Trekking in international destinations, such as Nepal’s Everest Base Camp or the Atsunta Pass in Georgia, is an adventure of a lifetime. However, these treks come with their own set of risks, including unpredictable weather, high altitude sickness, and remote locations. Having proper insurance coverage is not just an added safety measure; it’s an essential part of your trek preparation.

Here’s an incident that will tell you why 

A few weeks ago, one of our trek leaders returned from the Everest Base Camp trek and he shared an experience that left us all in deep thought.

During the trek, one of the trekkers started feeling unwell at Namche Bazaar. Within a few hours, the severity of the symptoms forced the trekker to descend immediately. He had to opt for a helicopter evacuation to Kathmandu via Lukla. 

The cost? A staggering $740 (Roughly Rs 62,000). To put it in perspective, it is double our trek fee.

Surprisingly, a regular flight from Lukla to Kathmandu usually costs around $100-$120. But in emergencies, helicopter services in Nepal operate in an unregulated market. Prices can skyrocket depending on the urgency and demand.

This incident underscored a vital point: trekking, especially in remote international locations, comes with its risks and unpredictabilities. Having trek insurance could have significantly offset this sudden expense, easing both financial and emotional strain during a stressful situation.

Understanding the cost of emergencies

Emergencies in remote locations are expensive. Helicopter evacuations, medical treatments, and logistical support in high-altitude regions are not just costly—they're exorbitant. Without insurance, these expenses can burn a deep hole in your pocket.

A helicopter evacuation from Namche Bazaar to Kathmandu costs around $700-$800, as in the story above.

A hospital stay in Kathmandu for treatment can add another $500-$1000, depending on the severity of the condition.

With trek insurance, most of these costs are covered, sparing you the financial burden during an already stressful time.

What Kind of Insurance Should You Opt For?

Not all travel insurance covers adventure activities like trekking. Many policies exclude high-altitude treks or any activities labeled as “extreme.”

This is why you must opt for adventure-specific insurance.

Which Insurance Company Covers Trekking and Adventure Sports?

At Indiahikes, we have been working with ASC 360 to insure our trekkers for several years now. Their policies cover:

Cashless hospitalization for injuries and altitude sickness

Medical expenses for accidents or sickness like AMS, frostbite, and hypothermia

We recommend going with ASC 360 for the following reasons:

ASC 360 offers exceptional service. Whether you’re in the middle of your trek or back home, they’re available 24/7 via call or email to assist you. Our trekkers have experienced this every time. 

Unlike most insurance providers, ASC 360 ensures that your insurance papers are processed swiftly. This is especially crucial in emergencies when time is of the essence.

ASC 360 doesn’t just offer adventure insurance—they also include travel insurance in the cost. This means you’re covered for both your trek and your journey to and from the destination.


Indiahikes has worked with ASC 360 for years, and they’ve consistently delivered excellent service. Their experience in trekking-related emergencies makes them our go-to insurance provider. We are yet to see another insurance company do the same for trekking as a sport.


ASC 360 offers several unique services, such as:

Cashless medical services and treatment for AMS, frostbite, or hypothermia

Field rescue teams for local ground evacuations

Instant reimbursements for eligible claims

Deployable medical teams and an Emergency Response Center

How to Apply for ASC 360 Insurance

To get in touch with ASC 360, write to info@asc360.com

Their team will guide you through the entire process.

Once you book an international trek with Indiahikes, your experience coordinator will share a brochure with you, explaining the insurance process and benefits. You can then directly email ASC 360 to apply.

Cost of ASC 360 Insurance for an international trek

The cost of insurance for an international trek ranges between ₹6,000 and ₹9,000, depending on the altitude, region, and country of your trek. Considering the comprehensive coverage and peace of mind it offers, this is a small investment compared to the potential costs of emergencies.


Conclusion

Trekking insurance is not just about financial protection—it’s about ensuring your safety and peace of mind. We highly recommend purchasing insurance before embarking on your trek.

This isn’t just a recommendation; please consider it an essential part of your journey. It ensures that you can focus on the adventure, knowing that you’re covered in case of emergencies.

If you have further questions on insurance for international treks, write to info@indiahikes.com, and we’ll be able to help you.

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Why is it crucial to have insurance on International treks?

