjaro. The challenge of the mountain lies within the fact that the summit is at a high elevation, where climbers must adapt to lower oxygen levels at altitude. Using supplementary oxygen is akin to putting the mountain at sea level, where nearly everyone can summit (see Should I use Supplemental Oxygen on Kilimanjaro?).

Portable Stretcher

Large, one-wheeled rescue stretchers are found on Mount Kilimanjaro but they are only available within a small area of the park. That means that if a climber is unable to walk due to severe altitude sickness or a leg injury that compromises mobility, getting that climber down the mountain could pose difficult challenges for Kilimanjaro operators. Usually it means assisting the injured climber by carrying him or her on one's back.

At Ultimate Kilimanjaro®, we carry a portable stretcher at all times in case of emergencies when a climber is unable to walk on their own and the trekking party is some distance away from the park's stretchers.

Our portable stretchers are compact, strong and lightweight. The device can be used to evacuate an injured climber quickly off the mountain. To use, the subject is secured to the stretcher using straps. Then porters hold on to the hand grips to usher the climber to safety.

Gamow Bag

The Gamow Bag is portable hyperbaric chamber used to treat AMS. The inflatable bag simulates descent to lower altitude. The patient is placed inside the bag and it is inflated with air to increase the concentration of oxygen. A Gamow bag weighs about 12 lbs. Inflated, the bag is about 7 feet long and 2 feet in diameter.

At 9,800 feet (3,000 m), the Gamow Bag can simulate a descent of 4,800 feet (1,500 m). After two hours in the bag, the person's body chemistry will have "reset" to the lower altitude. This acclimatization lasts for up to 12 hours outside of the bag which should be enough time to get them down to a lower altitude and allow for further acclimatization.

Our staff does not carry Gamow bags. Use of a Gamow bag on Mount Kilimanjaro is impractical because descent is the most immediate, accessible treatment.

Kilimanjaro Search and Rescue

We are partnered with Kilimanjaro Search and Rescue (SAR), a helicopter rescue operation which conducts modern, efficient rescue services on Kilimanjaro. Airbus AS 350 B3 helicopters waits nearby at Moshi Airport. Once a distress call is received, rescue procedures are activated within five minutes. Expert pilots, highly trained rescue doctors and emergency flight technicians are exceptionally qualified and prepared for all emergencies on the mountain.

Kilimanjaro SAR manages a medical clinic that focuses on high altitude related illnesses, mountain medicine, and trauma. It is staffed 24 hours a day by physicians, nurses and assistants offering the best possible treatment. This group is advised by a unique Clinical Advisory Team made up of top level medical and high altitude professionals.

Note that this service is only available to clients who have the required travel insurance. Special travel insurance is mandatory to participate in our trips. Clients must be covered to trek at high altitude up to 6,000 meters to qualify for Kilimanjaro SAR rescue. Your travel insurance will be verified by our staff before the trek.

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