A completely buried patient, even if uninjured, should be transported to the nearest medical facility capable of evaluating and stabilizing the patient. Avalanche resuscitation should include trauma care and hypothermia care.
If vital signs are not detectable, and there are no indications for withholding resuscitation, rescuers should start CPR and ALS while further assessment is performed. If return of spontaneous circulation is not achieved after at least 30 minutes, resuscitation attempts may be stopped (with certain exceptions below).
If duration of burial is ≤ 60 minutes, standard resuscitation and ALS, if possible, should be performed. If duration of burial is > 60 minutes, the core temperature < 30°C/86°F and the victim had a patent airway, arrest may be due to hypothermia; CPR should be continued, and the patient transported to a hospital with ECLS capability.
If available, mechanical chest compression should be used for difficult and long transports. If continuous CPR is not possible, intermittent CPR can be performed with ≥ 5 minutes of CPR alternating with ≤ 5 minute interruptions.
Several indications suggest one can withhold or terminate resuscitation:
- If a completely buried victim is in cardiac arrest that has clearly been caused by trauma.
- If a victim is completely frozen.
- If a victim is found pulseless and apneic with an obstructed airway and duration of burial is > 60 minutes and core temperature > 30°C/86°F.
- If an avalanche victim who has a serum potassium of > 8 mmol L-1.
- If rescuers are at high risk from terrain or weather, further rescue attempts should be delayed until conditions improve or risks can be mitigated.
- If resuscitation attempts exceed 30 minutes.
NONAVALANCHE SNOW BURIAL
Avoiding falling into tree wells and deep powder snow are the only known means of preventing nonavalanche snow burial (NASB), that is, in tree wells or open slopes in deep powder snow. Maintaining vocal and visual contact with a partner, yelling to alert a partner to a fall, and grabbing tree branches to stay upright during a fall may prevent NASB, although the effectiveness of these measures have not been confirmed. A victim should keep skis or snowboard attached to avoid sinking deeper and to provide visual clues to rescuers. There is insufficient evidence to recommend use of transceivers, avalanche airbags or artificial air pocket devices to prevent NASB.
Van Tilburg C, Grissom CK, Zafren K, McIntosh S, Radwin MI, Paal P. Wilderness Medical Society practice guidelines for prevention and management of avalanche and nonavalanche snow burial accidents. Wilderness Environ Med. 2017;28(1):23-42.