As a pioneer in India's trekking community, Indiahikes has spent over 15 years raising awareness about the medical well-being of trekkers in the mountains.

We are putting out this detailed piece of information on High-altitude pulmonary edema with the same intention. Over several years of training, observation, and experience with tens of thousands of trekkers, we have cracked down on how to avoid it to a large extent. 

If you are a hard-core trekker reading this, then you know what HAPE is and how fatal it can get. If you are a beginner or new to trekking at high altitudes, you should read it carefully.

This piece of article is not just for trekkers. If you are planning a bike ride to Leh or flying to a high altitude, this is a very beneficial read.

So, without further ado, let’s start with:

What is High Altitude Pulmonary Edema?

Edema is the swelling caused by too much fluid trapped in a particular body tissue.

When you are at a high altitude, there’s less oxygen pressure, which means the concentration of oxygen molecules in the air is lower. As a consequence, you breathe less oxygen per breath at higher altitudes. 

So, if I ask you to take a deep breath, say, at an altitude of 2,000 ft. your lungs will consume sufficient oxygen without exerting any pressure. But at 8,000 ft, you’ll need to breathe a lot harder to consume the same amount of oxygen. At the end of the day, your lungs exert a lot of pressure for very little oxygen.

In some cases, because of high pressure on the arteries, fluid from the blood leaks into air sacs in the lungs and that’s when a trekker/traveller in high altitudes is affected with HAPE.

When HAPE occurs, a trekker is essentially drowning in his body fluids. And when the lungs are incapacitated, the rest of the body soon stops functioning. This means HAPE can get fatal very soon.

Before I dive deep into HAPE, I want you to know about its initial stages — Acute Mountain Sickness, because often, when left untreated or undetected, AMS can soon turn into HAPE (although it is important to note that HAPE can occur without preceded by AMS).

What is acute mountain sickness (AMS)? Symptoms | Treatment

Any sickness that is caused because of gaining altitude is termed acute mountain sickness, often also called altitude sickness. It starts occurring as you climb over 8,000 ft above sea level. On average, 10% of trekkers can face some sort of altitude sickness. 

It all depends on how your body is getting acclimatised at the high altitude. The quicker it adapts, the lower the chances of getting AMS.

There’s one thumb rule for gaining high altitude: Give your body the time to adapt to the altitude and the low air pressure that comes with it. You will always observe trekkers in your group who have given more time to their body to rest will acclimatise well as compared to people who gain altitude in less time.

Travelling via flights to high altitudes is the riskiest. Yes, you read this right. Say you are travelling from Delhi to Leh; Delhi's elevation is between 650 and 820 feet and Leh is at an altitude of 11,480 feet. You are gaining this altitude in a few hours. This is very little time for your lungs to adjust to such low oxygen pressure.

What are the symptoms of acute mountain sickness?

Here are some of the most common symptoms of acute mountain symptoms 

Headache: You feel an extreme headache. Please note: In most cases, the headache will happen but we shouldn’t just look for a headache to detect if it’s AMS. 

Nausea/vomiting: You feel overcome by nausea or might have a feeling of vomitting.

Fatigue: You feel extremely fatigued. You will see a significant change in your movements on the trails. 

Insomnia: When affected by AMS, you will struggle to sleep during the night

Loss of appetite: You will experience a loss of appetite. You will eat less even after a long day of trek. I recommend everyone to keep a check on their eating patterns in the mountains.

As soon as you see any of these symptoms in your body, I advise you to inform your trek leader (if you are coming with Indiahikes). Our trek leaders are trained to nip these symptoms in the bud.

After you are affected by AMS, there’s one thing that our medical trainer, Diptarka, advises everyone to do: “Go up only when symptoms go down.”

Medicinal Treatment: Right, after you feel any of the symptoms I mentioned above, put yourself on a curative course of Diamox. 

Now as we discussed acute mountain sickness, let’s climb up slowly to HAPE.

How do I detect HAPE in the mountains? How is it different from AMS? Symptoms

High Altitude Pulmonary Edema Symptoms | How do I detect HAPE? 

