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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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White KS, Hood E, Wolken GJ, Peitzsch EH, Bühler Y, Wikstrom Jones K, Darimont CT. Snow avalanches are a primary climate-linked driver of mountain ungulate populations. Commun Biol 2024; 7:423. [PMID: 38684895 PMCID: PMC11058775 DOI: 10.1038/s42003-024-06073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Snow is a major, climate-sensitive feature of the Earth's surface and catalyst of fundamentally important ecosystem processes. Understanding how snow influences sentinel species in rapidly changing mountain ecosystems is particularly critical. Whereas effects of snow on food availability, energy expenditure, and predation are well documented, we report how avalanches exert major impacts on an ecologically significant mountain ungulate - the coastal Alaskan mountain goat (Oreamnos americanus). Using long-term GPS data and field observations across four populations (421 individuals over 17 years), we show that avalanches caused 23-65% of all mortality, depending on area. Deaths varied seasonally and were directly linked to spatial movement patterns and avalanche terrain use. Population-level avalanche mortality, 61% of which comprised reproductively important prime-aged individuals, averaged 8% annually and exceeded 22% when avalanche conditions were severe. Our findings reveal a widespread but previously undescribed pathway by which snow can elicit major population-level impacts and shape demographic characteristics of slow-growing populations of mountain-adapted animals.
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Affiliation(s)
- Kevin S White
- Department of Natural Sciences, Program on the Environment, University of Alaska Southeast, Juneau, AK, 99801, USA.
- Department of Geography, University of Victoria, Victoria, BC, V8W 2Y2, Canada.
- Division of Wildlife Conservation (ret.), Alaska Department of Fish and Game, Juneau, AK, 99811, USA.
| | - Eran Hood
- Department of Natural Sciences, Program on the Environment, University of Alaska Southeast, Juneau, AK, 99801, USA
| | - Gabriel J Wolken
- Alaska Division of Geological and Geophysical Surveys, Climate and Cryosphere Hazards Program, Fairbanks, AK, 99709, USA
- Alaska Climate Adaptation Science Center, University of Alaska Fairbanks, Fairbanks, AK, 99775, USA
| | - Erich H Peitzsch
- U.S. Geological Survey, Northern Rocky Mountain Science Center, West Glacier, Montana, MT, 59936, USA
| | - Yves Bühler
- WSL Institute for Snow and Avalanche Research SLF, Davos CH-7260, Davos, Switzerland
- Climate Change, Extremes and Natural Hazards in Alpine Regions Research Centre CERC, Davos CH-7260, Davos, Switzerland
| | - Katreen Wikstrom Jones
- Alaska Climate Adaptation Science Center, University of Alaska Fairbanks, Fairbanks, AK, 99775, USA
| | - Chris T Darimont
- Department of Geography, University of Victoria, Victoria, BC, V8W 2Y2, Canada
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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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Blasco Mariño R, Martínez IS, Bacardit M, Zafren K, Paal P. History of Avalanches in the Eastern Spanish Pyrenees. Wilderness Environ Med 2023; 34:606-609. [PMID: 37696722 DOI: 10.1016/j.wem.2023.07.008] [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: 03/16/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
Avalanches have caused injuries and deaths in mountain areas throughout history. We have examined the historical effects of avalanches on communities in the eastern Spanish Pyrenees. Surviving written records began in the year 1444 when an avalanche destroyed the village of Gessa. Many other avalanches since then have destroyed houses and other buildings and have caused injuries and deaths. In the 20th and 21st centuries, many villages evolved from agrarian areas to destinations for winter sports. The first known deaths during winter recreation likely occurred in 1930. Because of avalanche mitigation efforts, including relocating settlements, physical barriers, avalanche control measures, efforts to increase avalanche awareness, and avalanche warnings, avalanches now seldom affect inhabited areas in the eastern Spanish Pyrenees. Avalanche injuries and fatalities are now mainly limited to backcountry skiers and others traveling out of bounds near avalanche-controlled ski resorts.
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Affiliation(s)
- Robert Blasco Mariño
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain.
| | - Iñigo Soteras Martínez
- Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain; Department of Emergency, Cerdanya Hospital, Puigcerdà, Spain; Sistema Emergencies Mèdiques, Barcelona, Spain; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | | | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
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Chiarelli DD, Galizzi M, Bocchiola D, Rosso R, Rulli MC. Modeling snowmelt influence on shallow landslides in Tartano valley, Italian Alps. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:158772. [PMID: 36116659 DOI: 10.1016/j.scitotenv.2022.158772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 06/15/2023]
Abstract
Shallow landslides (SLs) are rapid soil mass movements, typically occurring in the mountain areas, involving the most superficial soil layers up to 5 to 10 m in depth. Damages, and casualties due to shallow landslides are recorded globally, and in literature a variety of models to study landslides have been implemented hitherto. Often times, shallow landslides occur in the wake of snowfall events, when sudden temperature increase triggers fast snow thaw, and soil moisture increases thereby. Several models studied the influence of intensity, and duration of rainfall upon shallow landslides, but the effect of snow melt in spring/summer was little considered so far. Thus, we developed a simple but robust, and parameter-wise parsimonious model, that mimics the triggering mechanism of SLs, accounting for the combined effect of precipitation duration and intensity, and snowmelt at thaw. The model is here applied to the case study of the high altitude Tartano basin, paradigmatic of SLs in the Alps of Lombardia. Our results showed that about 26 % of the Tartano basin slopes display unstable conditions. Using a traditional (i.e. rainfall-based) approach, the occurrence of shallow landslides was predicted in ca. 19 % of the basin, mainly during storms in October and November. In contrast, when snowmelt was included, the model was able to mimic potential SLs even during April and May, when snow melt rate is the highest, and may increase SLs triggering potential, to ca. 26 % of the treated area. With better spatial and temporal description of slope failure as achieved here, validated against observed failures, a public authority may be prepared to implement emergency plans, to prevent injuries, causalities, and damages to infrastructures even during springtime, when shallow landslides may occur in response to fast snowmelt, even during dry, clear sky days, and with scarce/null precipitation.
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Affiliation(s)
| | - Mattia Galizzi
- Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Daniele Bocchiola
- Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Renzo Rosso
- Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
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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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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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Snow Avalanche Assessment in Mass Movement-Prone Areas: Results from Climate Extremization in Relationship with Environmental Risk Reduction in the Prati di Tivo Area (Gran Sasso Massif, Central Italy). LAND 2021. [DOI: 10.3390/land10111176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mass movements processes (i.e., landslides and snow avalanches) play an important role in landscape evolution and largely affect high mountain environments worldwide and in Italy. The increase in temperatures, the irregularity of intense weather events, and several heavy snowfall events increased mass movements’ occurrence, especially in mountain regions with a high impact on settlements, infrastructures, and well-developed tourist facilities. In detail, the Prati di Tivo area, located on the northern slope of the Gran Sasso Massif (Central Italy), has been widely affected by mass movement phenomena. Following some recent damaging snow avalanches, a risk mitigation protocol has been activated to develop mitigation activities and land use policies. The main goal was to perform a multidisciplinary analysis of detailed climatic and geomorphological analysis, integrated with Geographic Information System (GIS) processing, to advance snow avalanche hazard assessment methodologies in mass movement-prone areas. Furthermore, this work could represent an operative tool for any geomorphological hazard studies in high mountainous environments, readily available to interested stakeholders. It could also provide a scientific basis for implementing sustainable territorial planning, emergency management, and loss-reduction measures.
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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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Garg RK, Bhola J, Soni SK. Healthcare monitoring of mountaineers by low power Wireless Sensor Networks. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100775] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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