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Strapazzon G, Taboni A, Dietrichs ES, Luks AM, Brugger H. Avalanche burial pathophysiology - a unique combination of hypoxia, hypercapnia and hypothermia. J Physiol 2024. [PMID: 39073871 DOI: 10.1113/jp284607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/17/2024] [Indexed: 07/30/2024] Open
Abstract
For often unclear reasons, the survival times of critically buried avalanche victims vary widely from minutes to hours. Individuals can survive and sustain organ function if they can breathe under the snow and maintain sufficient delivery of oxygen and efflux of carbon dioxide. We review the physiological responses of humans to critical avalanche burial, a model which shares similarities and differences with apnoea and accidental hypothermia. Within a few minutes of burial, an avalanche victim is exposed to hypoxaemia and hypercapnia, which have important effects on the respiratory and cardiovascular systems and pose a major threat to the central nervous system. As burial time increases, an avalanche victim also develops hypothermia. Despite progressively reduced metabolism, reduced oxygen and increased carbon dioxide tensions may exacerbate the pathophysiological consequences of hypothermia. Hypercapnia seems to be the main cause of cardiovascular instability, which, in turn, is the major reason for reduced cerebral oxygenation despite reductions in cerebral metabolic activity caused by hypothermia. 'Triple H syndrome' refers to the interaction of hypoxia, hypercapnia and hypothermia in a buried avalanche victim. Future studies should investigate how the respiratory gases entrapped in the porous snow structure influence the physiological responses of buried individuals and how haemoconcentration, blood viscosity and cell deformability affect blood flow and oxygen delivery. Attention should also be devoted to identifying strategies to prolong avalanche survival by either mitigating hypoxia and hypercapnia or reducing core temperature so that neuroprotection occurs before the onset of cerebral hypoxia.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Medicine - DIMEM, University of Padova, Padova, Italy
| | - Anna Taboni
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | | | - Andrew M Luks
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Bracco C, Strapazzon G, Sciolla A, Dupuis A, Lauria G, Fenoglio L. A critically prolonged avalanche burial with recorded cardiac electrical activity and complete recovery - a case report. Scand J Trauma Resusc Emerg Med 2024; 32:61. [PMID: 38961504 PMCID: PMC11223440 DOI: 10.1186/s13049-024-01230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
The probability of survival in avalanche accidents is time-dependent. Critically buried victims who undergo a long burial duration (over 60 min) face a possible mortality rate of over 80%. Understanding the physiological response during critical avalanche burial is crucial for improving rescue strategies and outcomes. We present the case of a 55-year-old male skier buried under an avalanche for 4 h and 51 min in the Italian Alps. Continuous heart rate monitoring revealed distinct phases of cardiac activity during burial. Despite severe hypothermia, the victim survived without extracorporeal rewarming. This case highlights the importance of continuous monitoring and appropriate on-site management in avalanche accidents. Factors such as the presence of an air pocket may positively influence survival. This case underscores the importance of comprehensive resuscitative measures and guidelines for managing avalanche victims with prolonged burial durations.
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Affiliation(s)
- C Bracco
- Department of Internal Medicine, Santa Croce E Carle Hospital, Cuneo, Italy
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - A Sciolla
- Department of Emergency Medicine, Santa Croce E Carle Hospital, Cuneo, Italy.
| | - A Dupuis
- Department of Internal Medicine, Santa Croce E Carle Hospital, Cuneo, Italy
| | - G Lauria
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - L Fenoglio
- Department of Internal Medicine, Santa Croce E Carle Hospital, Cuneo, Italy
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Eisendle F, Rauch S, Wallner B, Brugger H, Strapazzon G. Prevalence of airway patency and air pocket in critically buried avalanche victims - a scoping review. Scand J Trauma Resusc Emerg Med 2024; 32:34. [PMID: 38654361 PMCID: PMC11040957 DOI: 10.1186/s13049-024-01205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Survival of critically buried avalanche victims is directly dependent on the patency of the airway and the victims' ability to breathe. While guidelines and avalanche research have consistently emphasized on the importance of airway patency, there is a notable lack of evidence regarding its prevalence. OBJECTIVE The aim of this review is to provide insight into the prevalence of airway patency and air pocket in critically buried avalanche victims. METHODS A scoping review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline extension for scoping reviews. MEDLINE and Cochrane databases, as well as additional manual searching was performed to identify literature reporting data on airway patency and the presence of an air pocket in critically buried avalanche victims. After eliminating duplicates, we screened abstracts and main texts to identify eligible studies. RESULTS Of 4,109 studies identified 154 were eligible for further screening. Twenty-four publications and three additional data sources with a total number of 566 cases were included in this review. The proportion of short-term (< 35 min) to long-term burial (≥ 35 min) in the analysed studies was 19% and 66%, respectively. The burial duration remained unknown in 12% of cases. The prevalence of airway patency in critically buried avalanche victims was 41% while that of airway obstruction was 12%, with an overall rate of reporting as low as 50%. An air pocket was present in 19% of cases, absent in 46% and unknown in 35% of the cases. CONCLUSION The present study found that in critically buried avalanche victims patent airways were more than three times more prevalent than obstructed, with the airway status reported only in half of the cases. This high rate of airway patency supports the ongoing development and the effectiveness of avalanche rescue systems which oppose asphyxiation in critically buried avalanche victims. Further effort should be done to improve the documentation of airway patency and the presence of an air pocket in avalanche victims and to identify factors affecting the rate of airway obstruction.
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Affiliation(s)
- Frederik Eisendle
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Department of Anaesthesia and Intensive Care Medicine, Hospital of Merano, Merano, Italy
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy.
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
- SIMeM Italian Society of Mountain Medicine, Padova, Italy.
