Multiple trauma management in mountain environments - a scoping review

Abstract

Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.

Hypothermia in Trauma

“…Measuring core temperature with special urinary catheters in the bladder or central IV lines is reserved for clinical management, and rectal probes provide a delayed measurement and are impractical to insert prehospitally [23]. Epitympanic probes are in use but not widely adopted due to limited availability [26]. Epitympanic temperature measurements correlate well with the core temperature [27].…”

“…The value of exposure during physical exam should be weighed against the risk of hypothermia and should be performed sequentially by body region, preserving insulating clothing in the non-examined area. [26]. Resuscitation with intravenous fluids can worsen trauma-induced coagulopathy by diluting clotting factors and dislodging clots by raising blood pressure and inducing hypothermia [4].…”

A multi-center retrospective study on the effect of the establishment of the three-level trauma emergency center system on the success rate of patients with severe multiple injuries in Jiangxi Province, China

“…For example, the First A liated Hospital of Nanchang University is located in the provincial capital city, and the helicopter rescue is set to solve the urban tra c jam. Management of severe multiple injuries in mountainous environments is di cult and helicopter rescue can reduce the time to the scene [29]. The First A liated Hospital of Gannan Medical University is located in Ganzhou city with many mountains, and helicopter rescue solves the trouble caused by inconvenient tra c. Jiangxi provincial trauma emergency center realizes the network connection between each other through "Ziyun system", which is a system for collecting information about the trauma patients, and the senior trauma emergency center provides assistance and guidance to the junior trauma emergency center.…”

Search and Rescue in the Pacific West States

“…The Washington State Department of Health prolonged prehospital emergency care course and the International Commission for Mountain Emergency Medicine multiple trauma management guidelines promote evidence-based practices for civilian rescuers in remote environements. 14,15 Similarly, the Wilderness Medical Society (WMS) has clinical practice guidelines for current, evidence-based care in remote environments. 16 The adoption of evidence-based, expanded medical protocols similar to those described by WMS and other sources may be limited by the scope of practice under which US first responders have historically operated.…”