Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 160

on the victim’s chest. Hypothermia and trauma are secondary considerations.

and heavier probes are carried only by rescue teams performing body recovery. Treatment The treatment for avalanche survivors includes immediate positive pressure ventilation (PPV), supplemental oxygen, and evacuation. Once the patient is freed from the insulating snow pack, hypothermia becomes an anticipated problem. Airway control is critical if the patient is less than A on AVPU (Alert, responsive to Verbal stimuli, responsive to Pain, Unresponsive). Increased intracranial pressure (ICP) due to brain hypoxia can also develop, but this is likely to occur well after an evacuation has been accomplished.

General Principles

Live Find

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Treat what you see: • Respiratory failure is likely to be the primary problem. • Increased ICP is an anticipated problem from trauma and/or hypoxia. • Hypothermia is not an issue if burial < 35 minutes. • Once recovered, hypothermia is an anticipated problem.

Equipment like the Avalung can allow avalanche victims to continue breathing under the snow for an hour or more.

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Do not attempt to resuscitate an avalanche victim in full cardiopulmonary arrest if there is obvious lethal injury or if the effort puts rescu- ers at risk. Experience shows that the chances of success are minimal after 30 minutes of complete burial. If the victim’s airway is packed with snow, you can assume that breathing stopped at the time the avalanche occurred. It can be difficult to decide where to draw the line between treating a patient and performing a body recovery. If you choose to begin CPR, the effort may be discontinued after 30 minutes of pulselessness. If the equipment is available, a car- diac monitor showing asystole or an automated external defibrillator (AED) that refuses to shock a pulseless patient would also confirm that the patient has died.

An airspace can also be created by an airbag device installed in a backpack.The increasing use of ava- lanche survival devices like these increases the probability of a live find in a prolonged burial. Data indicate that survival is highly unlikely when burial is deeper than 2 meters. That’s why most avalanche probes carried by backcountry skiers are less than three meters long. The longer