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Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness Environ Med 2024; 35:20S-44S. [PMID: 37945433 DOI: 10.1016/j.wem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023]
Abstract
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
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Affiliation(s)
- Christopher Van Tilburg
- Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | | | - William Will R Smith
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
| | - Ken Zafren
- International Commission for Alpine Rescue
- Himalayan Rescue Association, Kathmandu, Nepal
- Stanford University Medical Center, Palo Alto, CA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Gruber E, Oberhammer R, Brugger H, Bresadola E, Avogadri M, Kompatscher J, Kaufmann M. Prolonged critical avalanche burial for nearly 23 h with severe hypothermia and severe frostbite with good recovery: a case report. Scand J Trauma Resusc Emerg Med 2024; 32:11. [PMID: 38347576 PMCID: PMC10863192 DOI: 10.1186/s13049-024-01184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Accidental hypothermia with severe frostbite is a rare combination of injuries with a high risk for long-term sequelae. There are widely accepted recommendations for the management of avalanche victims and for frostbite treatment, but no recommendation exists for the treatment of frostbite in severe hypothermic patients, specifically for the management of hypothermic avalanche victims presenting with frostbite. CASE PRESENTATION We present a case of a previously healthy, 53-year-old male skier who was critically buried by an avalanche at 2300 m of altitude at an ambient temperature of - 8 °C for nearly 23 h. The victim was found with the right hand out of the snow and an air connection to outside. He was somnolent with Glasgow Coma Scale 11 (Eye 4, Verbal 2, Motor 5) and spontaneously breathing, in a severely hypothermic state with an initial core temperature of 23.1 °C and signs of cold injuries in all four extremities. After rescue and active external forced air rewarming in the intensive care unit, the clinical signs of first-degree frostbite on both feet and the left hand vanished, while third- to fourth-degree frostbite injuries became apparent on all fingers of the right hand. After reaching a core body temperature of approximately 36 °C, aggressive frostbite treatment was started with peripheral arterial catheter-directed thrombolysis with alteplase, intravenous iloprost, ibuprofen, dexamethasone and regional sympathicolysis with a right-sided continuous axillary block. After ten months, the patient had no tissue loss but needed neuropathic pain treatment with pregabalin. CONCLUSION The combination of severe accidental hypothermia and severe frostbite is rare and challenging, as drug metabolism is unpredictable in a hypothermic patient and no recommendations for combined treatment exist. There is general agreement to give hypothermia treatment the priority and to begin frostbite treatment as early as possible after full rewarming of the patient. More evidence is needed to identify the optimal dosage and time point to initiate treatment of frostbite in severely hypothermic patients. This should be taken into consideration by future treatment recommendations.
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Affiliation(s)
- Elisabeth Gruber
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy.
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy.
| | - Rosmarie Oberhammer
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
- Department of Anaesthesia and Intensive Care, Emergency Medicine and Pain Therapy, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Ospedale 11, 39031, Brunico-Bruneck, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, 39100, Bolzano-Bozen, Italy
| | - Elisa Bresadola
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, 39040, Laion- Lajen, Italy
| | - Matteo Avogadri
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, 39040, Laion- Lajen, Italy
| | - Julia Kompatscher
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
| | - Marc Kaufmann
- Department of Emergency Medicine, Anaesthesia and Intensive Care, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, Via Lorenz Boehler 5, 39100, Bolzano-Bozen, Italy
- HELI HEMS Service South Tyrol, Via Lorenz Boehler 3, 39100, Bolzano-Bozen, Italy
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Lugnet V, McDonough M, Gordon L, Galindez M, Mena Reyes N, Sheets A, Zafren K, Paal P. Termination of Cardiopulmonary Resuscitation in Mountain Rescue: A Scoping Review and ICAR MedCom 2023 Recommendations. High Alt Med Biol 2023; 24:274-286. [PMID: 37733297 DOI: 10.1089/ham.2023.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Lugnet, Viktor, Miles McDonough, Les Gordon, Mercedes Galindez, Nicolas Mena Reyes, Alison Sheets, Ken Zafren, and Peter Paal. Termination of cardiopulmonary resuscitation in mountain rescue: a scoping review and ICAR MedCom 2023 recommendations. High Alt Med Biol. 24:274-286, 2023. Background: In 2012, the International Commission for Mountain Emergency Medicine (ICAR MedCom) published recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue. New developments have necessitated an update. This is the 2023 update for termination of CPR in mountain rescue. Methods: For this scoping review, we searched the PubMed and Cochrane libraries, updated the recommendations, and obtained consensus approval within the writing group and the ICAR MedCom. Results: We screened a total of 9,102 articles, of which 120 articles met the inclusion criteria. We developed 17 recommendations graded according to the strength of recommendation and level of evidence. Conclusions: Most of the recommendations from 2012 are still valid. We made minor changes regarding the safety of rescuers and responses to primary or traumatic cardiac arrest. The criteria for termination of CPR remain unchanged. The principal changes include updated recommendations for mechanical chest compression, point of care ultrasound (POCUS), extracorporeal life support (ECLS) for hypothermia, the effects of water temperature in drowning, and the use of burial times in avalanche rescue.
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Affiliation(s)
- Viktor Lugnet
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Swedish Mountain Guides Association (SBO), Gällivare, Sweden
| | - Miles McDonough
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Emergency Medicine, UCSF Fresno, Fresno, California, USA
| | - Les Gordon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Langdale Ambleside Mountain Rescue Team, Ambleside, United Kingdom
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, United Kingdom
| | - Mercedes Galindez
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Internal Medicine, Hospital Zonal Ramón Carrillo, San Carlos de Bariloche, Argentina
- Comisión de Auxilio Club Andino Bariloche, San Carlos de Bariloche, Argentina
| | - Nicolas Mena Reyes
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Emergency Medicine, Sótero del Río Hospital, Santiago de Chile, Chile
- Grupo de Rescate Médico en Montaña (GREMM), Santiago, Chile
- Emegency Medicine Section, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison Sheets
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Emergency Medicine, Boulder Community Health, Boulder, Colorado, USA
- Wilderness Medicine Section, University of Colorado Health Sciences Center, Aurora, Colorado, USA
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Himalayan Rescue Association, Kathmandu, Nepal
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA
- Alaska Native Medical Center, Anchorage, Alaska, USA
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
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Strapazzon G, Rauch S, Malacrida S, Dal Cappello T, Governo E, Catuzzo B, Mrakic-Sposta S, Urgesi M, Falla M, Cavoretto G, Visetti E, Giardini G, Brugger H, Prato F. Comparative Effectiveness of an Artificial Air Pocket Device to Delay Asphyxiation in Supine Individuals Critically Buried in Avalanche Debris. JAMA Netw Open 2023; 6:e2313376. [PMID: 37184835 DOI: 10.1001/jamanetworkopen.2023.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Importance Approximately 70% of individuals critically buried in avalanche debris die within 35 minutes as a result of asphyxial cardiac arrest. An artificial air-pocket device (AAPD) that separates inhaled air from exhaled air may delay the onset of severe hypoxemia and eventual asphyxia during snow burial. Objective To investigate the efficacy of a new AAPD during snow burial in a supine position. Design, Setting, and Participants This comparative effectiveness trial was performed in winter 2016 with data analysis in November 2016 and November 2022. Each trial used a simulated critical avalanche burial scenario, in which a trough was dug in a snow pile and an additional air pocket of 0.5 L volume was punched into the lateral wall for each control trial. All participants were buried in a supine position. Trials could be voluntarily terminated at any time, with a maximum length of 60 minutes; trials were automatically terminated if the participant's peripheral oxygen saturation (Spo2) dropped to less than 84%. Exposures Each participant conducted 2 trials, one in which they breathed into the AAPD (intervention trial) and the other in which they breathed into the prepared air pocket (control trial). Main Outcomes and Measures Measurements included Spo2, cerebral oxygenation, ventilatory parameters, respiratory gas concentrations, and visual-analogue scales. Kaplan-Meier survival curves and rank test for matched survival data were used to analyze the total burial time in each trial. Results A total of 13 volunteers (9 men; mean [SD] age, 33 [8] years) were exposed to the intervention and control trials. Intervention trials were terminated less often (2 of 13 trials) as a result of hypoxemia than control trials (11 of 12 trials). Similarly, survival curves showed a longer duration of burial in the intervention compared with the control trials for the time to reach an Spo2 less than 84% (rank test for matched survival data: P = .003). The intervention trials, compared with the control trials, also had slower rates of decrease in fraction of inspired oxygen (mean [SD] rate, -0.8 [0.4] %/min vs -2.2 [1.2] %/min) and of increase in fraction of inspired carbon dioxide (mean [SD] rate, 0.5 [0.3] %/min vs 1.4 [0.6] %/min) and expired ventilation per minute (mean [SD] rate, 0.5 [1.0] L/min2 vs 3.9 [2.6] L/min2). Conclusions and Relevance This comparative effectiveness trial found that the new AAPD was associated with delaying the development of hypoxemia and hypercapnia in supine participants in a critical burial scenario. Use of the AAPD may allow a longer burial time before asphyxial cardiac arrest, which might allow longer times for successful rescue by companions or by prehospital emergency medical services.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Corpo Nazionale Soccorso Alpino e Speleologico, Milano, Italy
