On Site Treatment of Avalanche Victims

Abstract

An avalanche accident is a medical emergency. 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, snow conditions, as well as topographic and meteorological factors must be evaluated. “Thinking ahead” should be the guiding principle of the rescue procedure. Try to bring emergency doctors and/or paramedics and dog handlers with dogs (“docs and dogs") as soon as possible to the site of the avalanche. The more persons buried the more doctors and/or paramedics you need.

In case of a short burial time (up to 35 minutes) a rapid extrication has absolute priority. If a buried person is in a critical condition, it will probably be attributable to acute asphyxia or to mechanical trauma. In case of respiratory arrest start artificial respiration as soon as possible during recovery. After a complete burial (head and trunk buried) hospitalise the patient in any case for 24 hours for observation (pulmonary complications: aspiration, pulmonary oedema). After a prolonged burial time (as from 35 minutes) hypothermia is to be expected, therefore extrication should be not as speedy as possible but as gently as possible. An air pocket and free airway are essential for survival and that's why on uncovering the face it's absolutely necessary to look for them. So far a core temperature of 13° can be supposed as lower therapeutic limit for re-warming, but core temperature in that limit area has to be measured oesophageally since an epitympanic measurement can give low values (see ICAR guidelines for hypothermia treatment). Many clinicians reject a lower temperature limit on principle so as not to wreck therapeutic outcomes in future. Nowadays a non-lethal injury is no longer a contra-indication for re-warming with cardiopulmonary bypass. If several buried persons must be attended to simultaneously, the maintenance of vital functions of surviving patients must have priority over reanimation of buried ones without vital functions.

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