AVALANCHE COMMISSION REPORT International Commission for Alpine Rescue Commission for Avalanche Rescue. October 19-22, 2016 in Borovets, Bulgaria

Transcription

1 AVALANCHE COMMISSION REPORT International Commission for Alpine Rescue Commission for Avalanche Rescue October 19-22, 2016 in Borovets, Bulgaria Prepared By: James Marc Beverly, PhD, PA-C, IFGMA 12127B North Highway 14 Suite 5 Cedar Crest, New Mexico (505) marc@beverlymountainguides.com For the Mountain Rescue Association (MRA-USA) INTRODUCTION: The International Committee for Alpine Rescue (ICAR) annual meeting was held in Borvetes, Bulgaria the week of October Intermittent showers over the Balkan Mountains made for some good hiking, and excellent rock climbing. The Bulgarian Red Cross and the Mountain Rescue Service hosted the event at the Samokov Hotel. Bulgarian Mountain Rescue was inaugurated in 1933 after the Rila and Vitosha Mountains were bustling with new shelters and refugios, as ascents to the highest peaks began to become more popular. Borovets is nestled in the Rila Mountains, and the Borovets ski area is located a mere hour outside of Sofia. Bulgaria Mountain Rescue celebrates its 83rd year in Mountain Rescue this year. Bulgaria is also home to world-class fantastic ranges, farms, cliff, crags, and caves to explore and sport climb in. So it should also be said in this report, Bulgaria is a wonderful place to visit. The Congress: Many nations and regions send their members to participate, attend the meetings, and to share informative techniques, thoughts, and to propose theories that generate research and development of Mountain Rescue. More than 30 countries were represented to take part in this year s Congress. Figure 1 Doolin and Cliffs of Moher region. The theme of this year s congress was search function improving the search before the rescue. This is always the case in avalanche rescue, and good case reports were presented from multiple entities

2 English has become the ubiquitous language adopted by ICAR, but it was decided that translators were going to be used once again this year. This was helpful for those who did not speak 4 or more languages, and allowed for those presenters who spoke their native tongue to be able to present. Translators worked long hors and did a wonderful job as accuracy in translation is important. Delegates representing the United States of America s National Mountain Rescue Association (MRA) in Borovettes were Charlie Shimanski (Air Rescue), James Marc Beverly (Avalanche Rescue), Tom Wood (Terrestrial Rescue), Ken Zafren, M.D. (Medical), and Oyvind Henningsen (Avalanche Rescue). The U.S. MRA delegates are grateful to our sponsors for the long-term support of this important international exchange. PRACTICAL SESSIONS Preconference Practical Field Sessions Many vendors filled the exhibition hall throughout the duration of the conference. You see a few more new avalanche specific gadgets out there including these new strike plates that have the correct target size and feel when your probe finds it buried in the snow. Airbag technology is only getting better as well, and airbags are becoming more lightweight with the advent of carbon fiber tanks and new polymers for airbag construction. As usual, the first day was a practical session where a discussion and demonstration of scoop and run with intermittent CPR performed outside the Samakov Hotel. Although intermittent CPR has not been accepted as a standard practice in the USA, it has gained wide acceptance from the medical community abroad and is being used on a regular basis, especially with hypothermia arrests (See the medical reports from this, and previous ICAR reports). This technique has shown some positive outcomes, and in many avalanche scenarios where a patient goes into arrest secondary to hypothermia, rather than asphyxia or trauma, it may be indicated. Although Mountain Rescue teams across the USA don t necessarily have advanced practitioners, it s a good idea to at least have a working knowledge of resuscitation decision-making for avalanche victims. See once again, the flowchart (below). Practical field sessions were also held at the Borovets Ski Area as well as the Samokov Hotel. Medical A quick medical scenario was set up and students were taken through a medical-only scenario involving critical decision making on a basic level of medical care. The scoop and run mentality was the basis for this drill October, 2016 ICAR Congress Borovets, Bulgaria 2