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesia and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy
| | - Sandro Malacrida
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Enrica Governo
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
| | - Bruna Catuzzo
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
| | | | - Margherita Urgesi
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | | | - Enrico Visetti
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
- Department of Anesthesia and Intensive Care, Gruppo Policlinico di Monza, Monza, Italy
| | - Guido Giardini
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Federico Prato
- Corpo Nazionale Soccorso Alpino e Speleologico, Milano, Italy
- Mountain Medicine Center, Azienda Sanitaria Valle d'Aosta, Aosta, Italy
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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8
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Pasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K, Artoni C, Van Tilburg C, Sheets A, Ellerton J, McLaughlin K, Gordon L, Martin RW, Jacob M, Musi M, Blancher M, Jaques C, Brugger H. On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation 2023; 184:109708. [PMID: 36709825 DOI: 10.1016/j.resuscitation.2023.109708] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims. METHODS ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system. RESULTS We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%). CONCLUSIONS AND RECOMMENDATIONS For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.
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Affiliation(s)
- M Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
| | - A Kottmann
- Swiss Air Ambulance - Rega, Zurich Airport, Switzerland; Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University Salzburg, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - K Zafren
- Department of Emergency Medicine, Alaska Native Medical Center Anchorage, Alaska, USA; Department of Emergency Medicine Stanford University Medical Center Stanford, CA, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K Oshiro
- Cardiovascular Department, Mountain Medicine, Research, & Survey Division, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan; Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - C Artoni
- ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - C Van Tilburg
- Providence Hood River Memorial Hospital, Hood River, Oregon, USA; Mountain Rescue Association, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA; University of Colorado Wilderness and Environmental Medicine Fellowship Faculty, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - J Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K McLaughlin
- Canmore Hospital, Alberta, Canada; University of Calgary, Canada; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - L Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, England; Langdale Ambleside Mountain Rescue Team, England; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - R W Martin
- Mountain Rescue Association, USA; ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - M Jacob
- Bavarian Mountain Rescue Service, Bad Tölz, Germany; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Musi
- Emergency Department, University of Colorado, Aurora, Colorado, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Blancher
- Department of Emergency Medicine, University Hospital of Grenoble Alps Grenoble, France; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - C Jaques
- Lausanne University Medical Library, Lausanne, Switzerland.
| | - H Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
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9
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Troeger W, Isser M, Lengerer T, Wiedermann FJ, Lederer W. Electromagnetic Interference from Heated Gloves May Compromise Avalanche Transceiver Function. Wilderness Environ Med 2022; 33:422-428. [PMID: 36210278 DOI: 10.1016/j.wem.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Rapid location of avalanche victims by companions using avalanche transceivers is of utmost importance to prevent asphyxiation. The objective was to determine whether electromagnetic interference from heating elements in gloves worn by rescuers or victims can impair the receiving or transmitting function of avalanche beacons. METHODS Commercially available heated gloves from 3 different manufacturers were examined during a simulated search with 3 common brands of avalanche transceivers. Distance to target beacon at first signal detection and accuracy of direction to target, as indicated by the arrow from the direction indicator, were evaluated. RESULTS Preliminary tests showed that transmitting and receiving signals are degraded by electromagnetic interference caused by rectangular pulses emitted by activated heating elements. Field tests revealed significantly reduced distances of first signal detection when heated gloves were turned on near receiving avalanche transceivers (P<0.001; Wilcoxon signed-rank test). Decreased distance to target beacon ranged between 1.9 m (5%) and 41.5 m (94%) at first detection, depending on the avalanche transceiver used. CONCLUSIONS Avalanche transceivers are susceptible to electromagnetic interference from gloves with electric heating elements. We do not recommend using heated gloves when performing a transceiver search for avalanche victims because it can lead to a delay in rescue.
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Affiliation(s)
- Willi Troeger
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria; Austrian Mountain Rescue Service - Tyrol, Telfs, Austria.
| | - Markus Isser
- Austrian Mountain Rescue Service - Tyrol, Telfs, Austria
| | | | - Franz J Wiedermann
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Lederer
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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10
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Di Stefano LL, Libera BD, Rodi P. Effectiveness and Use of Avalanche Airbags in Mortality Reduction among Winter-Recreationists. J Travel Med 2022:6812861. [PMID: 36349697 DOI: 10.1093/jtm/taac133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/04/2022] [Indexed: 11/10/2022]
Abstract
RATIONALE FOR REVIEW the number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment. This study provides a review of available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations. KEY FINDINGS causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing chances of critical burial, the most determining risk factor. However, there is scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education, and risk compensation. CONCLUSIONS/RECOMMENDATIONS avalanche airbags seem to be an important tool in reducing mortality in backcountry expeditions. However, more research and standardized data collection is needed to fill the knowledge gap, mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche, and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels, and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia, and trauma.
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Affiliation(s)
| | | | - Paolo Rodi
- General surgery resident, Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; European Master of Disaster Medicine candidate
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11
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Habegger K, Brechbühler S, Vogt K, Lienert JS, Engelhardt BM, Müller M, Exadaktylos AK, Brodmann Maeder M. Accidental Hypothermia in a Swiss Alpine Trauma Centre-Not an Alpine Problem. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10735. [PMID: 36078450 PMCID: PMC9518193 DOI: 10.3390/ijerph191710735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research in accidental hypothermia focuses on trauma patients, patients exposed to cold environments or patients after drowning but rarely on hypothermia in combination with intoxications or on medical or neurological issues. The aim of this retrospective single-centre cohort study was to define the aetiologies, severity and relative incidences of accidental hypothermia, methods of measuring temperature and in-hospital mortality. METHODS The study included patients ≥18 years with a documented body temperature ≤35 °C who were admitted to the emergency department (ED) of the University Hospital in Bern between 2000 and 2019. RESULTS 439 cases were included, corresponding to 0.32 per 1000 ED visits. Median age was 55 years (IQR 39-70). A total of 167 patients (38.0%) were female. Furthermore, 63.3% of the patients suffered from mild, 24.8% from moderate and 11.9% from severe hypothermia. Exposure as a single cause for accidental hypothermia accounted for 12 cases. The majority were combinations of hypothermia with trauma (32.6%), medical conditions (34.2%), neurological conditions (5.2%), intoxications (20.3%) or drowning (12.0%). Overall mortality was 22.3% and depended on the underlying causes, severity of hypothermia, age and sex.
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Affiliation(s)
- Katrin Habegger
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Simon Brechbühler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Karin Vogt
- Hôpital du Valais, Spitalzentrum Oberwallis, 3930 Visp, Switzerland
| | - Jasmin S. Lienert
- Department of Emergency Medicine, Fribourg Hospital, 1752 Villars-sur-Glâne, Switzerland
| | - Bianca M. Engelhardt
- Swiss Army, Military Medical Service, Regional Military Medical Center of Thun, 3600 Thun, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Monika Brodmann Maeder
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- EURAC Research, Institute of Mountain Emergency Medicine, 39100 Bolzano, Italy
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12
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Genswein M, Macias D, McIntosh S, Reiweger I, Hetland A, Paal P. AvaLife-A New Multi-Disciplinary Approach Supported by Accident and Field Test Data to Optimize Survival Chances in Rescue and First Aid of Avalanche Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095257. [PMID: 35564653 PMCID: PMC9104102 DOI: 10.3390/ijerph19095257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023]
Abstract
Snow sports in the backcountry have seen a steep increase in popularity, and therefore preparedness for efficient companion and organized rescue is important. While technical rescue skills are widely taught, there is a lack of knowledge regarding first aid for avalanche patients. The stressful and time-critical situation for first responders requires a rule-based decision support tool. AvaLife has been designed from scratch, applying mathematical and statistical approaches including Monte Carlo simulations. New analysis of retrospective data and large prospective field test datasets were used to develop evidence-based algorithms exclusively for the avalanche rescue environment. AvaLife differs from other algorithms as it is not just a general-purpose CPR algorithm which has been slightly adapted for the avalanche patient. The sequence of actions, inclusion of the ≥150 cm burial depth triage criterion, advice to limit CPR duration for normothermic patients to 6 min in case of multiple burials and shortage of resources, criteria for using recovered subjects as a resource in the ongoing rescue, the adapted definition of "injuries incompatible with life", reasoning behind the utmost importance of rescue breaths, as well as the updated BLS-iCPR algorithm make AvaLife useful in single and multiple burial rescue. AvaLife is available as a companion rescue basic life support (BLS) version for the recreational user and an advanced companion and organized rescue BLS version for guides, ski patrols and mountain rescuers. AvaLife allows seamless interoperability with advanced life support (ALS) qualified medical personnel arriving on site.
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Affiliation(s)
- Manuel Genswein
- MountainSafety.info, 7260 Davos, Switzerland
- Correspondence: ; Tel.: +41-79-236-36-76
| | - Darryl Macias
- Department of Emergency Medicine, University of New Mexico, International Mountain Medicine Center, Albuquerque, NM 87131, USA;
| | - Scott McIntosh
- Department of Emergency Medicine, University of Utah Health, AirMed, Salt Lake City, UT 84132, USA;
| | - Ingrid Reiweger
- Institute of Mountain Risk Engineering, University of Natural Resources and Life Sciences, 1190 Vienna, Austria;
| | - Audun Hetland
- CARE Center for Avalanche Research and Education, UiT The Arctic University of Norway, 9010 Tromsø, Norway;
| | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5010 Salzburg, Austria;
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Rauch S, Koppenberg J, Josi D, Meuli L, Strapazzon G, Pasquier M, Albrecht R, Brugger H, Zweifel B, Pietsch U. Avalanche survival depends on the time of day of the accident: A retrospective observational study. Resuscitation 2022; 174:47-52. [PMID: 35341911 DOI: 10.1016/j.resuscitation.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We aimed to investigate the relationship between the time of the day and the probability of survival of completely buried avalanche victims. We explored the frequency of avalanche burials occurring after sunset, and described victims' characteristics, duration of burial and rescue circumstances compared to daytime avalanches. METHODS In this retrospective, observational study, we analysed avalanche data from the registry of the Swiss Institute for Snow and Avalanche Research, from 1998 to 2020. RESULTS A total of 3,892 avalanche victims were included in the analysis, with 72 of the accidents (1.85%) occurring in the nighttime. Nearly 50% of the victims involved in nighttime avalanche accidents were completely buried, compared to about 25% of victims in daytime avalanches. Completely buried victims were rescued by a companion less often at night than in the daytime (15% vs. 51%, p<.001). The search and rescue of completely buried avalanche victims took longer during the nighttime compared to the daytime (median 89 min vs 20 min, p=.002). The probability of survival decreased as the day progressed; it was highest at around midday (63.0%), but decreased at sunset (40.4%) and was the lowest at midnight (28.7%). CONCLUSIONS Avalanche accidents at night are a rare event, and probability of survival after complete burial is lower during the nighttime compared to the daytime. The most relevant reason for this is the longer duration of burial, which is explained in part by the lower rate of companion rescue and the lower rate of victim localisation with an avalanche transceiver.
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Affiliation(s)
- Simon Rauch
- Department of Anaesthesiology and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy; Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.
| | - Joachim Koppenberg
- Department of Anaesthesiology, Pain Therapy and Emergency Medicine, Lower Engadine Hospital and Health Centre, Scuol, Switzerland; Aquatic Ecology, Institute of Ecology and Evolution, University of Bern, Bern, Switzerland.
| | - Dario Josi
- Aquatic Ecology, Institute of Ecology and Evolution, University of Bern, Bern, Switzerland; Department of Fish Ecology and Evolution, EAWAG Swiss Federal Institute of Aquatic Science and Technology, Center for Ecology, Evolution and Biogeochemistry, Kastanienbaum, Switzerland.
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy; Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Roland Albrecht
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy; Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Benjamin Zweifel
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland.
| | - Urs Pietsch
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland; Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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14
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Perlite is a suitable model material for experiments investigating breathing in high density snow. Sci Rep 2022; 12:2070. [PMID: 35136116 PMCID: PMC8827056 DOI: 10.1038/s41598-022-06015-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Outdoor breathing trials with simulated avalanche snow are fundamental for the research of the gas exchange under avalanche snow, which supports the development of the international resuscitation guidelines. However, these studies have to face numerous problems, including unstable weather and variable snow properties. This pilot study examines a mineral material perlite as a potential snow model for studies of ventilation and gas exchange parameters. Thirteen male subjects underwent three breathing phases—into snow, wet perlite and dry perlite. The resulting trends of gas exchange parameters in all tested materials were similar and when there was a significant difference observed, the trends in the parameters for high density snow used in the study lay in between the trends in dry and wet perlite. These findings, together with its stability and accessibility year-round, make perlite a potential avalanche snow model material. Perlite seems suitable especially for simulation and preparation of breathing trials assessing gas exchange under avalanche snow, and potentially for testing of new avalanche safety equipment before their validation in real snow. The study was registered in ClinicalTrials.gov on January 22, 2018; the registration number is NCT03413878.
