Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

temperature is above 30ºC would also confirm that the patient has died.

cases where the chance for finding a live victim is minimal. Various groups and agencies such as the European Resuscitation Council, Wilderness Medical Society, andThe International Committee on Alpine Rescue offer guidelines for rescuers suggesting full resuscitation efforts for any victim without obvious lethal injury, especially if buried for less than 60 minutes. The probability of sur- vival decreases with the time and depth of burial, and the time to access advanced medical care. In the end, sound judgment on scene is every- thing. Any guideline must be weighed against the risk to rescuers and the unique situation on scene. A low probability of victim survival does not jus- tify a high probability of rescuer injury or death.

Cardiorespiratory Arrest

Do Not Resuscitate: • Effort puts rescuers at risk • Obvious lethal trauma • >35 min burial and 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.”

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

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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