AVALANCHE EMERGENCIES - NEW PERSPECTIVES ON THE PATHOPHYSIOLOGY AND MANAGEMENT OF PERSONS BURIED IN AN AVALANCHE

A series of investigations on the pathophysiology and management of pe rsons buried in an avalanche has been undertaken over the past few yea rs in response to increased awareness of the importance of emergency m edical treatment of avalanche victims and the fact that the high morta lity rate has not decreased in spite of the improvement in rescue tech niques. This paper is the very first review of the problems encountere d in avalanche disasters. The developments over the past 20 years, in particular, are summarized and discussed. Furthermore, current opinion s and recommendations on optimal rescue procedure, as well as the prev ention of such emergencies are presented. Precise assessment of the su rvival probability after burial under an avalanche and recognition of the prognostic importance of an air pocket, but only limited role of h ypothermia, provide the basis for new concepts governing therapy and t riage by the emergency doctor. Resulting guidelines have been endorsed by the Emergency Medicine Subdivision of the International Commission of the Alpine Rescue Services (ICAR) and these recommendations are in tended for implementation by organised rescue teams in order to reduce secondary deaths following successful extrication of victims from the avalanche masses. However, the chance of being rescued alive depends primarily on the rapidity of extrication, i.e. how quickly the rescue teams are alerted and transported to the disaster area in the first in stance, then how quickly the victims are located and extricated. In or der to reduce the mortality additional preventive measures must be int roduced to avoid complete burial if possible, or appreciably hasten th e rescue procedure. The very steep drop (''fatal kink'') in survival p robability as from 15 minutes after burial underlines the absolute nec essity of the mastery of efficient rescue procedure by uninjured compa nions. Improvement of the technical developments for the avoidance of total burial (avalanche air bag) and optimization of the electronic lo cation (transceiver) of buried skiers by uninjured companions are esse ntial future requirements. Nonetheless, primary prevention remains of paramount importance in governing decision making by off-piste skiers. Correct assessment of the inherent risks according to the prevailing circumstances and strict adherence to safety rules take precedence ove r all other considerations.