Wilderness and Rescue Medicine 8th Edition

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Section V: Environmental Medicine

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

skiers are less than three meters long. The longer and heavier probes are carried only by rescue teams performing body recovery. Treatment The treatment for avalanche survivors includes immediate airway control, positive pressure ven- tilation (PPV), supplemental oxygen, and evacua- tion. 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

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. 4

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 35 minutes of complete burial with an airway packed with snow. In this case you can assume that breathing stopped at the time the avalanche occurred. In the absence of obvious lethal injury it can be difficult to decide where to draw the line between treating a patient and performing a body recov- ery. Equipment like a cardiac monitor and reli- able thermometer can help make that decision. If you choose to begin CPR, the effort may be discontinued after 30 minutes of pulselessness unless severe hypothermia is a factor. A cardiac monitor showing asystole in a patient whose core

An airspace can be created by an inflatable floata- tion device installed in a backpack. The increas- ing use of avalanche survival devices like these increases the probability of a live find in a pro- longed burial. Data indicate that survival is highly unlikely when burial is deeper than 2 meters. That’s why most avalanche probes carried by backcountry