On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom)

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.

In-area and backcountry snowboarding: medical and safety aspects

Snowboarding is now a well-established winter sport and a popular mode of mountaineering. In-area and backcountry snowboarding are defined, as well as a new term, glisse, that refers to all types of skis and snowboards. New developments in equipment focus on boot and binding systems. Backcountry travel is highlighted, including ascent with snowshoes, skis, a splitboard, and crampons. Injuries are about 4-6 per 1000 snowboarding days. Upper extremity injuries are most often wrist sprains or fractures. Lower extremity injuries are primarily ankle sprains and are generally less severe than knee injuries in skiers. Fracture to the lateral process of the talus has been called snowboarder's fracture. Backcountry injuries include avalanche suffocation and trauma, deep snow immersion asphyxiation, hypothermia, frostbite, dehydration, fatigue, acute mountain sickness, and sunburn. Specific recommendations for prevention and safety are discussed.

Surfing, windsurfing, snowboarding, and skateboarding: medical aspects of board sports

With the rise in popularity of board sports, primary care physicians need to understand the injury risks and environmental hazards faced by surfers, windsurfers, snow-boarders, and skateboarders. Physicians can play an important role by telling patients about injury prevention strategies, including using proper equipment, wearing protective gear, taking lessons, and riding in terrain and weather conditions appropriate for one's skill level.

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.