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15
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Prevention of Hypothermia in the Aftermath of Natural Disasters in Areas at Risk of Avalanches, Earthquakes, Tsunamis and Floods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031098. [PMID: 35162119 PMCID: PMC8834683 DOI: 10.3390/ijerph19031098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Throughout history, accidental hypothermia has accompanied natural disasters in cold, temperate, and even subtropical regions. We conducted a non-systematic review of the causes and means of preventing accidental hypothermia after natural disasters caused by avalanches, earthquakes, tsunamis, and floods. Before a disaster occurs, preventive measures are required, such as accurate disaster risk analysis for given areas, hazard mapping and warning, protecting existing structures within hazard zones to the greatest extent possible, building structures outside hazard zones, and organising rapid and effective rescue. After the event, post hoc analyses of failures, and implementation of corrective actions will reduce the risk of accidental hypothermia in future disasters.
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Wik L, Brattebø G, Østerås Ø, Assmus J, Irusta U, Aramendi E, Mydske S, Skaalhegg T, Christjar Skaiaa S, Thomassen Ø. Physiological effects of providing supplemental air for avalanche victims. A randomised trial. Resuscitation 2022; 172:38-46. [DOI: 10.1016/j.resuscitation.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
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Castellani JW, Eglin CM, Ikäheimo TM, Montgomery H, Paal P, Tipton MJ. ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise. Curr Sports Med Rep 2021; 20:594-607. [PMID: 34752434 DOI: 10.1249/jsr.0000000000000907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Cold injury can result from exercising at low temperatures and can impair exercise performance or cause lifelong debility or death. This consensus statement provides up-to-date information on the pathogenesis, nature, impacts, prevention, and treatment of the most common cold injuries.
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Affiliation(s)
- John W Castellani
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA
| | - Clare M Eglin
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
| | | | - Hugh Montgomery
- University College London, Centre for Human Health and Performance, London, United Kingdom
| | - Peter Paal
- Hospitallers Brothers Hospital, Anaesthesiology and Intensive Care Medicine, Salzburg, Austria
| | - Michael J Tipton
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
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18
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On-Site Medical Management of Avalanche Victims-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910234. [PMID: 34639535 PMCID: PMC8507645 DOI: 10.3390/ijerph181910234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 12/26/2022]
Abstract
Avalanche accidents are common in mountain regions and approximately 100 fatalities are counted in Europe each year. The average mortality rate is about 25% and survival chances are mainly determined by the degree and duration of avalanche burial, the patency of the airway, the presence of an air pocket, snow characteristics, and the severity of traumatic injuries. The most common cause of death in completely buried avalanche victims is asphyxia followed by trauma. Hypothermia accounts for a minority of deaths; however, hypothermic cardiac arrest has a favorable prognosis and prolonged resuscitation and extracorporeal rewarming are indicated. In this article, we give an overview on the pathophysiology and on-site management of avalanche victims.
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Kottmann A, Pasquier M, Strapazzon G, Zafren K, Ellerton J, Paal P. Quality Indicators for Avalanche Victim Management and Rescue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189570. [PMID: 34574495 PMCID: PMC8464975 DOI: 10.3390/ijerph18189570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022]
Abstract
Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.
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Affiliation(s)
- Alexandre Kottmann
- Rega—Swiss Air Ambulance, Zürich Airport, 8058 Zürich, Switzerland
- Emergency Department, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Correspondence:
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, 1011 Lausanne, Switzerland;
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
| | - Giacomo Strapazzon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- CNSAS—Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School, 20124 Milano, Italy
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Alaska Native Medical Center, Department of Emergency Medicine, 4300 Diplomacy Drive, Anchorage, AK 99508, USA
- Stanford University Medical Center, Department of Emergency Medicine, 900 Welch Road, Palo Alto, CA 94304, USA
| | - John Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), 8058 Zürich, Switzerland; (G.S.); (K.Z.); (J.E.); (P.P.)
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria
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Wallner B, Moroder L, Salchner H, Mair P, Wallner S, Putzer G, Strapazzon G, Falk M, Brugger H. CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial. Scand J Trauma Resusc Emerg Med 2021; 29:129. [PMID: 34481521 PMCID: PMC8418718 DOI: 10.1186/s13049-021-00944-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy.
| | - Luca Moroder
- Department of Anaesthesiology and Critical Care Medicine, Hospital of Bolzano, Lorenz Böhler Strasse 5, 39100, Bolzano, Italy
| | - Hannah Salchner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefanie Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy.,eScience, Sonnenstrasse 11, 39031, Bruneck, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy
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Eidenbenz D, Techel F, Kottmann A, Rousson V, Carron PN, Albrecht R, Pasquier M. Survival probability in avalanche victims with long burial (≥60 min): A retrospective study. Resuscitation 2021; 166:93-100. [PMID: 34107337 DOI: 10.1016/j.resuscitation.2021.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial. AIM We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations. METHODS We retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability. RESULTS We identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase. CONCLUSIONS The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.
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Affiliation(s)
- David Eidenbenz
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
| | - Frank Techel
- WSL Institute for Snow and Avalanche Research SLF, Flüelastrasse 11, 7260 Davos-Dorf, Switzerland.
| | - Alexandre Kottmann
- Swiss Air Ambulance - Rega and Emergency Department, Lausanne University Hospital, P.O. Box 1414, 8058 Zürich Airport, Switzerland.
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), route de Berne 113, 1010 Lausanne, Switzerland.
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
| | - Roland Albrecht
- Swiss Air Ambulance - Rega, P.O. Box 1414, 8058 Zürich Airport, Switzerland.
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, BH 09, CHUV, 1011 Lausanne, Switzerland.
