Responders must be familiar with the important factors of a medical call-out, medical priorities related to avalanche burials, and the importance of the air-pocket assessment. Additionally, responders should be aware of conditions where survival is unlikely, and thus know how to appropriately manage fatalities.
An avalanche incident is considered a medical emergency. If an individual is caught in an avalanche, the possibility of suffering a traumatic injury or being buried below the snow surface is significant. For this reason, medical assistance should be requested immediately in response to an avalanche incident report.
Information relayed to medical assistance should include:
Automated External Defibrillator (AED):
It is extremely important to document all observations taken in the airway assessment. They have direct consequences in both the pre-hospital and in-hospital patient care. For a buried avalanche victim, an air pocket is defined as any cavity in front of the moth and nose, no matter how small; provided the airway is clear. No air pocket is assumed only if the subject’s moth and nose are found to be sealed by snow or debris. With no air pocket, avalanche survivability is directly linked to the length of time the subject has been buried. Survival rates differentiate greatly between uncovering the subject before and after 60 minutes of burial time. A person must have an air pocket and an ability to breath under the snow to survival a burial of more than 35 minutes; otherwise he or she will die of asphyxia.
Medical Priority before 60 minutes: Perform rapid extrication to avoid subject asphyxia.
If a buried person is in a critical condition, this is likely attributable to acute asphyxia or mechanical trauma. The medical priority is to remove the subject from the snow as quickly as possible, clear the airway, and activate breathing. (Survival rate in the first fifteen minutes of burial is about 90% if the subject is recovered within this time).
Medical Priority after 60 minutes: Handle with great care – subject is likely hypothermic. Rough handling may trigger fatal arrhythmia.
The flowing algorithm helps ALS providers to assess treatment for extricated avalanche subjects who have been buried for prolonged periods. The primary goal of this checklist is to increase resuscitation of subjects with a real chance of survival (e.g. hypothermic with a patent airway). This checklist may also help to optimize the use of resources and avoid resuscitation of subjects with no chance of survival.
The checklist is assigned to every avalanche subject as soon as their head and upper body are exposed. It should be completed by the rescuers in a step-by-step manner throughout the rescue operation. The checklist should remain attached to the subject throughout all phases of care to guarantee pertinent information is transferred.
Avalanche subjects with severe hypothermia (<28oC) and in cardiac arrest should receive a cardiopulmonary bypass (CPB) rewarming, a process that mechanically circulates oxygenated blood while bypassing the heart and lungs. CPB is performed at certain hospitals with cardiac surgery programs. There are also portable CPB machines, but their availability, and the expertise in using them, may be limited. The goal should always be rapid transport to the appropriate hospital. Refer to the avalanche management algorithm for the steps taken in treating avalanche subjects with hypothermia.
The following steps should be taken in cases of death where resuscitation was not initiated or has ceased:
AvSAR personnel should establish working relationships with local agencies responsible for missing and injured persons to improve efficiency in the event of a fatality.
Rapid evacuation of avalanche subjects is extremely important and must be considered early in the response. The goal is to quickly and safely transport all subjects to the appropriate care facility. Rescuers must prioritize subjects for evacuation considering the factors discussed in Lesson 12 – Rescue and Medical Triage.
Preparing Patients for Evacuation. Patients must be properly immobilized in order to ensure that no further injury is caused during transport. The extent of immobilization depends on the severity and type of injury. Some of the methods for packaging and evacuation include:
Transport to Hospital / Clinic. In many cases, the subjects will need to be moved to a safe staging area by means of the evacuation methods described above. From the staging area, subjects will need to be transported to appropriate treatment centres. The type of treatment centre will largely depend on the subject’s status. Some options for subject transport in the backcountry include:
Helicopter Transport. All AvSAR responders must be trained in emergency procedures and safe working procedures around helicopters. Before any operation the pilot will brief each person on the specific safety guidelines for each machine. Communications between the pilot and ground crews must also be established. In larger operations an individual may be assigned to supervise safety around helicopters.
Follow standard safe working procedures around helicopters: