ON-SITE TRIAGE OF AVALANCHE VICTIMS WITH ASYSTOLE BY THE EMERGENCY DOCTOR

Asystole in avalanche victims is generally due to asphyxia and not pri marily to hypothermia. Hence, on-site establishment of death by asphyx iation would avoid evacuation risks to the rescue party, as well as hi gh costs of transport to, and treatment at, frequently distant special ist centres in cases with a hopeless prognosis. This paper presents a novel differential diagnostic scheme based on burial duration (critica l time 45 min) and core temperature (critical level 32 degrees C) of t he person on extrication, as well as the presence or absence of an air pocket, facilitating on-site identification of asphyxiated victims. W hen information regarding an air pocket is uncertain in victims buried longer than 45 min, determination of serum potassium (critical level 10 mmol/l) at the nearest hospital becomes an alternative criterion fo r triage. The proposed guidelines aim to clarify field decision-making for the emergency doctor with respect to discontinuation of resuscita tion and limitation of transferral for cardiopulmonary bypass core rew arming to those patients with presumptive reversible hypothermia.