Lessons learned from avalanche survival patterns

ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise

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.

A simulated avalanche search and rescue mission induces temporary physiological and behavioural changes in military dogs

Saving human lives is of paramount importance in avalanche rescue missions. Avalanche military dogs represent an invaluable resource in these operations. However, their performance can be influenced by several environmental, social and transport challenges. If too severe, these are likely to activate a range of responses to stress, which might put at risk the dogs' welfare. The aim of this study was to assess the physiological and behavioural responses of a group of military dogs to a Simulated Avalanche Search and Rescue mission (SASR). Seventeen avalanche dogs from the Italian Military Force Guardia di Finanza (SAGF dogs) were monitored during a simulated search for a buried operator in an artificial avalanche area (SASR). Heart rate (HR), body temperature (RBT) and blood samples were collected at rest the day before the trial (T0), immediately after helicopter transport at the onset of the SASR (T1), after the discovery of the buried operator (T2) and 2h later (T3). Heart rate (HR), rectal body temperature (RBT), cortisol, aspartate aminotransferase (AST), creatine kinase (CK), non-esterified fatty acids (NEFA) and lactate dehydrogenase (LDH) were measured. During the search mission the behaviour of each SAGF dog was measured by focal animal sampling and qualitatively assessed by its handler and two observers. Inter-rater agreement was evaluated. Snow and environmental variables were also measured. All dogs successfully completed their search for the buried, simulated victim within 10min. The SASR was shown to exert significant increases on RBT, NEFA and cortisol (P<0.001), CK and HR (P<0.01), AST and LDH (P<0.05). These indicate the activation of a response to stress probably induced by the addition of factors such as helicopter transport, disembarking, and the search and rescue exercise. However, changes were moderate and limited over time, progressively decreasing with complete recovery at T3 except for sera cortisol that showed a slightly slower decline. More time walking within the search was related to lower RBT, conversely to walking. Standing still with head up and exploring with head-up were inversely related with HR. Agreement between handler and observers' opinions on a dog's search mission ability was found only for motivation, signalling behaviour, signs of stress and possessive reward playing. More time signalling was related to shorter search time. In conclusion, despite extreme environmental and training conditions only temporary physiological and behavioural changes were recorded in the avalanche dogs. Their excellent performance in successful simulated SASR may be attributable to extensive training and good dog-handler relationships. Simulated SASR did not seem to impair SAGF dogs' performance or welfare.

The prehospital management of avalanche victims

Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.