Multiple symptoms show both at the initial stage and at the advanced stage. Below, I will share some common high-altitude pulmonary edema (HAPE) signs and symptoms

The first symptom to look for is if you have shortness of breath at rest or if you are gasping for air even while at rest. This is one of the most common symptoms that our trek leaders at Indiahikes have observed in multiple cases.

Look for a dry cough. Please do not ignore it, at the later stage of HAPE it might get advanced and can develop into a productive wet cough.

You might also experience extreme fatigue & drowsiness.

Rattling chest sound. If you put a stethoscope or simply an ear on the chest of a HAPE-affected patient, you will hear a rattling sound.

Another symptom to detect HAPE is pale or cynatic skin colour.

At a very late stage, you might also discover pink frothy Sputum (sputum is a mixture of mucus and saliva) 

The medical trainer at Indiahikes, Diptarka, says and I quote, “I want you to note that you don't need to first have symptoms of AMS then it will turn to HAPE. HAPE can happen directly too.”

High Altitude Pulmonary Edema treatment

Our medical trainer mentions, “HAPE is the biggest killer in the mountains if you ignore symptoms.” Hence, I will help you understand the on-spot treatment of high altitude pulmonary edema.

The rule of thumb is to lose altitude as soon as possible. 

But to ease the symptoms for the trekker and buy time to descend, you must administer the right medicines: Diamox & Nifedipine.

Here’s the dosage of medicine you should take when you learn that you are affected with HAPE, assuming you do not have canned oxygen with you.

Take 500 mg of Diamox immediately (even if you have taken Diamox a few hours earlier). This means two tablets of Diamox.  

Follow it up with 20 mg of Nifedipine. In India, we mostly get 10 mg tablets of Nifedipine. So take your first 10 mg, wait for 20 minutes and then take the next 10 mg.

This will let the tablet settle in slowly. Within 30 minutes of the second 10 mg, you should be able to breathe easier.

Nifedipine reduces the pressure in your heart, lungs and blood vessels, giving it some space to breathe. If you remember, I told you that HAPE occurs because of high pressure around the lungs, when the air sacs start accumulating fluid from your blood.

With these two tablets in your system, climb down as much as possible. Start your descent & reach a safe height, at least around 8,000ft., so your lungs have to put in less work to breathe.

If you cannot reach around 8,000 ft even after six hours, repeat the dose of 500 mg Diamox and 20 mg Nifedipine and continue descending.

You’ll be tired, but it’s a matter of life and death. You need to be at a lower altitude.

Most trekkers recover upon reaching lower altitudes. You’ll recover too.

Evacuation Process at Indiahikes

If you are on a trek with Indiahikes, there are very minute chances you will be evacuated because of HAPE. We treat it at a very initial stage right after seeing the symptoms. But, there are certain cases where things are not under our control and we have to evacuate the trekker in an emergency. 

Your health is monitored three times a day. We check your vitals thrice daily, ensuring we nip any health issues in the bud, even before they show up.

Our trek leaders are handpicked outdoor experts. Our trek leaders are hand-picked and undergo rigorous training in wilderness first aid and emergency care. Our training is so intensive that only 70 per cent make it through our training. 

We always have a HAM kit handy (High Altitude Medical Kit). The HAM kit contains 17 essential medicines, including three life-saving drugs. They also carry bottled oxygen. Our trek leaders are always ready to handle medical emergencies. 

We have an evacuation kit ready for emergencies. With a stretcher, two oxygen cylinders, and an emergency shelter, our teams have tested evacuation protocols in place. They can carry out smooth evacuations even in the middle of the night. We have a complete protocol for the evacuation of a trekker. We are equipped with manpower & medical resources to bring a HAPE-affected trekker down to safety.

We cannot repeat enough that safety is in prevention. The Indian Himalayas do not allow easy evacuations. Heli rescues are unheard of on most treks. It’s extremely resource-intensive to evacuate anyone from these regions and often the weather and terrain are not on your side.  

How to prevent high-altitude pulmonary edema?

The first thing I am going to suggest here is to plan your itinerary mindfully. Give yourself rest days in between so your body gets enough time to acclimatise well.

Another, we recommend you follow a preventive course of Diamox. It helps with acclimatisation. (Read more about how Diamox helps at high altitudes.)