3 Transceiver Search Strategies and Techniques Pictures are recommended, and are generic, but do not work for all transceivers. 3 antenna digital beacons with marking functions are considered the standard, please use them. Pictures are better to pass along information, rather than texts. Helicopter + Avi, a Proposal. Although the term scoop and run (and its connotations) has been around for a long time in the EMS world, it is also a term being coined in high-risk avi terrain. However, Patrick Fauchère, who has been spearheading this technique in France, would say that hovering for 20 min is hardly fast. This is a technique that is continued to be practiced in Europe, and was demonstrated during the practical day using a re-direct from the ski lift tower in order to mimic a heli hoist operation. Purpose: To place rescuers on-scene of an avalanche within a few minutes, and with high-risk terrain where subsequent avalanches are possible, or high exposure to a rescue team is not acceptable. Procedure with the helicopter: The training level must be quite high for everyone involved. A long line of 50m is preferred as the pilot needs to move backwards and away from the 1-2 rescuers that have been placed on a slope. At the end of the 50m rope, is a 10-15kg balloon/mass that the pilot keeps on the avalanche surface of the snow slope in order to use as a reference. The two rescuers are then attached to the end of the rope with 4m lanyards, below the balloon, with rescue equipment attached with bungee cords. The rescuers are guaranteed to shovel snow onto their lanyards, as well as the long haul line. Genswein and the French team performed testing this year by burying a rope 1-1.5m deep in compacted snow, and measuring the force it takes to pull the rope out of the snow, simulating this rescue procedure. It was found that the forces were low enough for a helicopter to pull out, and that using a regular static rope is sufficient, rather than having to go with ¼ cable or a small rope with less strength. Good communication is a must. Safety first, assessment, & communications is imperative. Progress has been made and continued practice will help to sculpt the techniques. Another name for the procedure is also pending October, 2016 ICAR Congress Borovets, Bulgaria 3

4 AVALANCHE COMMISSION President of the Commission: Dominic Bestler As in usual exemplary professional style, Dominic oversaw the congress of the Avalanche Commission. He continues to champion the knowledge Manual Genswein started the assembly of avalanche delegates and members with the continued work on the major focus project on Accident Prevention, which continues in draft-proposal form. The Avalanche Commission has been tasked with review of this proposal. Dominic Bestler PRESENTATIONS Excavation Manuel Genswein The UIAA continues to work on a safety label for shovels. Although this may seem trivial, a shovel that cannot stand up to the rigors of avalanche rescue are of no use. A safety label works to assure that the shovels that are sold as avalanche shovels are indeed capable to handle to workload. The conveyor belt technique has been established as the standard for avalanche excavations as it is the most efficient. This image, taken from Manuel Genswein s paper, should be standard and applied knowledge for all avalanche rescuers. Probing strategies Manuel Genswein Several probing strategies continue to be used. As in previous ICARs, choosing the right kind of probing is important in order for it to be effective for the terrain and resources that are presenting and available. For example, Slalom probing should be used by trained professionals and in unhindered terrain. It may be fast than all other types of probing, but is difficult to train bystanders. Two-hole-per-step method is more likely to be used by Mountain Rescue teams in the USA, and-one-hold-per-step also has its place. Knowing when is the right technique is important. If you have questions, please get professional training. Manuel strongly contending that there should be no more hasty search. Hasty search should be combined with the signal search. (Perhaps this should be called the CLUE SEARCH Beverly). He also has pointed out that there should not be a need for guide-on cords at this point, as this takes away from resources and has proven of little value in his testing. Mountain Safety Knowledgebase Manuel Genswein The Mountain Safety Knowledgebase is a new concept that a working group has been diligently contributing to over the past year, including the Avalanche Commission of ICAR. There is a 40-page document (that will not be covered here) that should be read and understood, as answers to many of the questions that people have are in this transcript. Although the idea is to start with avalanche rescue, this concept is one that is similar on scale to Wikipedia or UpToDate, only for mountaineering October, 2016 ICAR Congress Borovets, Bulgaria 4

