Fidel Elsensohn

Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM) Intended for physicians and other advanced life support personnel

BACKGROUND In North America and Europe ∼150 persons are killed by avalanches every year. METHODS The International Commission for Mountain Emergency Medicine (ICAR MEDCOM) systematically developed evidence-based guidelines and an algorithm for the management of avalanche victims using a worksheet of 27 Population Intervention Comparator Outcome questions. Classification of recommendations and level of evidence are ranked using the American Heart Association system. RESULTS AND CONCLUSIONS If lethal injuries are excluded and the body is not frozen, the rescue strategy is governed by the duration of snow burial and, if not available, by the victims core-temperature. If burial time ≤35 min (or core-temperature ≥32 °C) rapid extrication and standard ALS is important. If burial time >35 min and core-temperature <32 °C, treatment of hypothermia including gentle extrication, full body insulation, ECG and core-temperature monitoring is recommended, and advanced airway management if appropriate. Unresponsive patients presenting with vital signs should be transported to a hospital capable of active external and minimally invasive rewarming such as forced air rewarming. Patients with cardiac instability or in cardiac arrest (with a patent airway) should be transported to a hospital for extracorporeal membrane oxygenation or cardiopulmonary bypass rewarming. Patients in cardiac arrest should receive uninterrupted CPR; with asystole, CPR may be terminated (or withheld) if a patient is lethally injured or completely frozen, the airway is blocked and duration of burial >35 min, serum potassium >12 mmol L(-1), risk to the rescuers is unacceptably high or a valid do-not-resuscitate order exists. Management should include spinal precautions and other trauma care as indicated.

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.

Abstract 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.

Current Status of Medical Training in Mountain Rescue in America and Europe

Limited medical training of mountain rescuers may adversely affect the outcome of casualties. Thus, this study evaluated medical training of mountain rescuers in countries associated with the International Commission of Mountain Emergency Medicine. A questionnaire was completed by 33 mountain rescue services from 18 countries in America and Europe. First-aid topics taught most often are (absolute values, percentage): chest compression, hypothermia, cold injuries (32 of 33 organization 97%); avalanche rescue, first-aid kit of rescuer, cervical collar (31, 94%); hemorrhagic shock, automated blood pressure measurement, wound dressing (30, 91%); and heat injuries and SAM SPLINT (29, 88%). Cardiopulmonary resuscitation manikins are used in 32 (97%) organizations, and in 17 (52%) organizations manikins have feedback functionality. After training, exams are compulsory in 27 (83%) organizations. Yearly retraining is done in 12 (36%) organizations; 22 (67%) organizations would like to increase medical training. The study shows high variability in the medical training programs among the surveyed organizations and the need to improve medical education. The authors recommend standardization of medical training and examinations on an international level. Additional topics tailored to the typical injury and illness patterns of a particular area should supplement this core training. Training should be performed by highly qualified instructors on a yearly basis.

Treatment of Casualties in Hostile Environments

Millions of people are seeking recreation, fun, and challenge in the mountains and remote areas all over the world. Few of them are performing extreme sports, but in many cases hostile weather conditions can turn an easy mountain hike into a challenging and dangerous situation. Additionally high endurance sport events, free ride, and mountain bike competitions are becoming more and more popular.

Anforderungen an den Bergrettungsarzt und den alpinen Flugrettungsarzt

Notfalle in den Bergen stellen besondere Anforderungen an das Rettungspersonal und speziell an Notarzte. Objektive Gefahren und organisationsbedingte Einschrankungen setzen den notfallmedizinischen Masnahmen oft Grenzen. Diese muss sowohl der bodengebunden operierende als auch der Flugrettungsarzt kennen und seine Handlungen danach ausrichten. Er muss in der Lage sein, die jeweilige Situation in ihrer Gesamtheit zu beurteilen. Als Mitglied eines Bergrettungsteams ist er nicht nur als Notarzt gefordert, sondern ist auch fur seine eigene und die Sicherheit seiner Helfer verantwortlich. Diese darf durch uberzogene medizinische Masnahmen nicht gefahrdet werden. Bergsteigerische und rettungstechnische Kompetenz sowie Kenntnisse uber spezielle Unfallsituationen in den Bergen sind neben den gesetzlichen und organisationsbedingten Anforderungen (Flugrettungsbetreiber und Bergrettungsorganisationen) sowie langjahriger Erfahrung Grundvoraussetzungen fur eine erfolgreiche Tatigkeit als Bergrettungsarzt.

Terrestrische Bergrettung Bergrettung terrestrische : spezifische ärztliche Einsatztaktiken

Bergrettungseinsatze stellen spezielle Anforderungen an den Notarzt. Verzogerte Eintreffzeiten und Witterungseinflusse verstarken oft die Folgen von Verletzungen. Objektive Gefahren machen ein rasches und zielgerichtetes therapeutisches Management notwendig um das Risiko fur Opfer und Helfer so gering wie moglich zu halten. Spezielle Situationen erfordern spezielle medizinische Kenntnisse. Der Notarzt muss sich als Teil eines Rettungsteams verstehen und sollte die Rettungsaktion nicht durch uberzogene medizinische Masnahmen behindern. In vielen Fallen muss er ohne die gewohnte professionelle Assistenz und Uberwachungssysteme arbeiten. Grose Herausforderungen stellen die Behandlung von schweren traumatischen Verletzungen in unzuganglichem Gebiet dar.