Search is a time-critical event: when search and rescue missions may become futile.

OBJECTIVES: The purpose of this study was to derive and validate a rule for duration of search (ie, search time) that maximizes survivors and after which a search and rescue (SAR) mission may be considered for termination. METHODS: This was a retrospective cohort study of all SAR missions initiated in Oregon over a 7-year period, which were documented in a population-based administrative database. The following types of search missions were excluded from analysis: redundant reports of a single search; lost helicopters and airplanes; support of organized events; law-enforcement searches; searches for persons actively avoiding rescue; body recovery missions; and cases without outcome information. The cohort was divided into a derivation cohort (searches from 1997-2000) and a validation cohort (2001-2003). The primary outcome was survival. Variables considered in the model included age, gender, minimum and maximum daily temperatures, precipitation, search time, and whether the search involved an air or water incident. Missing data were handled using multiple imputation. Classification and regression tree (CART) methods were used to derive the model. RESULTS: The derivation cohort included 1040 searches involving 1509 victims, 70 (4.6%) of whom died. The validation cohort included 1262 searches involving 1778 victims; 115 (6.5%) died. Search time was the only variable retained in the final model, with a cut-point of 51 hours. The derivation model was 98.9% sensitive; the same model run using the validation cohort was 99.3% sensitive. CONCLUSIONS: This time-based model may aid search managers in the decision about starting a search or changing search tactics for missing persons.

Skiing, snowboarding, and sledding injuries in a northwestern state.

OBJECTIVE: Winter sports continue to be a popular form of recreation, but few studies have focused on serious injuries. The objectives of this study were to evaluate the major morbidity associated with downhill skiing, snowboarding, and sledding and to determine the incidence of serious injuries sustained while downhill skiing and snowboarding. METHODS: State trauma registry data from the 1992-93 through 1998-99 ski seasons on all snow sports participants transported to tertiary trauma hospitals in Oregon were analyzed. RESULTS: Of 132 patients, 80% were male and 20% were female, with a mean age of 30.4 +/- 15.6 for skiers, 24.1 +/- 10.5 for snowboarders, and 18.8 +/- 11.9 for sledders. The mean Injury Severity Score was 12.3 +/- 7.6 for skiers, 10.3 +/- 7.4 for snowboarders, and 12.8 +/- 8.5 for sledders. Head injuries accounted for 55% of sledding injuries and 39% of all injuries. Skiers and snowboarders were less likely to have head injuries than sledders (odds ratio [OR] = 0.45; 95% CI, 0.21 to 0.98). A higher proportion of injuries sustained by snowboarders were due to falls from heights (29%) compared with injuries sustained by skiers or sledders (OR = 4.8; 95% CI, 1.6 to 13.7). Sledders were more likely to be injured during collisions than were skiers or snowboarders (OR = 16.7; 95% CI, 5.8 to 47.6). The incidence of serious skiing and snowboarding injuries was 6.4 injuries per million visits. There were 4 deaths (3%), 1 each from snowboarding and skiing (head injuries) and 2 from sledding (1 from head and 1 from head and thoracic injuries). CONCLUSIONS: Serious snow sports injuries are rare but potentially debilitating. Head injuries account for the majority of deaths and functional impairment.