5 Synopsis Mountain terrain is used for recreational and occupational activities, residential areas, work sites and traffic systems. The mountain terrain adds hazards to the environment which are different form hazard in flat terrain and thus require specific accident prevention strategies as well as safety and rescue procedures. Their goal is to prevent accidents in the first place and provide efficient rescue if required. Although there are some locally specific circumstances, the hazards imposed by the mountain environment and the characteristics of the human beings interacting with it are worldwide extremely similar. Thus, the techniques, methods, strategies and systems in accident prevention and rescue should be standardized and therefore equally taught and applied by all members of international organizations such as UIAA, ICAR or UIAGM. Mission of the Mountain Safety Knowledgebase Standardized systems, teaching materials and terminology ensure equal effectiveness and cost efficiency. The prime goals of the "Mountain Safety Knowledgebase" are: 1) to document "best practice in mountain safety" in a database 2) to describe strategies, techniques, methods, systems in a standardized format, using standardized illustrations and terminology 3) to lead the "best practice" consensus workgroups on a world-wide level in collaboration with expert groups of its partner organizations 4) to standardize terminology in mountain safety across different disciplines of mountain safety 5) to define and ensure standardized terminology across different languages and countries in collaboration with expert groups of its partner organizations 6) to organize, lead and promote projects to evaluate "best practice" in mountain safety on a world-wide level in collaboration with expert groups of its partner organizations 7) to efficiently distribute the content of the knowledgebase to all those in need of mountain safety knowhow 8) to ensure a sustainable future development of mountain safety know-how by an institutional representation of IPR providers towards the various users groups of mountain safety know-how Knowledgebase items are non-exhaustive, but it would be a system that would decrease reproduction of many techniques, and would aim to standardize much of what techniques exist, but with a peer review process. Concerns: The size and scale of the project Possible to achieve the goals? Setting Standards Uncertainty of how people/organizations can be a part of the project Making experience available free of charge An electronic copy of the proposed Knowledgebase can be obtained by contacting Manuel mailto:manuel@genswein.com October, 2016 ICAR Congress Borovets, Bulgaria 5

6 ACCIDENT REPORTS France ANENA Fred Jarry Another slow start for snowfall in France marked an unprecedented low avalanche fatality years since the 70 s. 107 people were caught, 12 fatal accidents (10 year average = 22/year), 21 fatalities total. Of those 11 were ski touring, 6 were off-piste, and 4 were alpinists. Of note, was the accident of January 13 at Les Deux Alpes ski resort where 3 fatalities (2 high school students, and 1 UA) went out onto a closed black diamond ski run. Skiers uphill triggered the avi, and there was a lot of media pressure as they were already on-scene by the time the rescue party arrived. The other avalanche that created a lot of pressure for the rescue team was the Foreign Legion incident (see report by François Albasini (below). Switzerland Gian Darms, Beni Zweifel / SLF Davos There was a very slow start to avalanche deaths in Switzerland during the seasons. Possible reasons: safe conditions during Christmas (almost no snow) Jan/Feb: often bad weather during weekends no accidents with more than 2 fatalities Danger in Jan/Feb very obviously (whumpfing, shooting crack, natural releases) Although there were 21 fatalities, this is less than the national average of 25. Gian, postulates that there were many involved people, so they may have simply been lucky. Gian also had another presentation Avalanche fatalities in the European Alps long-term trends and statistics. His group contends that interpretation of avalanche accident data is often complicated. Statistics can be highly influenced by, small number of events, under reporting of non-fatal accidents, single multi-fatality accidents, extreme years, and random effects. They attempted to address this issue by investigating and comparing data from 7 alpine countries (CH, FRA, AUT, ITA, DEU, LIE, SVN). Getting rid of major outlier years of snowfall, and excluding roof avalanches and cornice collapse. Terrain was normalized and controlled terrain vs. uncontrolled terrain appeared to be the biggest notable difference. In controlled terrain, the number of fatalities has reduced drastically since the 70 s in all 7 Alpine countries. In uncontrolled terrain, the number of fatalities has almost doubled between the 60 s and the 80 s. Since the 80 s number of fatalities has largely remained stationary, despite the increasing amount of recreationalists. This is thought to be due to mitigating measures, but no one measure was specifically identified (avalanche education, rescue techniques, etc) October, 2016 ICAR Congress Borovets, Bulgaria 6

