The prehospital management of avalanche victims

Abstract

Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.The most frightening enemy was nature itself…. entire platoons were hit, smothered, buried without a trace, without a cry, with no other sound than the one made by the gigantic white mass itself.

Types of wounds on those rescued from the avalanche disaster

“…10 The victims killed by nontraumatic causes gradually experience hypoxia, hypercapnia, and hypothermia. 12 Of the victims presented in the study, 40 were found dead after the incidence, and one casualty died after an admission to a secondary care hospital. The rate of mortality per total number of victims was 33.06%.…”

“…The data dramatically vary depending on the area's topographic structure, the composite structure of snow, and the incident site being a forested or rocky terrain. 12 The avalanche victim can hit trees and rocks and fall down a cliff while rolling in a large mass of snow. 6,8 Of avalanche deaths, 57% are caused by internal and 43% are caused by external injuries.…”

“…According to the results of clinical and autopsy studies, trauma most commonly affects the head, spine, chest, and extremities. 7,8, 12 According to the Canadian data, the injury site is the chest in 46% and head in 42% of the victims. 6 The extremities, spine, and head were the most commonly affected body sites in the present study.…”

“…14 The intervention to avalanche disaster must begin with the safety of the medical management team. 12 The primary strategy in avalanche disaster is the stay in the safe zone. Rescue training must have been received, and the essential equipment must be carried.…”

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

“…Similarly, control of major hemorrhages as an integral part of the triage process emerged as a recurrent topic in the included PHLSDC references, with a special emphasis on the role of non-medical bystanders, as specifically stressed by the Hartford Consensus after the Sandy Hook Elementary School mass shooting and by Lesaffre and colleagues after the 2015 Paris attacks [ 46 – 48 , 50 , 51 , 61 – 63 , 73 , 77 , 80 , 169 ]. Overall, attention was given to the importance of continuous real-time monitoring and re-assessment of casualties to guide prioritization of life-saving interventions and transportation, suggesting the possibility to introduce deployable technology, provided it to be quick, reliable, and easy to use [ 48 , 50 , 54 – 56 , 63 , 69 , 75 , 76 ].…”