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22
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Strapazzon G, Schweizer J, Chiambretti I, Brodmann Maeder M, Brugger H, Zafren K. Effects of Climate Change on Avalanche Accidents and Survival. Front Physiol 2021; 12:639433. [PMID: 33912070 PMCID: PMC8072472 DOI: 10.3389/fphys.2021.639433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Avalanches are major natural hazards in snow-covered mountains, threatening people and infrastructure. With ongoing climate change, the frequency and types of snow avalanches may change, affecting the rates of avalanche burial and survival. With a wetter and warmer snow climate, consequences of burial may become more severe. In this review, we assess the potential effects of climate change on the frequency and characteristics of avalanches. We then discuss how these changes might affect the survival rates of subjects buried by avalanches and might influence the responses of search and rescue (SAR) teams and health care providers. While climate change is inevitable, the effects on avalanches remain elusive. The frequency of human triggered avalanches may not change, because this depends largely on the number and behavior of winter recreationists. Blunt trauma and secondary injuries will likely become more frequent as terrain roughness is expected to rise and snow cover to become thinner. Higher snow densities in avalanche debris will likely interfere with the respiration of completely buried victims. Asphyxia and trauma, as causes of avalanche death, may increase. It is unlikely that SAR and health care providers involved in avalanche rescue will have to change their strategies in areas where they are already established. The effects of climate change might foster the expansion of mitigation strategies and the establishment of mountain rescue services in areas subject to increased avalanche hazards caused by changes in snow cover and land use.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Jürg Schweizer
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland
| | - Igor Chiambretti
- AINEVA Interregional Association for Coordination and Documentation of Snow and Avalanche Problems, Trento, Italy
| | - Monika Brodmann Maeder
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Department of Emergency Medicine, Inselspital University Hospital Bern and Bern University, Bern, Switzerland
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.,Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, United States.,Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, United States
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23
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Fischer K, Kauert-Willms A, Heinisch PP, Kadner A, Jenni H, Eberle B, Erdoes G, Guensch DP. Resolution of Strain Abnormalities During Extracorporeal Rewarming From Accidental Hypothermic Cardiac Arrest Following Avalanche Burial. JACC Case Rep 2020; 3:99-103. [PMID: 34317478 PMCID: PMC8305070 DOI: 10.1016/j.jaccas.2020.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022]
Abstract
A hypothermic avalanche victim underwent, during extracorporeal warming from asystolic arrest, 3-dimensional transesophageal echocardiography. At 33°C core temperature, left ventricular ejection fraction had recovered, whereas myocardial strain still demonstrated significant dysfunction until 36°C. Deformation analysis seems more sensitive than global assessment during myocardial recovery from hypothermic cardiac arrest. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annegret Kauert-Willms
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hansjörg Jenni
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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24
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Strapazzon G, Gatterer H, Falla M, Dal Cappello T, Malacrida S, Turner R, Schenk K, Paal P, Falk M, Schweizer J, Brugger H. Hypoxia and hypercapnia effects on cerebral oxygen saturation in avalanche burial: A pilot human experimental study. Resuscitation 2020; 158:175-182. [PMID: 33249253 DOI: 10.1016/j.resuscitation.2020.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A sufficient supply of oxygen is crucial to avoid hypoxic cardiac arrest and brain damage within 30 min in completely-buried avalanche victims. Snow density influences levels of hypoxia and hypercapnia. The goal of this study was to investigate the effects of hypoxia and hypercapnia on cerebral oxygenation (ScO2) in humans breathing into an artificial air pocket. METHODS Each subject breathed into a closed system (air-tight face mask - plastic tube - snow air-pocket of 4 L) up to 30 min. Each subject performed three tests in different snow densities. ScO2 was measured by a near-infrared spectroscopy (NIRS) device. Measurements included peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), air pocket gases and blood gases. Snow density was assessed via standard methods and micro-computed tomography. Based on predetermined criteria, tests were classified based on whether they were terminated before 30 min and the reason for termination. The categories were: completed tests (30 min), tests terminated before 30 min when SpO2 dropped to ≤75% and tests that were terminated before 30 min by requests of the subjects. General linear models were used to compare termination groups for changes in ScO2, ETCO2, SpO2 and air pocket gases, and a multivariate analysis was used to detect factor independent effects on ScO2. RESULTS ScO2 was decreased in the group in which the tests were terminated for SpO2 ≤ 75% caused by a decrease in oxygen supply in high snow densities. In the completed tests, an increase in ScO2 occurred despite decreased oxygen supply and decreased carbon dioxide removal. CONCLUSIONS Our data show that ScO2 determined by NIRS was not always impaired in humans breathing into an artificial air pocket despite decreased oxygen supply and decreased carbon dioxide removal. This may indicate that in medium to low snow densities brain oxygenation can be sufficient, which may reflect the initial stage of the triple H (hypothermia, hypoxia, and hypercapnia) syndrome. In high snow densities, ScO2 showed a significant decrease caused by a critical decrease in oxygen supply. This could lead to a higher risk of hypoxic cardiac arrest and brain damage.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Centre for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto (TN), Italy
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Sandro Malacrida
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Kai Schenk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Jürg Schweizer
- WSL Institute for Snow and Avalanche Research SLF, Davos Dorf, Switzerland
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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25
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Strapazzon G, Putzer G, Dal Cappello T, Falla M, Braun P, Falk M, Glodny B, Pinggera D, Helbok R, Brugger H. Effects of hypothermia, hypoxia, and hypercapnia on brain oxygenation and hemodynamic parameters during simulated avalanche burial: a porcine study. J Appl Physiol (1985) 2020; 130:237-244. [PMID: 33151777 DOI: 10.1152/japplphysiol.00498.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Avalanche patients who are completely buried but still able to breathe are exposed to hypothermia, hypoxia, and hypercapnia (triple H syndrome). Little is known about how these pathological changes affect brain physiology. The study aim was to investigate the effect of hypothermia, hypoxia, and hypercapnia on brain oxygenation and systemic and cerebral hemodynamics. Anesthetized pigs were surface cooled to 28°C. Fraction of inspiratory oxygen ([Formula: see text]) was reduced to 17% and hypercapnia induced. Hemodynamic parameters and blood gas values were monitored. Cerebral measurements included cerebral perfusion pressure (CPP), brain tissue oxygen tension ([Formula: see text]), cerebral venous oxygen saturation ([Formula: see text]), and regional cerebral oxygen saturation (rSo2). Tests were interrupted when hemodynamic instability occurred or 60 min after hypercapnia induction. ANOVA for repeated measures was used to compare values across phases. There was no clinically relevant reduction in cerebral oxygenation ([Formula: see text], [Formula: see text], rSo2) during hypothermia and initial [Formula: see text] reduction. Hypercapnia was associated with an increase in pulmonary resistance followed by a decrease in cardiac output and CPP, resulting in hemodynamic instability and cerebral desaturation (decrease in [Formula: see text], [Formula: see text], rSo2). Hypercapnia may be the main cause of cardiovascular instability, which seems to be the major trigger for a decrease in cerebral oxygenation in triple H syndrome despite severe hypothermia.NEW & NOTEWORTHY Avalanche patients who are completely buried but still able to breathe are exposed to hypothermia, hypoxia, and hypercapnia (triple H syndrome). In a porcine model, there was no clinically relevant reduction in cerebral oxygenation during hypothermia and initial reduction of fraction of inspiratory oxygen ([Formula: see text]), as observed during hypercapnia. Hypercapnia may be the main cause of cardiovascular instability, which seems to be the major trigger for a decrease in cerebral oxygenation in triple H syndrome despite severe hypothermia.
