Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update.

The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.

Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update.

To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.

Should Airbag Backpacks Be Standard Avalanche Safety Equipment?

Avalanche airbag backpacks have been shown to be effective at reducing avalanche mortality. However, they are yet to be considered standard avalanche safety equipment, which has long consisted of a transceiver, a shovel, and a probe. This is despite data showing that airbags reduce mortality by decreasing the likelihood of burial. In addition, airbags probably lessen trauma and possibly delay asphyxia. Moreover, the literature suggests airbags reduce mortality at a rate similar to transceivers. For those who work, volunteer, and recreate in avalanche terrain, airbags should be considered standard safety equipment. However, multiple barriers exist for universal adoption, including cost, size, weight, training burden, availability, risk tolerance, and lack of community support and recommendations from professional societies and associations.

Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents.

To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

First Report of Using Portable Unmanned Aircraft Systems (Drones) for Search and Rescue.

Unmanned aircraft systems (UAS), colloquially called drones, are used commonly for military, government, and civilian purposes, including both commercial and consumer applications. During a search and rescue mission in Oregon, a UAS was used to confirm a fatality in a slot canyon; this eliminated the need for a dangerous rappel at night by rescue personnel. A second search mission in Oregon used several UAS to clear terrain. This allowed search of areas that were not accessible or were difficult to clear by ground personnel. UAS with cameras may be useful for searching, observing, and documenting missions. It is possible that UAS might be useful for delivering equipment in difficult areas and in communication.

Non-avalanche-related snow immersion deaths: tree well and deep snow immersion asphyxiation.

Non-avalanche-related snow immersion death (NARSID), or snow immersion asphyxiation, is a significant winter mountain hazard for skiers and snowboarders. This phenomenon occurs predominately in western North America, where large tree wells and deep snowpacks develop. Although statistics are difficult to procure, snow immersion asphyxiation has resulted in more than 70 documented deaths in the past 2 decades. The primary purpose of this review is to examine the existing literature on NARSID to help prevent such dangerous accidents through educating wilderness medicine professionals and fostering public awareness. The exact duration of burial to time of death and the cause of death are not precisely known but can be postulated from accident reports, experimental snow burial studies, and avalanche literature. In most cases, death probably occurs within 15 to 30 minutes from the time of burial. However, survival after prolonged burial in a tree well and deep snow is possible. The cause of death is asphyxiation, probably due to one of the mechanisms that produce asphyxia in avalanche burial victims: positional asphyxia, airway obstruction, or carbon dioxide displacement asphyxia. Prevention of snow immersion asphyxiation begins with skiers and snowboarders staying within the limits of their skills, using the proper tools for deep powder, staying in control at all times, and employing a buddy system. A skier or snowboarder who falls near or into a tree well should tuck, roll, and try to land upright, grab the tree trunk or a branch, and yell or blow a whistle to alert partners. If buried upside down, the person should stay calm and create an air pocket, which is probably of paramount importance. Skiers and snowboarders should use avalanche safety equipment to lessen the risk of snow submersion asphyxiation.