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

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Section V: Environmental Medicine

General Principles

Cardiorespiratory Arrest

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Do Not Resuscitate*: • Effort puts rescuers at risk • Obvious lethal trauma • > 35 min burial without air pocket, or airway is packed with snow • Body core temp < 10°C

“Drawing the line between treating a patient and performing a body recovery can be a difficult decision to make.”

©2018WMA

General Principles

Long Burial • Survival of prolonged burial is possible. • Severe hypothermia may be responsible for depressed or undetectable vital signs. • Treat as severe hypothermia if: - clear airway - minimal ice mask - obvious air pocket or Avalung - acceptable risk to rescuers 5

©2018WMA

Hypothermia is rarely an immediate prob- lem or benefit to the completely buried victim. Respiratory failure is likely to kill the victim long before any protective effect of severe hypothermia is realized. There is no demonstrated reason to extend resuscitation beyond the 30-minute CPR protocol. The only exception might be the recov- ery after a prolonged burial of a severely hypother- mic victimwearing an Avalung, or from a buried building, vehicle, or tree well with a preserved air space. Risk Versus Benefit Avalanche awareness and search and recovery are major topics in their own right. Practitioners working with search and rescue (SAR) teams in avalanche terrain must be trained and equipped for safe travel and operation. Avalanche recovery represents a considerable risk to rescuers, often in cases where the chance for finding a live victim is minimal. In the end, sound judgment on scene is everything.