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Affiliation(s)
- Giacomo Strapazzon
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy.,Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Tomas Dal Cappello
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Marika Falla
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy.,Centre for Mind/Brain Sciences (CIMeC), University of Trento, Italy
| | - Patrick Braun
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Falk
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy.,Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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26
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McIntosh SE, Little CE, Seibert TD, Polukoff NE, Grissom CK. Reply to: Reconsidering the air pocket around mouth and nose as a positive outcome predictor in completely buried avalanche victims. Resuscitation 2020; 152:210-211. [PMID: 32234369 DOI: 10.1016/j.resuscitation.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/21/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Scott E McIntosh
- University of Utah Health, Division of Emergency Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, United States.
| | - Colin E Little
- University of Utah Health, Division of Emergency Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, United States
| | - Thomas D Seibert
- University of Utah Health, Division of Emergency Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, United States
| | - Natalya E Polukoff
- University of Utah Health, Division of Emergency Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, United States
| | - Colin K Grissom
- Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States
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27
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Strapazzon G, Brugger H, Paal P, Brown D. Reconsidering the air pocket around mouth and nose as a positive outcome predictor in completely buried avalanche victims. Resuscitation 2020; 152:208-209. [PMID: 32229217 DOI: 10.1016/j.resuscitation.2020.02.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland
| | - Peter Paal
- International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Doug Brown
- International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland; Department of Emergency Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, Canada
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28
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Niedermeier M, Gatterer H, Pocecco E, Frühauf A, Faulhaber M, Menz V, Burtscher J, Posch M, Ruedl G, Burtscher M. Mortality in Different Mountain Sports Activities Primarily Practiced in the Winter Season-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010259. [PMID: 31905912 PMCID: PMC6981978 DOI: 10.3390/ijerph17010259] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
Annually, millions of people engage in mountain sports activities all over the world. These activities are associated with health benefits, but concurrently with a risk for injury and death. Knowledge on death rates is considered important for the categorization of high-risk sports in literature and for the development of effective preventive measures. The death risk has been reported to vary across different mountain sports primarily practiced in the summer season. To complete the spectrum, the aim of the present review is to compare mortality rates across different mountain sports activities primarily practiced in winter. A comprehensive literature search was performed on the death risk (mortality) during such activities, i.e., alpine (downhill) skiing, snowboarding, cross-country skiing, ski touring, and sledging. With the exception of ski touring (4.4 deaths per 1 million exposure days), the mortality risk was low across different winter sports, with small activity-specific variation (0.3–0.8 deaths per 1 million exposure days). Traumatic (e.g., falls) and non-traumatic (e.g., cardiac death) incidents and avalanche burial in ski tourers were the predominant causes of death. Preventive measures include the improvement of sport-specific skills and fitness, the use of protective gear, well-targeted and intensive training programs concerning avalanche hazards, and sports-medical counseling for elderly and those with pre-existing diseases.
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Affiliation(s)
- Martin Niedermeier
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, EURAC Research, 39100 Bolzano, Italy;
| | - Elena Pocecco
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
- Center for Teaching Methodology, Pedagogical University Tyrol, 6020 Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
| | - Martin Faulhaber
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
- Austrian Society for Alpine and High-Altitude Medicine, 6020 Innsbruck, Austria
| | - Verena Menz
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
| | - Johannes Burtscher
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland;
| | - Markus Posch
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
| | - Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.N.); (E.P.); (A.F.); (M.F.); (V.M.); (M.P.); (G.R.)
- Austrian Society for Alpine and High-Altitude Medicine, 6020 Innsbruck, Austria
- Correspondence:
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29
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Avalanche airbag post-burial active deflation - The ability to create an air pocket to delay asphyxiation and prolong survival. Resuscitation 2019; 146:155-160. [PMID: 31812665 DOI: 10.1016/j.resuscitation.2019.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/10/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022]
Abstract
AIM The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation. METHODS Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket. RESULTS Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials. CONCLUSION The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims.
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30
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Wallner B, Moroder L, Brandt A, Mair P, Erhart S, Bachler M, Putzer G, Turner R, Strapazzon G, Falk M, Brugger H. Extrication Times During Avalanche Companion Rescue: A Randomized Single-Blinded Manikin Study. High Alt Med Biol 2019; 20:245-250. [PMID: 31264903 DOI: 10.1089/ham.2019.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims: This study aimed to determine the time needed for one or two companion rescuers to access, extricate, and deliver cardiopulmonary resuscitation (CPR) to a fully buried manikin during a simulated avalanche burial scenario. Materials and Methods: In this randomized, single-blinded study, 18 medical students were required to extricate a manikin manually from a simulated avalanche burial of 1 m in depth, either alone or in teams of two. Each participant performed three consecutive tests with the manikin in three different positions in random order. Results: Median time to first manikin contact was 2.5 minutes, median time to airway access 7.2 minutes, and median time to standard position for CPR 10.1 minutes. Overall, the number of rescuers (one compared to two rescuers, 10.5 minutes vs. 9.3 minutes; p = 0.686) and the burial position of the manikin (10.8 minutes vs. 10.6 minutes vs. 8.8 minutes; p = 0.428) had no influence on extrication times. Preexisting training (6.1 minutes vs. 11.0 minutes p = 0.006) and a learning effect obtained during the experiments (12.4 minutes the first test vs. 9.3 in the third test; p = 0.017) improved all extrication times. Conclusion: It takes an average of 7 minutes after location of a simulated avalanche victim, buried at a depth of 1 m, to free the airway, plus a further 3 minutes to initiate CPR in standard supine position. This is more than two-thirds of the 15 minutes considered necessary for successful companion avalanche rescue. Even minimal training significantly reduced extrication times. These findings emphasize the importance of regular practice in specific extrication techniques that should be part of any training in avalanche companion rescue.
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Luca Moroder
- Department of Anaesthesiology and Critical Care Medicine, General Hospital Brixen, Brixen, Italy
| | - Anna Brandt
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Erhart
- Department of Orthopaedics and Traumatology, University Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Mirjam Bachler
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, University Clinic Innsbruck, Medical University Innsbruck, Innsbruck, Austria
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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31
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Strapazzon G, Brugger H. On-Site Treatment of Snow Avalanche Victims: From Bench to Mountainside. High Alt Med Biol 2018; 19:307-315. [PMID: 30183350 DOI: 10.1089/ham.2018.0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The number of avalanche accidents involving winter recreationists has notably increased in recent decades due to the increasing popularity of outdoor winter activities. The International Liaison Committee on Cardiopulmonary Resuscitation, the International Commission for Mountain Emergency Medicine (ICAR Medcom), and the Wilderness Medical Society have recently published evidenced-based recommendations for the on-site treatment of snow avalanche victims. Despite these recommendations, recent studies found poor knowledge and compliance by both healthcare providers and laypersons. The aim of this nonsystematic review is to provide an updated overview of avalanche accident epidemiology, to present recent advances in snow avalanche pathophysiology, and to discuss recent advancements in on-site treatment of snow avalanche victims.