So for most treks that gain altitude too quickly, taking a preventive course of Diamox really helps, especially if your trek climbs above 13,000 – 14,000 ft.

In fact, even for those who suddenly go up to high altitudes, like those who drive or fly to Leh, we recommend Diamox.

| Dosage: Start with a dosage of 125 mg (half a tablet) every 12 hours 2 days prior to your trek (usually when you arrive at Delhi). Increase it to 250 mg (full tablet) every 12 hours from the day you get to the base camp and continue until you complete the trek.

| Side effects: There aren’t too many side effects of taking Diamox. You feel a numbness/tingling sensation in your hands and feet. You pee more often (which means the medicine is doing its job). Some claim that they get a bit of loosies after Diamox. Generally, a Digene takes care of this.

Keep in mind that Diamox is a sulfa-based drug. If you’re allergic to sulphides, avoid Diamox. Again I will say, consult your doctor beforehand.

While Diamox reduces the chances of AMS hitting you, it isn’t a fool-proof medicine. Even those who are on a course of Diamox can get hit by AMS.

Busting Myths About AMS

There are a lot of myths that exist about AMS. Below I am going to attach a video where the head of our Learning & Development team, Lakshmi Selvakumaran, debunks most common myths that revolve around Altitude sickness. 

How safe are you on a trek with Indiahikes?

As I mentioned we take all mandatory steps to ensure the safety of the trekkers. Multiple procedures go behind the curtains. It starts even before the trek starts

We check trekkers’ Blood pressure on the first day to ensure it is within an acceptable standard at high altitudes.

We record oximeter recordings thrice every day and ensure it never gets down to our cut-off numbers.

All the trek leaders carry with them life-saving drugs to treat AMS, HAPE, and HACE. They are trained on how to treat trekkers with these medications. 

For an emergency HAPE case, our trek leaders carry oxygen cylinders with them.

All campsites are equipped with a bigger oxygen cylinder. We are also equipped with stretchers for severe case evacuation.

The most important thing that matters is the observation. Our trek leaders observe trekkers throughout & assist them as per the situation demands.

Our trek leaders, staff, and slope managers regularly undergo extensive training to manage any medical emergency cases.

In the last two years, we have seen approximately 15 HAPE cases on Indiahikes treks. Trekkers were administered with oxygen and life saving drugs promptly. They were rescued down safely to the base camp and given required medical care in the hospital.

This detailed post helps you understand what HAPE is and what it looks like in the mountains. You can reach out to me in the comments section if you have any questions.

This detailed article on HAPE would help you understand what HAPE is and what it looks like in the mountains. If you are a beginner or new to trekking at high altitudes, you should read it carefully.

What is High-altitude Pulmonary Edema? Symptoms | Treatment | Prevention

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At Indiahikes, we have been trekking at high altitudes for over 15 years, taking over 20,000 trekkers every year. We have been lucky enough to observe a huge cross-section of trekkers, their medical well-being at high altitudes, and their physiological responses to altitude. 

Among the many issues we see is High Altitude Cerebral Edema, an advanced form of Acute Mountain Sickness. 

We have seen a few cases of High Altitude Cerebral Edema in our early years, but have cracked down on how to avoid it over several years of training and experience. 

So in this post, I am sharing what HACE is, what it looks like, its symptoms, treatment, and prevention.

What is high-altitude cerebral edema?

High-Altitude Cerebral Edema is an advanced form of Acute Mountain Sickness. When left untreated, Acute Mountain Sickness could lead to HACE.  

HACE occurs when the blood vessels in the brain dilate, resulting in the accumulation of fluids.

Edema is the swelling caused by too much fluid trapped in a particular body tissue.
The danger: HACE can turn fatal if not given immediate attention & treatment.

Symptoms of HACE: What does HACE look like?

One of the main signs of HACE is an extreme headache. It is not a normal kind of headache. It feels different. (Again, please note: some people might not feel a headache). Another symptom is confusion.

In addition to this, you will see an altered nature of behaviour. So what does HACE look like?

A person affected with HACE struggles with mind & body coordination. The phenomenon is called Ataxia. For example, in many cases, a HACE-affected patient struggles with their shoelaces, they won’t be able to walk in a straight line if you ask them to, or they might not be able to draw a circle.