7 United States of America James Marc Beverly The current rise in avalanche fatalities due to snowmobilers now exceeds that of any other in the USA. US Avalanche Fatality % by Activity SM 37% DROWN 3% SKI 30% SM Snowmobile SKI BC skiing FR Freeride OP in bounds (on piste) BLDG building related ALP aplinist Drown Road BLDG 3% ALP 7% OP 0% FR 20% ROAD 0% There is also a large trend in the season that a weak layer in the midpack was responsible for more avalanches than any other, including storm slab or depth hoar together. However, there were no correlations between number of days of snow on the ground, or depth of snow in relation to avalanche deaths over a 10-year period in Colorado (data from AAA & CAIC, statistical evaluation by Beverly). The data for Colorado are not sufficient alone to draw conclusions from US Avalanche Deaths by State The amount of deaths by state appeared to be spread through a large region and not consolidated. The snowpacks ranged considerably and so that information was not presented at this time as it would have been too lengthy. Reporting of avalanches triggered, injuries, and near misses were also not included in this report as there are still much missing data. For example, 2 snowboarders were caught and partially buried in Taos, New Mexico, but the event was unrecorded from any national database. Again, until there is better reporting of avalanches in general, the data will continue to not support the actual occurrences. Reports should be submitted for any avalanche occurrence to the National or Regional database October, 2016 ICAR Congress Borovets, Bulgaria 7

8 Italy - Winter was not so critical for spontaneous avalanches. Total fatalities = % BC skiing. 66% of accidents occurred after the 1 st day of good weather after a snowfall. 87% of accidents occurred within 3 days after snowfall. BC skiing = 13, 1 off piste, 1 Again, many more people are BC skiing. Contact: mailto:aineva@aineva.it in the Aosta valley for more information. Slovakia and Poland Marek Biskupič This was a very warm winter, and much less snow than average for the region. A mountain guide was buried and killed while guiding. The crew traveled up the slope they came down. There was a lot of solar gain and the hard slab was triggered at approx. 1.5m deep, in the afternoon. Of note, there were 13 fatal climbing accidents that involved a significant icing period in late December. In a data analysis, there was found a significant increasing trend from , but the trend shows no significant increase from 86 to the present in uncontrolled terrain. Significantly decreasing trend in controlled terrain since Uncontrolled terrain, the number of fatalities has almost doubled. It has been proposed that the amount of BC travelers has increased a factor of 5, and in some places like France, it has been thought the increase is as much as a factor of 8. A case report was presented on the Jasná Avalanche balloon incident, Slovakia. This was a personal account from an avalanche forecaster. This was triggered on a wind slab. Perhaps the biggest point of note is that during what the presenter calls the Black period , there were 13 climbing accidents during this short period, as there was verglass and thicker ice only in the mountains, with most of the region denuded of snow. Total avalanche deaths was 2, 16 total were caught, 2 were totally buried, 12 were partially buried, 2 were above ground, and 5 were injured. To Bag or Not To Bag - Marek Biskupič Marek Biskupič discussed a near miss that happened to him while he was collecting information for avalanche forecasting. Wrong judgment, no expected triggering of slab, and did not manage to stop at the top, were at least some of the problems that caused Marek to trigger a slab. The good news is that he was able to get rid of his poles, deploy the airbag, and come to a stop prior to going over a cliff. He suspects that his airbag kept him from getting drawn deeper into the flow of the debris, which is why he was able to come to a stop and not be swept of a large cliff. The question was posed about attitudes towards avalanche risk as a function of having an airbag, and although the presenter has to wear an airbag as a professional, he does not feel that it will change his behavior because professionals are more exposed to avalanche risk than recreationalists and should take care with as many precautions as possible to help mitigate risk. [An author s comment: it is interesting that the AvaLung has fallen by the wayside, although it has good application, and it has been cited many times as helpful, even at this ICAR meeting.] Marek states that all we should always stack the odds in our favor, as much as we can October, 2016 ICAR Congress Borovets, Bulgaria 8

