By Paul Kelly, Head of Adventures at Follow Alice, with insight from Chris Sichalwe, Head of Follow Alice in Tanzania
A few people have asked lately whether Follow Alice carries a portable hyperbaric chamber on Kilimanjaro. It's usually asked the way you'd ask about a life jacket: as if the answer they want is "yes, obviously." I totally understand why. In theory, it sounds like exactly the kind of thing a safety-conscious operator should have as part of every Kilimanjaro climb.
So I want to use this article to answer the question properly rather than just saying yes or no, because the honest answer is more useful than the reassuring one. We don't treat carrying a hyperbaric bag as a safety perk, and after talking this through with Chris, Head of Follow Alice in Tanzania, who has managed altitude emergencies on this mountain for decades, I think that position holds up. Here's the reasoning, not just the conclusion.
What these bags actually are
The device people mean when they say "hyperbaric chamber" on a mountain isn't the rigid, walk-in kind you picture at a dive clinic. It's a Gamow bag, or one of its cousins (the Certec bag, or a PAC). It's a lightweight, single-occupant inflatable sack, roughly 5 to 8kg depending on the model, that a sick climber gets zipped into. A rescuer then works a foot or hand pump to raise the pressure inside by about 2 PSI.
That pressure increase tricks the body into experiencing something like a descent, usually equivalent to dropping somewhere between 1,000 and 3,000 metres, depending on whose figures you use (the UIAA puts it at 1,500 to 2,500m, the CDC nearer 1,500 to 1,800m). The Gamow bag is the only soft-sided version cleared by the FDA for treating altitude illness, which tells you it's a real, legitimate piece of medical kit. It's also not cheap: a new unit runs somewhere around $2,600 to $2,700.
None of that is in dispute. What's worth thinking about is the trade-off of actually carrying one: several kilos of extra weight for a porter team, a few thousand dollars of kit that mostly sits unused, and a device that only helps for the narrow window before someone can be moved. That's a reasonable trade-off for a genuine stopgap. It's a strange thing to put front and centre in your marketing.
Where it gets misused is in what people assume the bag is for.
What it's for, and what it isn't
The bag exists to stabilise someone with severe acute mountain sickness, HACE, or HAPE when real descent isn't possible right now: it's dark, the weather has turned, the terrain is too dangerous to move someone, or there's no porter team or evacuation available in that moment. Used that way, it buys time. It is not a treatment on its own, and it was never designed to be one.
The clearest statement of this comes from the people whose actual job is writing altitude medicine guidance for mountain operators: the UIAA Medical Commission. Their 2012 consensus statement on portable hyperbaric chambers lays out the priority order in plain terms: descend at least 300 to 500 metres first if at all possible; use oxygen or drugs only to buy time toward that descent; and treat the hyperbaric bag as something used alongside those two, never instead of them. The statement is unambiguous that "such chambers are unnecessary for nearly all trekking routes" when an operator is already running proper acclimatisation profiles.
That's not a fringe opinion. The Wilderness Medical Society's 2024 clinical practice guidelines for altitude illness say the same thing from the clinical side: descent, at least 300m for mild AMS and 1,000m or more for HAPE, is the actual treatment. Oxygen, medication, and hyperbaric bags are adjuncts that support a descent, not substitutes for one.
There's a specific misuse the UIAA calls out that I think matters most for anyone booking a climb: using the bag to patch someone up enough that the group can keep going up, rather than sending them down. That's the opposite of what it's for. The statement also notes that untrained use has caused real complications, including eardrum rupture and hypercapnia (a dangerous buildup of carbon dioxide from being sealed in a small bag). This isn't a device you want deployed by someone whose main qualification is having read the instruction leaflet once.
On Kilimanjaro specifically, "descend at least 300 to 500 metres" usually means walking someone down to the previous camp, sometimes further, with a guide and often a stretcher team if they can't walk unassisted. It's slower and less dramatic than sealing someone into a bag, and that's rather the point: it treats the actual cause (altitude), not just the symptoms for an hour or two.
Why it still gets marketed as a differentiator
Here's my honest gripe. Some operators advertise carrying a hyperbaric chamber on every single trip as a headline safety feature, the kind of line that shows up near the top of a sales page. I understand the instinct: it's a tangible, photographable object, and "we carry emergency equipment" sounds reassuring in a way that "we plan your itinerary carefully" doesn't.
But that framing has it backwards. If a company is regularly needing to zip clients into a pressure bag, that's a sign their itineraries aren't giving people enough time to acclimatise in the first place, not a sign they're well prepared. A chamber you never need to use is a much better outcome than a chamber you're proud to have used.
Chris put it to me plainly when I asked him about it: on Kilimanjaro specifically, altitude illness is something you prevent with pacing and time, and manage with descent when it happens anyway. A bag doesn't do either of those jobs. He's seen HAPE and HACE cases close up on this mountain over the years, and in every one of them the thing that actually resolved it was getting the person down, not sealing them into a tent that simulates being down. His view is that a chamber's real use case on Kilimanjaro is narrow: someone seriously ill high on the mountain at night, in weather too bad to move safely, where it buys an hour or two until first light or until a stretcher team can reach them. Outside that specific situation, he'd rather his guides be moving a sick client downhill than pumping air into a bag.
What we do instead
This is what I really want to convey about our Follow Alice safety process: our entire approach is built around not needing the bag, rather than owning one to point to. A few concrete things that make that up:
Our itineraries are built with proper acclimatisation profiles as the default rather than the upsell. We run the 7 and 8 day routes specifically because more time on the mountain, with a sensible ascent rate, prevents the large majority of serious altitude illness before it starts. That's the same conclusion the UIAA statement leans on: chambers become largely unnecessary once acclimatisation is handled properly. In practice that means building extra nights into routes like the Northern Circuit and Lemosho, and following "climb high, sleep low" on days like the Barranco Wall approach, where you gain altitude during the day and drop back down to sleep. It's a slower, less flashy way to keep people safe, and it's the one with the actual evidence behind it.
We run daily health checks on every climber, tracking blood oxygen saturation and heart rate with a pulse oximeter each morning and evening, so a problem shows up in the numbers before it shows up as a crisis.
Every climb carries emergency oxygen and our team is trained in when and how to use it, as a bridge toward descent, not a way to avoid one.
Our guides are Wilderness First Responder certified and retrain periodically, so the person managing a HAPE case on your climb has real training behind the decision to turn someone around, not just a checklist.
And when descent is the call, we make it. Chris's team has the authority to send a client down with a guide at any point, and that decision doesn't get second-guessed because it's inconvenient for the schedule. You can read more about how all of this fits together on our Kilimanjaro safety page, and about how altitude sickness actually develops and gets managed if you want the fuller picture, along with the Wilderness First Responder training our crew go through.
What I'd actually tell you
If you're comparing operators and one of them leads with "we carry a hyperbaric chamber," it's worth asking a follow-up question rather than crossing them off: how often do you actually use it, and what does your itinerary do to avoid needing it in the first place? A good answer will sound a lot like descent times and acclimatisation days, not like a product feature.
We don't carry a Gamow bag as a marketing point, and I'd rather explain exactly why than let the absence speak for itself. The goal on every one of our Kilimanjaro climbs isn't having the right emergency equipment on hand. It's building the trip so you never get close to needing it.
Have questions about how we manage altitude on your climb?
Talk it through with our Tanzania team before you book.
