Avalanche victims in cardiac arrest are unlikely to survive despite adherence to medical guidelines.

AIMS: Our goals were to describe and analyse the medical management and clinical course of avalanche victims in cardiac arrest (CA), focusing on adherence to international recommendations on avalanche victims in CA regarding critical decisions. METHODS: We retrospectively included all avalanche victims with CA from 1st January 2004 to 1st June 2016 in a single physician-staffed alpine helicopter emergency medical service. Data regarding cardiopulmonary resuscitation (CPR), transportation to hospital whilst undergoing CPR, and extracorporeal life support rewarming (ECLSR) for patients still in CA at hospital admission were abstracted from the prehospital and medical health records. RESULTS: Sixty-six victims were included in this study; 31 (47%) were declared dead on scene. Of the remaining 35 victims, 7 (20%) had prehospital return of spontaneous circulation (ROSC), 28 (80%) were transported whilst undergoing CPR, 3 had hospital ROSC and 7 (28%) of the 25 patients with persistent CA at hospital underwent ECLSR. The medical management comprised 126 documented critical decisions, corresponding to guidelines in 117 (93%) decisions. None of the 66 studied patients survived to hospital discharge, and 7 (11%) were organ donors. CONCLUSIONS: The management of avalanche victims in CA respect current guidelines regarding the critical decisions, but no patient survived in this sample. The presence of a few cases with incorrect management and potential undertreatment suggests some room for improvement.

Indications and Outcomes of Helicopter Rescue Missions in Alpine Mountain Huts: A Retrospective Study.

Pasquier, Mathieu, Louis Marxer, Hervé Duplain, Vincent Frochaux, Florence Selz, Pierre Métrailler, Grégoire Zen Ruffinen, and Olivier Hugli. Indications and outcomes of helicopter rescue missions in alpine mountain huts: A retrospective study. High Alt Med Biol 18:355-362, 2017. AIMS: This retrospective study describes the rescue indications and outcome of patients rescued by helicopter from mountain huts in the Swiss Alps. The hospital course and operational data were also studied. RESULTS: Among 14,872 helicopter rescue missions undertaken during the 10-year study period, 309 (2.1%) were performed from mountain huts at a mean altitude of 2794 ± 459 m. The mean age of the patients was 43 ± 16 and 66% were male. Thirty-four percent of the patients had a National Advisory Committee for Aeronautics score ≥3. Most (89%) patients were transported to hospital and only 12 (3.9%) patients had to stay more than 48 hours. Hospital diagnoses were extremely varied. Trauma accounted for 50% and altitude diseases for 7% of the cases. A winching procedure was performed 18 times and 19 missions included a night flight. CONCLUSIONS: Helicopter rescue missions in mountain huts are a small part of all rescue missions. Our study provides a better understanding of medical emergencies arising in mountain huts. The diagnoses encountered are extremely varied in their type and severity. Hut keepers should be prepared for these situations as they will often have to act as first responders in the case of medical problems.

Managing moderate and severe pain in mountain rescue.

AIMS: We aimed to describe evidence-based options for prehospital analgesia, and to offer practical advice to physicians and nonphysicians working in mountain rescue. METHODS: A literature search was performed; the results and recommendations were discussed among the authors. Four authors considered a scenario. The final article was discussed and approved by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) in October 2013. RESULTS AND RECOMMENDATIONS: Many health care providers fail to recognize, assess, and treat pain adequately. Assessment scales and treatment protocols should be implemented in mountain rescue services to encourage better management of pain. Specific training in assessing and managing pain is essential for all mountain rescuers. Persons administrating analgesics should receive appropriate detailed training. There is no ideal analgesic that will accomplish all that is expected in every situation. A range of drugs and delivery methods will be needed. Thus, an 'analgesic module' reflecting its users and the environment should be developed. The number of drugs carried should be reduced to a minimum by careful selection and, where possible, utilizing drugs with multiple delivery options. A strong opioid is recommended as the core drug for managing moderate or severe pain; a multimodal approach may provide additional benefits.

Homemade thermometry instruments in the field.

OBJECTIVE: Esophageal temperature is the gold standard for in-the-field temperature monitoring in hypothermic victims with cardiac arrest. For practical reasons, some mountain rescue teams use homemade esophageal thermometers to measure esophageal temperature; these consist of nonmedical inside/outside temperature monitoring instruments that have been modified to allow for esophageal insertion. We planned a study to determine the accuracy of such thermometers. METHODS: Two of the same model of digital cabled indoor/outdoor thermometer were modified and tested in comparison with a reference thermometer. The thermometers were tested in a water bath at different temperatures between 10°C and 35.2°C. Three hundred measurements were taken with each thermometer. RESULTS: Our experimental study showed that both homemade thermometers provided a good correlation and a clinically acceptable agreement in comparison with the reference thermometer. Measurements were within 0.5°C in comparison with the reference thermometer 97.5% of the time. CONCLUSIONS: The homemade thermometers performed well in vitro, in comparison with a reference thermometer. However, because these devices in their original form are not designed for clinical use, their use should be restricted to situations when the use of a conventional esophageal thermometer is impossible.

Fluid management in traumatic shock: a practical approach for mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

Sumann, Günther, Peter Paal, Peter Mair, John Ellerton, Tore Dahlberg, Gregoire Zen-Ruffinen, Ken Zafren, and Hermann Brugger. Fluid management in traumatic shock: a practical approach for mountain rescue. High Alt. Med. Biol. 10:71-75, 2009.-The management of severe injuries leading to traumatic shock in mountains and remote areas is a great challenge for emergency physicians and rescuers. Traumatic brain injury may further aggravate outcome. A mountain rescue mission may face severe limitations from the terrain and required rescue technique. The mission may be characterized by a prolonged prehospital care time, where urban traumatic shock protocols may not apply. Yet optimal treatment is of utmost importance. The aim of this study is to establish scientifically supported recommendations for fluid management that are feasible for the physician or paramedic attending such an emergency. A nonsystematic literature search was performed; the results and recommendations were discussed among the authors and accepted by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Diagnostic and therapeutic strategies are discussed, as well as limitations on therapy in mountain rescue. An algorithm for fluid resuscitation, derived from the recommendations, is presented in Fig. 1. Focused on the key criterion of traumatic brain injury, different levels of blood pressure are presented as a goal of therapy, and the practical means for achieving these are given.