Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016.

INTRODUCTION: Carrying standard safety gear (beacon, probe, and shovel), planning a route of descent, and recreating with companions can help to mitigate the risk of injury or death resulting from avalanches in the backcountry. The goal of this study was to identify factors associated with performance of these safety practices. METHODS: A convenience sample of backcountry skiers and snowboarders was surveyed in 2016 at the backcountry gates of Jackson Hole Mountain Resort. Each participant was surveyed on characteristics including skill level, sex, age, prior avalanche education, and residency in the Jackson Hole area. Safety practices were also measured against avalanche hazard forecasts. Correlations were assessed using Fisher's exact testing. RESULTS: A total of 334 participants were surveyed. Factors associated with carrying avalanche safety gear included higher expertise, being a resident of the Jackson Hole area, and prior avalanche education. Factors associated with having a planned route of descent included higher expertise and being a resident of the Jackson Hole area. Factors associated with recreating with companions included younger age and lower expertise. Sex had no association with any of the surveyed safety practices. Participants were less likely to carry avalanche safety gear on low avalanche hazard days. CONCLUSIONS: Certain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists.

Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas.

INTRODUCTION: In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS: 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. RESULTS: Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. CONCLUSIONS: The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.

Zika Virus Advice for Mountaineers: A UIAA Medcom Consensus Advice Sheet.

Hillebrandt, David, Paul Richards, Andy Clark, and Dominique Jean. Zika virus advice for mountaineers: A UIAA Medcom consensus advice sheet. High Alt Med Biol. 17:70-71, 2016.-With the current media coverage of the spread of Zika virus from Africa and Asia to Central and South America and its possible relationship with fetal abnormalities, UIAA Medcom has produced an advice sheet for mountaineers visiting risk areas.

Evaluación de la adherencia a las medidas de seguridad en la práctica deportiva del barranquismo en la sierra de Guara (Huesca) / Evaluation of adherence to safety practices in the practice of canyoning in sierra de Guara (Huesca, Spain)

Objetivos: Analizar el grado de adopción de medidas de seguridad básicas en la práctica deportiva del barranquismo en la Sierra de Guara (Huesca, España).Método: Durante 5 años consecutivos se realizaron encuestas a barranquistas a la finalización de la actividad. Se recogió información sobre cada grupo (número de integrantes, equipamiento colectivo básico, información y formación técnica previa, conocimientos sobre la normativa del parque, planificación previa de la actividad y experiencia de sus componentes en la disciplina deportiva) y participante (sexo, edad, equipamiento individual y posesión o no de licencia federativa en montaña o espeleología). Se realizó estadística descriptiva y cálculo del Odds Ratio (OR) y sus intervalos de confianza al 95%(IC95%) mediante análisis de regresión multivariante para la variable dependiente “dotación completa de material colectivo básico” y distintas covariables. Resultados: Se encuestaron a 8.019 barranquistas distribuidos en 1.648 grupos. La composición media de cada grupo era de 4,8 (Desviación estándar: 2,7) integrantes. El 71,5% de los deportistas se encontraba provisto del material individual indispensable (casco y neopreno). Los barranquistas federados presentaron una mayor adherencia al uso de material individual de protección. Sólo el 28,2% de los grupos disponía de la dotación completa de material colectivo (bidón estanco, material duro, teléfono y botiquín), condición que se asoció a aquellos grupos que previamente habían planificado la actividad (OR=3,07; p<0,001); con algún integrante experimentado (OR=1,56; p=0,01) o experto (OR=1,47; p=0,001) en el descenso de barrancos y grupos con 5 ó más integrantes (OR=1,43; p=0,002). Conclusiones: La adhesión a las principales recomendaciones preventivas en la práctica del barranquismo es inferior a lo deseable. Los deportistas no federados presentan una menor adhesión al uso de los equipos individuales de seguridad que los federados. La dotación en el grupo de material colectivo de seguridad se asocia a que la actividad haya sido previamente planificada, que el grupos esté conformado por 5 o más integrantes o la presencia de deportistas expertos o experimentados (AU)

