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.

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.AIMSThis 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.RESULTSAmong 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.CONCLUSIONSHelicopter 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.

The Kendrick Extrication Device (KED) is used worldwide by rescue teams in difficult rescue environments. It greatly facilitates trauma patient management in situations such as road traffic accidents, steep slopes, and rescues in tight places like glacier crevasses.1 Many air medical services are equipped with a KED, and some use it during winch operations. Because the KED handles are not designed to support the patient's weight, winching is usually performed using a dedicated harness that encloses both the patient and the KED.

High Altitude Medicine & BiologyVol. 13, No. 1 Letter to the EditorPre-Hospital Wrist Block for Digital Frostbite InjuriesMathieu Pasquier, Gregoire Zen Ruffinen, Hermann Brugger, and Peter PaalMathieu PasquierEmergency Department, University Hospital Centre, Lausanne, Switzerland.Search for more papers by this author, Gregoire Zen RuffinenAir-Glaciers SA, Maison François-Xavier Bagnoud du Sauvetage, Sion, Switzerland.Search for more papers by this author, Hermann BruggerInstitute of Mountain Emergency Medicine, European Academy, Bozen/Bolzano, Italy.Search for more papers by this author, and Peter PaalDepartment of Anesthesioloy and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.Search for more papers by this authorPublished Online:19 Mar 2012https://doi.org/10.1089/ham.2011.1072AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Pre-Hospital Wrist Block for Digital Frostbite Injuries." , 13(1), pp. 65–66FiguresReferencesRelatedDetailsCited byUltrasound-Guided Posterior Tibial Nerve Block for Frostbite of the Plantar Surfaces: A Case Series24 October 2022 | Clinical Practice and Cases in Emergency Medicine, Vol. 6, No. 4Frostbite of The Extremities – Recognition, Evaluation and TreatmentInjury, Vol. 53, No. 10Frostbite: A Conundrum in High Altitudes27 October 2021Interventions for frostbite injuries20 December 2020 | Cochrane Database of Systematic Reviews, Vol. 2020, No. 12Analgesie im alpinen GeländeErfrierungenMöglichkeiten und Grenzen terrestrischer Notfallmedizin im alpinen GeländeWireless and Low-Weight Technologies: Advanced Medical Assistance During a Cave Rescue: A Case ReportWilderness & Environmental Medicine, Vol. 29, No. 2FrostbiteEmergency Medicine Clinics of North America, Vol. 35, No. 2Lesiones por congelaciónEMC - Aparato Locomotor, Vol. 49, No. 4A New Proposal for Management of Severe Frostbite in the Austere EnvironmentWilderness & Environmental Medicine, Vol. 27, No. 1Möglichkeiten und Grenzen terrestrischer Notfallmedizin im alpinen Gelände20 May 2015Erfrierungen20 May 2015Managing Moderate and Severe Pain in Mountain Rescue John Ellerton, Mario Milani, Marc Blancher, Grégoire Zen-Ruffinen, Sven Christjar Skaiaa, Bruce Brink, Ashish Lohani, and Peter Paal27 March 2014 | High Altitude Medicine & Biology, Vol. 15, No. 1 Volume 13Issue 1Mar 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Mathieu Pasquier, Gregoire Zen Ruffinen, Hermann Brugger, and Peter Paal.Pre-Hospital Wrist Block for Digital Frostbite Injuries.High Altitude Medicine & Biology.Mar 2012.65-66.http://doi.org/10.1089/ham.2011.1072Published in Volume: 13 Issue 1: March 19, 2012PDF download

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 degrees C and 35.2 degrees 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 degrees 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.

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.

Injured patients in crevasses who are suspected of having sustained spinal injuries should ideally be extricated after being immobilized in a horizontal position on a stretcher and having a cervical collar applied. Sometimes, however, horizontal stabilization is not possible, because the crevasse is too narrow, and the patient needs to be stabilized in a vertical position. In such cases an extrication device can be a useful adjunct. The Kendrick Extrication Device (TM) stabilizes the position of the body and maintains firm support of the head, neck, and torso. Therefore, the International Commission for Mountain Emergency Medicine supports the use of this device in narrow crevasses, if horizontal evacuation is not possible.