Treatment of casualties in hostile environments: Emergency medicine in mountain sports

Abstract

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. Mountain rescue teams all over the world are trained and prepared to provide first aid to sick and injured persons in the mountains. This requires a high training level for all team members in technical and medical skills. However, the first and most important issue is safety for rescuers and victims. To achieve this high standard, almost all mountain rescue teams are gathering under the umbrella of ICAR, the International Commission for Alpine Rescue (www.alpine-rescue.org), an international platform for the exchange of knowledge and experience. ICAR and its four subcommissions are establishing recommendations and guidelines for technical rescue, safety issues, legal advice for local, national, and international authorities, and medical treatment. Considering the mechanism of injury, assessment, and a correct diagnosis on-site is a keystone in every rescue mission. Most patients in the mountains are suffering from trauma, and therefore trauma treatment including lifesaving measurements and splinting for the rescuers and advanced trauma life support including sufficient analgesia and artificial ventilation on-site by emergency physicians and paramedics are essential. All victims in the mountains should be considered hypothermic, and hypothermia reduces the outcome of trauma patients. On-site treatment of hypothermia and gentle but rapid transportation to an appropriate medical facility may be lifesaving. Avalanche accidents are one of the most challenging situations for mountain rescue teams. “Time is Life” is not only a training DVD for rescuers and emergency physicians but the key in avalanche burial. Survival is depending on rapid extrication by colleagues or the presence of free airways and an air pocket. Guidelines for resuscitation of avalanche victims according to ILCOR (International Liaison Committee on Resuscitation) have been established and published in peer-reviewed journals. Sports in extreme environments such as canyoning, base jumping, and paragliding (hang gliding) are becoming more and more popular and require specific rescue strategies and medical skills. This chapter provides information about mountain rescue in general, training, rescue strategy and risk assessment, equipment, and medical treatment.