Objectives: To analize the degree of adoption of basic security measures in the practice of canyoning in Sierra de Guara (Huesca, Spain).Methods: For 5 consecutive years surveys for canyoning practitioners were performed. Data were collected at the end of activities on each group (number of members, collective equipment basic, technical training and information, knowledge about the regulations of the park, planning of the activity and previous experience of its members in the sport) and participant(sex, age, individual equipment and possession of federal license). Descriptive statistical techniques and multivariate logistic regression were used to estimate adjusted Odds Ratio (OR) and 95% confidence interval (95%CI) for “full complement of basic collective material” variable. Results: 8019 canyoning practitioners were survered, distributed on 1648 groups. The mean composition of group was 4.8 (Standard deviation: 2.7) members. 71.5% of sportsmen were provided with the necessary personal equipment (helmet and neoprene). Federated sportmen had a higher adherence to the use of individual safety equipment. Only 28.2% of the groups provided the full complement of collective material (waterproof container, hard material, phone kit and first aids material). This condition was associated with groups who had previously planned activity (OR = 3.07, p <0.001), with an experienced (OR =1.56, p = 0.01) or expert member in canyoning (OR = 1.47, p = 0.001) and groups with 5 or more members (OR = 1,43, p = 0.002).Conclusions: Adherence to the main recommendations in the preventive practice of canyoning is less than desirable. Unfederated sportsmen have lower adherence to individual security equipment. The provision in the group of collective safety material is associated with previously planned activities, groups with five or more members or the presence of experts and experienced sportmen (AU)

Avalanche safety practices in Utah.

OBJECTIVE: Avalanche fatalities occur on a yearly basis in Utah. The purpose of this study was to assess avalanche safety practices of different backcountry users in Utah and to identify groups that can be targeted for avalanche safety education. METHODS: We surveyed 353 winter backcountry users to determine the percentage of participants in each group who were traveling with one or more partners; the percentage who were carrying avalanche transceivers, shovels, probes, or AvaLungs; and the percentage who had taken an avalanche safety course. A measure of minimum safe practice was defined as 1) traveling with a partner, 2) carrying an avalanche transceiver, and 3) carrying a shovel. Participants in this study were backcountry skiers, snowboarders, snowshoers, snowmobilers, and out-of-bounds resort skiers/snowboarders traveling in the Wasatch and Uinta Mountains of Utah during the winter of 2005-06. RESULTS: The percentage of backcountry recreationists traveling with one or more partners was not significantly different (P=.0658) among backcountry skiers, snowboarders, snowshoers, snowmobilers, and out-of-bounds resort skiers/snowboarders. These groups did, however, differ in the percentage who carried avalanche transceivers (P<.0001), shovels (P<.0001), probes (P<.0001), and AvaLungs (P=.0020), as well as in the percentage who had taken an avalanche safety course (P<.0001) and the percentage who were carrying out minimum safe practices (P<.0001). Backcountry skiers showed the highest level of avalanche preparedness, with 98% carrying avalanche transceivers, 98% carrying shovels, 77% carrying probes, 86% having taken an avalanche safety course, and 88% carrying out minimum safe practices. Out of bounds snowboarders were the least prepared with 9% carrying avalanche transceivers, 9% carrying shovels, 7% carrying probes, 33% having taken an avalanche safety course, and 2% carrying out minimum safe practices. CONCLUSIONS: There are significant differences in the avalanche safety practices of the various groups of backcountry travelers in Utah. Backcountry skiers and snowboarders were the most prepared, while snowmobilers, snowshoers, and out-of-bounds skiers/snowboarders were relatively less prepared.

The use of automated external defibrillators and public access defibrillators in the mountains: official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM.

In this article we propose guidelines for rational use of automated external defibrillators and public access defibrillators in the mountains. In cases of ventricular fibrillation and pulseless ventricular tachycardia, early defibrillation is the most effective therapy. Easy access to mountainous areas permits visitation by persons with high risks for sudden cardiac death, and medical trials show the benefit of exercising in moderate altitude. The introduction of public access defibrillators in popular areas in the mountains may lead to a reduction of fatal outcome of cardiac arrest. Public access defibrillators should be placed with priority in popular ski areas, in busy mountain huts and restaurants, at mass-participation events, and in remote but often-visited locations that do not have medical coverage. Automated external defibrillators should be available to first-responder groups and mountain-rescue teams. It is important that people know how to perform cardiopulmonary resuscitation and how to use public access defibrillators and automated external defibrillators.

A year's experience as advisory doctor to a commercial mountaineering expedition company.

The purpose of this paper is to outline one U.K. doctor's experience as advisor to a British commercial high altitude expedition company. Within the United Kingdom, this is pioneering work, and various aspects of the job are outlined that have evolved in response to the current medical needs and market forces. The U.K. medicolegal aspects of the work are considered in the light of there being no current case law to guide doctors in this role. With more people worldwide making use of commercial companies for expeditions with the associated duty of care, it is hoped that this will stimulate further debate on some potentially delicate issues that cross international boundaries.