They might have no idea that something is off with them. It sometimes requires another person to identify and treat the symptoms.

How to treat high-altitude cerebral edema?

If you suspect someone has HACE - immediately administer dexamethasone. It brings down the edema. If you have oxygen, administer it immediately. Once you give these two, descend.

The Rule of Thumb Says: Descend Descend Descend. 

You should start your descent as soon as you identify the symptoms of HACE. It is the most straightforward way to treat HACE. 

Certain medications help curb symptoms of HACE while you start your descent: Diamox and Dexamethasone. (This treatment is an addition to descent, and is not a standalone treatment.)

Start with a 500 mg dose of Diamox and around 8mg of Dexamethasone intravenously. This combination will reduce inflammation and stop your brain from swelling, giving you a window of a few hours to get yourself out of that altitude. 

Try to reach down to an altitude of around 8,000 ft in the next six hours. If you fail to do it, repeat the same dosage of Diamox & Dexamethasone.

Around 8000 ft. is a safe enough height. Lower the dosage only when the patient is showing some improvement.

If you notice symptoms fading away, lower your dosage of Dexamethasone to 4 mg (orally), followed by 2 mg (orally) every 6 hours. Dex needs to be weaned away and cannot be stopped immediately.

There is one very important thing, there should always be someone accompanying the HACE-affected trekker/traveller while they are climbing down. It is very risky leaving them alone.

If you are on a trek with Indiahikes, we take all the safety measures to bring you down to safety and provide you with the required professional medical attention as soon as you reach the base camp.

How to prevent high-altitude cerebral edema?

How to prevent high-altitude cerebral edema? What can you do? How can you prepare?

Our staunch belief while trekking at high altitudes is that prevention is better than cure. Here are a few preventive measures to avoid HACE: 

Acclimatise well: Plan your itinerary well. Give your body enough time to acclimatise well to the altitude.

Get on a preventive course of Diamox, especially if you’re climbing higher than 12,000 ft. Here’s a detailed article on how Diamox deals with AMS.

Work on your fitness. Indeed, a fit trekker can also get affected by HACE but physical fitness aids better acclimatisation, which helps avoid AMS and HACE. (This small clip will help you get a better understanding of how it works.) 

Hydrate yourself well and eat a good diet. 

Do not consume alcohol. Keep your diet simple & balanced.

I am attaching a detailed article on preventing altitude sickness. Give it a thorough read.
Having said that, if you are trekking with Indiahikes, you are not likely to face an advanced form of AMS / HACE, since we go out of our way with preventive measures. We aim to identify the mildest symptoms of AMS and treat it so that we are not in a state of emergency deep inside the mountains.

When is the need for evacuation?

The moment you identify symptoms of HACE, you must start evacuation. It’s already too late. For as long as you’re at the same high altitude, your brain will continue to accumulate fluids. Even if you’re on medication to treat HACE, the medicines are a mere way of buying time for you to descend.  

If you are on a trek with Indiahikes, we take evacuation calls promptly. We have manpower, medical resources, and stretchers to bring you back to a safe altitude. While we ensure our own trekkers don’t reach situations where they need such emergency evacuations, our teams have led rescue operations for multiple other organisations in the mountains. 

It’s important to identify symptoms of AMS at the earliest and treat them.

Between January 2017 and September 2024, we have seen just two cases of HACE on Indiahikes treks. This is not by chance. Our trek leaders take action promptly against AMS before it develops into HACE.

As mentioned earlier, we take all mandatory steps to ensure the safety of the trekkers. Multiple procedures go behind the curtains. It starts even before the trek starts.

For an emergency HACE case, our trek leaders carry oxygen cylinders with them.

Our belief in the mountains is simple: better safe than sorry. The mountains are always there for you to come back and trek. It cannot be at the cost of your health. 

Indiahikes Trek Leaders are casually called “doctors in the mountains” by many of our trekkers. They know high altitude issues and medications like the back of their hand. You can rest assured that you’re in safe hands with them. 

I hope this article helped you understand what High-altitude cerebral edema looks like in the mountains and how to deal with it. It is helpful for anyone going to higher altitudes & not just for trekkers. Make sure you bookmark it. 

If you have any questions, get in touch with me by dropping in your comments.

