Deep Snow Immersion Deaths

Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update

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.

Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents

To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

Trauma risks and prevention strategies for snowboarders

PURPOSE

To provide primary care providers with current information about the risk of injury and trauma prevention measures for snowboarders.

DATA SOURCES

Selected research articles and Internet sources.

CONCLUSIONS

Beginners are at increased risk for snowboarding injuries. Lower extremity injuries have been reduced in recent years by the introduction of the hybrid boot for beginners. Little has been done to reduce the significant impact of head injuries and wrist fractures to snowboarders.

IMPLICATIONS FOR PRACTICE

Snowboarders comprise approximately 25%-37% of the population on ski slopes. Recommending the use of helmets and wrist guard protection to snowboarding patients is a useful trauma prevention measure. The high rate of injury to the beginner and young snowboarder makes a particularly strong argument for these safety recommendations to this patient population.

Pulmonary air leaks resulting from outdoor sports. A clinical series and literature review

The occurrence of pulmonary air leaks consequent to recreational sports is considered to be rare. We performed a retrospective records review for cases of pulmonary air leaks for the 5-year period 1993 to 1997 at a community hospital that serves a popular tourist destination area having intense year-round outdoor recreational activities. We identified 20 patients who had sustained a spontaneous or traumatic pulmonary air leak while engaged in an outdoor sport. All but one case (95%) were due to blunt chest trauma. A total of nine different sports were involved, but the majority of cases (11, or 55%) occurred during skiing or snowboarding. Three (15%) patients died. Nine (53%) of the surviving 17 patients sustained injuries serious enough to require hospitalization for tube thoracostomy and other trauma care. We concluded that pulmonary air leaks due to blunt chest trauma occur more frequently in outdoor sports than the literature suggests.

Snowboarding injuries in children and adolescents

To study snowboarding injuries in children and adolescents, a 6-year retrospective study was conducted of patients 18 years old and younger admitted to a pediatric trauma center after snowboarding accidents. The study was designed to identify the most severely injured patients. Comparison was made to data from a recent comparable study of skiing injuries. Twenty-seven patients were identified, all but one male and none under 10 years old. Nineteen were injured in a fall, 6 collided with a stationary object, one collided with a skier, and in one case the mechanism of injury was unclear. The average pediatric trauma score was 10.5, and the average injury severity score 10.2. Most of the 12 head injuries were minor. Most extremity fractures were to the upper extremity. There were two lumbar vertebral burst fractures, suggesting that the sport may predispose to this injury. There were no deaths. When compared with skiing, in snowboarding the overall severity of injury is lower, collision is a less common mechanism of injury and results in less serious injury, head injuries are less severe, the relative frequency of upper extremity fracture is higher, abdominal injuries are caused by falls rather than collisions, and facial injuries are less common. These differences are predictable on the basis of differences in the equipment. However, it is too early to say that snowboarding has less potential for life-threatening injury than skiing. Expected changes in the mix of participants, with an increase in the average skill level over time, may well result in different patterns, mechanisms, and severity of injury.

Backcountry snowboarding: medical and safety aspects

As backcountry snowboarding becomes increasingly popular, wilderness enthusiasts and medical providers should be aware of its medical and safety aspects. This overview highlights the history of snowboarding and snowboarding today. In addition to proper mountaineering gear and winter clothing, special equipment is needed including a backpack, boots, a snowboard, and a method of ascent such as snowshoes. Medical studies on resort snowboarding have been reviewed and related to the wilderness setting for this study. Special limitations pertaining to snowboards are also discussed. For safety, one should seek instruction, practice, and experience in all aspects of backcountry travel including weather reading, route finding, enviromental hazards, cold injury treatment, and construction of emergency bivouacs. Backcountry snowboarders should be experts or at least advanced intermediates and should be proficient at climbing, snowshoeing, or free-heel skiing for ascent. One should understand avalanche terrain and glacier travel and he prepared for rescue. Snowboarders should also take limitations of snowboards into consideration when riding in the backcountry.