Field management of avalanche victims
Introduction
The number of persons killed annually by snow avalanches world-wide is not known precisely. However, in the 17 countries represented by the International Commission for Alpine Rescue (ICAR) in Europe and North America, deaths from avalanche incidents have been accurately recorded over the past two decades; the median annual mortality registered between 1981 and 1998 was 146 (range 82–226) [1]. Fig. 1 shows no significant change over this period in avalanche mortality in the European Alpine countries (Austria, France, Germany, Italy and Switzerland), in contrast to the significant increase noted for the data from Canada and the USA [2]. Avalanche accidents are mostly sports-related, triggered by skiers, snowboarders and, especially in the USA, snowmobilers in open, i.e. non-controlled, areas. Avalanches triggered spontaneously by specific topographic or meteorological circumstances are rare, but inflict a high death toll on victims buried in buildings or on roads engulfed by the snow masses. Thus, major elemental avalanche catastrophes claimed 284 lives in south east Asia Minor in 1992 [3], 197 in two disasters in 1995 (Kashmir [4] and Iceland [5]) and, most recently, 38 in Austria in 1999 [6].
Switzerland is the only country in which all avalanche accidents are comprehensively documented with scrupulous precision. Retrospective analysis of these recorded data enabled accurate calculation of avalanche survival chances [7], and formulation of guidelines for mountain rescue doctors undertaking on-site triage of asystolic victims [8]. In this further study a protocol is proposed for the field management of rescued persons.
Section snippets
Avalanche mortality
‘Complete burial’ is defined as coverage of the victim's head and chest by snow, otherwise the term ‘partial burial’ applies [9]. Altogether, 1886 avalanche victims were registered in Switzerland 1981–1998 [9]. An analysis (Table 1) shows an overall mortality rate of 23.0%; 735 of these persons (39.0%) were completely buried, with 52.4% dead on extrication, compared with only 4.2% in 1151 partially-, or non-buried, victims. Avalanches struck in open areas in 1434 (76.0%), whilst the remaining
General therapeutic principles
Risks to avalanche victims and their rescuers during the rescue operation are not always calculable. Hence, in all decisions the goal of rapid rescue of the victim(s) must be balanced against the risks to the rescue team. The possibility of a second avalanche, the snow conditions, and the relevant topographic and meteorological factors must be evaluated. Furthermore, time factors must be taken into consideration. ‘Thinking ahead’ should be the guiding principle of the rescue procedure.
Individual steps of field management
Highest priority must be given to ensuring reversal of hypoxia and hypothermia after extrication of avalanche victims. Often several buried persons are dug out of the snow masses simultaneously and, thus, adherence to specific triage criteria is important in the assessment of treatment priorities and mandatory in on-site pronouncement of death [8].
During extrication of the victim from the snow masses, unnecessary movement of the trunk and large joints (shoulder, hip and knee) must be avoided,
Acknowledgements
We thank all members of the International Commission for Mountain Emergency Medicine for discussion of the proposed guidelines, presented at the meetings at the Fanes Hut (Italy) 1998 and Sonthofen (Germany) 1999: Messrs. Wiget U (President, Switzerland), Agazzi G (Italy), Aleraj B (Croatia), Beaufort J (Czech Republic), Bonthrone I (Great Britain), Brandt S (Italy), Elsensohn F (Austria), Escoda M (Andorra), Farstad G (Norway), Flora G (Austria), Forster H (Germany), Hora L (Rumania), Jakomet
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This paper is dedicated in memory of Frank Tschirky, who died suddenly aged 45 from a heart attack whilst trekking in Nepal on April 25th 2001, shortly before publication of this study. His untimely death represents a great loss of the field of avalanche research.