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Affiliation(s)
- Giacomo Strapazzon
- 1 Institute of Mountain Emergency Medicine , Eurac Research, Bolzano, Italy .,2 International Commission of Mountain Emergency Medicine (ICAR Medcom) , Kloten, Switzerland
| | - Hermann Brugger
- 1 Institute of Mountain Emergency Medicine , Eurac Research, Bolzano, Italy .,2 International Commission of Mountain Emergency Medicine (ICAR Medcom) , Kloten, Switzerland
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Kottmann A, Carron PN, Theiler L, Albrecht R, Tissi M, Pasquier M. Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement. Scand J Trauma Resusc Emerg Med 2018; 26:54. [PMID: 29973290 PMCID: PMC6033290 DOI: 10.1186/s13049-018-0520-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts. METHODS This 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported. RESULTS Our analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period. CONCLUSIONS Our data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.
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Affiliation(s)
- Alexandre Kottmann
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | | | - Lorenz Theiler
- Swiss Air Ambulance, Rega, Zürich, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Mario Tissi
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Strapazzon G, Migliaccio D, Fontana D, Stawinoga AE, Milani M, Brugger H. Knowledge of the Avalanche Victim Resuscitation Checklist and Utility of a Standardized Lecture in Italy. Wilderness Environ Med 2018; 29:56-60. [DOI: 10.1016/j.wem.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
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Effects of snow properties on humans breathing into an artificial air pocket - an experimental field study. Sci Rep 2017; 7:17675. [PMID: 29247235 PMCID: PMC5732296 DOI: 10.1038/s41598-017-17960-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/01/2017] [Indexed: 11/11/2022] Open
Abstract
Breathing under snow, e.g. while buried by a snow avalanche, is possible in the presence of an air pocket, but limited in time as hypoxia and hypercapnia rapidly develop. Snow properties influence levels of hypoxia and hypercapnia, but their effects on ventilation and oxygenation in humans are not fully elucidated yet. We report that in healthy subjects breathing into snow with an artificial air pocket, snow density had a direct influence on ventilation, oxygenation and exhaled CO2. We found that a rapid decline in O2 and increase in CO2 were mainly associated with higher snow densities and led to premature interruption due to critical hypoxia (SpO2 ≤ 75%). However, subjects in the low snow density group demonstrated a higher frequency of test interruptions than expected, due to clinical symptoms related to a rapid CO2 accumulation in the air pocket. Snow properties determine the oxygen support by diffusion from the surrounding snow and the clearance of CO2 by diffusion and absorption. Thus, snow properties are co-responsible for survival during avalanche burial.
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Frühauf A, Hardy WAS, Pfoestl D, Hoellen FG, Kopp M. A Qualitative Approach on Motives and Aspects of Risks in Freeriding. Front Psychol 2017; 8:1998. [PMID: 29184524 PMCID: PMC5694463 DOI: 10.3389/fpsyg.2017.01998] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022] Open
Abstract
Recent research has shown that there are multiple motives for participation in high-risk sport; however these results have come from studies that consider a number of different sports. Therefore, the aim of the present study was to better understand the motives and risk-related aspects of freeriding, using a qualitative approach. Semi-structured interviews were conducted with 40 professional and semi-professional freeride skiers and snowboarders. All freeriders were highly experienced, of different age (19–44 years; 27.5 ± 4.5 years), gender (female = 13), and profession (professional athletes = 11). Analyses were done using MAXQDA software following a code theme approach. Mixed methods analyses using χ2-tests were computed for age (<25 years ≥) and gender (female/male) on motives and risk factors. Five emerging themes were found, namely Challenge (n = 36), Friends (n = 31), Nature (n = 27), Balance (n = 26), and Freedom (n = 26). A sixth theme Habit (n = 13) was allocated as a subtheme due to minor responses. With regard to risk management, participants decided upon a risk calculation strategy which included multiple factors (e.g., planning, conditions, current situation, knowledge, and experience). Trusting in one's own abilities, avoiding negative fear and having trusted partners were among the risk factors. Deliberately seeking out dangerous situations was not a motive. χ2-tests revealed no gender or age differences regarding aspects of risk (range of p-scores: p = 0.17–1.00) or motives (p = 0.16–1.00). Freeriding was shown to provide positive effects through participation. Some important factors seem to be motivational drivers for freeriders: challenging oneself, experiencing nature, contributing to deep friendships, freeriding as a counterbalance to everyday life and escape from restrictions. Contrary to prior research reports on sensation seeking, experienced freeriders do not search the risk; they seem to minimize it based on knowledge and experience. Analyses of the present data did not show any gender or age differences, which may suggest that experience plays a more important role in high-risk sports than age or gender. Future research should qualitatively investigate further terrain based activities and implement motives and risk-related factors in quantitative research.
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Affiliation(s)
- Anika Frühauf
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Will A S Hardy
- Institute for the Psychology of Elite Performance, School of Sport, Health, and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Daniel Pfoestl
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Schindelwig K, Hoffmann A, Mössner M, Nachbauer W. Does Avalanche Shovel Shape Affect Excavation Time: A Pilot Study. Sports (Basel) 2017; 5:sports5020031. [PMID: 29910391 PMCID: PMC5968987 DOI: 10.3390/sports5020031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022] Open
Abstract
In Europe and North America, approximately 150 fatalities occur as a result of avalanches every year. However, it is unclear whether certain shovel shapes are more effective than others in snow removal during avalanche victim recovery. The objective was to determine the performance parameters with a developed standardized test using different shovel shapes and to determine sex-specific differences. Hence, several parameters were determined for clearing the snow from a snow filled box (15 men, 14 women). A flat (F) and a deep (D) shovel blade with the shaft connected straight (S) or in clearing mode (C) were used for the investigation of the shovel shapes FS, DC and the subsequent use of DC&DS. Mean snow mass shifted per unit time increased significantly from 1.50 kg/s with FS to 1.71 kg/s (14%) with DS and further to 1.79 kg/s (4%) with DC&DS for all participants. Snow mass shifted per unit time was 44% higher (p < 0.05) for men than for women. In excavation operations, the sex-specific physical performance should be taken into account. The results were limited to barely binding snow, because only with this snow did the tests show a high reliability.
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Affiliation(s)
- Kurt Schindelwig
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Alexander Hoffmann
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Martin Mössner
- Centre of Technology of Ski and Alpine Sport, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
- Centre of Technology of Ski and Alpine Sport, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
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Brugger H, Grasegger K, Soteras I, Strapazzon G. In Reply to Drs Pasquier, Gnaegi, and Hugli. Wilderness Environ Med 2016; 27:534. [PMID: 27816379 DOI: 10.1016/j.wem.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/16/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM
| | - Katharina Grasegger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy; Faculty of Medicine, LMU Munich, Munich, Germany
| | - Inigo Soteras
- International Commission for Mountain Emergency Medicine ICAR MEDCOM, Cerdanya Hospital, Puigcerdà, Spain; Faculty of Medicine, Girona University, Girona, Spain
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy; International Commission for Mountain Emergency Medicine ICAR MEDCOM
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