Frequently Asked Questions

1) Why does high-altitude cause cerebral edema?

HACE occurs when blood vessels in the brain dilate resulting in the accumulation of fluids. It happens beause your body is unable to acclimatise well to the higher-altitude. It starts as AMS, & if left untreated, can turn to HACE. 

Acute mountain sickness generally occurs above 8000ft. It happens because your body is unable to acclimatise to higher altitudes. Again, there’s no definite number. You can also feel the symptoms of AMS below 8000ft.

3) How to prevent high altitude cerebral edema?

To prevent high altitude cerebral edema, ensure adequate time to acclimatise to high altitude well. Most importantly, plan your itinerary well, ensure you’re fit and hydrated and be on a preventive course of Diamox if you’re climbing high quickly, especially on forced ascents like in the Himalayas.  

Among the many issues we see is High Altitude Cerebral Edema, an advanced form of Acute Mountain Sickness. Read what HACE is, what it looks like, its symptoms, treatment, and prevention.

What is High-altitude Cerebral Edema? Symptoms | Treatment | Prevention

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Going on a trek isn’t as big an investment as buying a car or a home. However, it is a highly adventurous activity and by nature involves a certain amount of risk.

There are chances of avalanches, floods, or landslides occurring in the mountains due to unpredictable weather. From fractures and sprains to higher forms of AMS, injuries and illnesses are thus highly probable for trekkers.

Here’s where trek insurance comes into play.

Having trek insurance is an essential part of your pre-trek planning. At Indiahikes, we have always strived to make treks safer for our trekkers. We used to offer trek insurance as an option over the past years. We have now made it mandatory for all our treks.

Though you may have your own life insurance and/or a medical insurance policy, chances are these policies do not cover any risks incurred while participating in adventurous activities like trekking. Read the fine print and you’ll know what we’re talking about.

In this article, we explain why trek insurance is important and what our insurance policy covers.

Trekking by nature is a high-risk activity. You are at a high altitude (above 8,000 ft), the weather is unpredictable and at most times the terrain is difficult too. Illnesses, accidents, and injuries aren’t uncommon in the mountains. Most of these can be sourced for a couple of reasons.

Firstly, most of our treks are at high altitudes.

In most of your treks with Indiahikes, you’ll be reaching heights of 11,000 ft or higher. The chances of getting hit by AMS are very real.

When we see a trekker consistently display symptoms of AMS, the first thing we do is make him or her descend. In most cases, quick descent coupled with a course of Diamox treatment does the job.

But in some severe cases, the AMS progresses to the more dangerous HAPE or HACE. These require immediate evacuation and medical attention.

The more remote the trek, the more serious the condition. And higher costs of rescue and medical assistance.

To give you an example, we had a trekker on our Goechala trek get hit by HAPE on the Goechala trek. This was at Lamuney campsite (13,743 ft). Out Trek Leader immediately brought her down to base camp, hired a car, and transported her to the nearest hospital. The total charges for treatment, evacuation, and stay amounted to approximately Rs. 11,000.

Even though we emphasise on safety, accidents are inevitable in the Himalayas. Unpredictable weather conditions and the nature of the terrain can cause unexpected injuries.

In our experience, these are the possible injuries:

Ligament tears while climbing steep terrains if your muscles are not warmed up

Injuries during playing games at the campsite

Accidents like these always require immediate evacuation and urgent medical expertise.

At Indiahikes, we’ve always put in processes and measures to increase the safety standards on every single trek of ours. All our Trek Leaders are Wilderness First Responder (NOLS) certified. They are equipped with a High Altitude Medication Kit, oxygen cylinders, and two-way radios for constant communication with the base. We have made microspikes mandatory on all our snow treks. And so much more.

In spite of that, the nature of trekking is such that you never know when a mishap could occur.

And in these cases, owing to the remoteness of the region, expenses may shoot up exponentially.

Here’s when the mandatory trek insurance comes to your rescue. It takes care of these emergency expenses which can burn a hole in your pocket.

And since it’s a matter of money, we don’t want to leave things to the fine print.

We’ll explain more about our trek insurance policy.

Trekking in the Himalayas comes with its own risks. To ensure your own safety, Indiahikes has made Trek Insurance mandatory. Read on to know why.

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