9 Of Dog and Man - Ion Sănduloiu, SALVAMONT Argeș The avalanche dog handlers from Italy gave a brief presentation, demonstrating a cursory pilot project about dog handler/dog performance on a standardized search area. Although this was not a rigorous research effort, an approximate 66% success rate of a victim find at two different elevations, with two different courses of difficulty. Rescue Dog Qualification A Romanian presentation on how to qualify an avalanche dog. Generally, this is a long process in which the Romanians worked closely with the French region of Savoy. The dog handlers must be a member of a member of ICAR. Romania has since established it s own school in Salvamont as of 2015, and have since increased the amount of environment and situational team building between the dogs and the dog handlers. Manuel Genswein After a long discussion regarding the Knowledgebase, Manuel covered in detail, probing techniques, as they apply in not only companion rescue, but also in multiple situations. Standardization of techniques, terminology, and pictographs, have been provided by the ICAR avalanche working group for a best practices approach. Guideline cords, nets, etc., are not recommended at this point. French PSAP: 2002: European directive for the Public Safety access to the Caller location via cell phone. The French law and transcription has been poor. There is a lack of smart apps to make this an effective process. Unfortunately, the subject can be located as far as 15km, so this is still not an effective way to located subjects. An app can be sent to the caller with a smartphone, and locations can be localized much more quickly. Some benefits of a new system (similar to what the USA has in place) are many. Phones can be tracked realtime, it is quick, <120s, and hours of ground search can be only a few minutes for a helicopter. GENDLOC Olivier Favre, PGHM This is a form of geolocation a subject s location using GPS and mobile phones. The person to be located confirms the link that was sent to them. Every 2 minutes, information is pinged back to the rescuer(s). The National Geographic Institute powers the mapping software. Overall, this technique decreases time in the field, is also effective in the forest, and works during times of bad weather. GENDLOC was first used in the PGHM, and since its inception in 2012, has been instituted in over 150 programs. The emergency dispatchers are IFMGA/PGHM/Gendarmerie. At this point, any point of access from an emergency number, is capable of initialization of the use of this system. There is a call from the French government for Apple, Samsung, etc., to install the app, preeminently. ICAR recommendation TER-REC 0001 For air operations, ICAR recommends the use of triple-action self-locking carabiners. EN362 (steel screw lock carabiner may also be used October, 2016 ICAR Congress Borovets, Bulgaria 9

10 Multiple Casualty Incidents (MCI): MCI Avi triage In an academic MCI, we use specific tools with temporary START system, a list of victims, and a map. We must use an MCI toolbox in order to get good results and reduce risk to the rescuers. It is important to go from improvised rescue to organized rescue. Switching from emergency medicine to MCI medicine is not easy, and can be affected by environment, technical terrain, avalanche, etc. There is no indication to work someone in cardiac arrest with multiple patients. With airbag: Mortality rate is approx. 44% of those critically buried, non-critical à overall there is a 11.1% benefit. So 22/100 without airbag, 11/100 with airbag Non-inflation rate was 22% and only reduces mortality difference 9% Non-inflation rate of professional vs non-professionals is 3x lower. The reduction of wearing an airbag is nullified by getting caught in a grade larger avalanche. 60% of cases with non-inflated airbags: deployment failure Familiarity with release procedure and correct maintenance Medical treatment of Avalanche Victims European Resuscitation Guidelines by Herman Brugger, Peter Paal: Although these concepts have not yet been incorporated by the USA on a grand scale, we need to make the effort to understand and utilize these guidelines. Discriminate asphyxia vs. hypothermia for ECMO (Extracorporeal membrane oxygenation) Cut offs for CPR and EMCO 1) >60 minute burial + patent airway 2) Core temperature, esophageal <30 C 3) Serum K+, >8 mmol Recent outcome studies of avalanche victims with cardiac arrest + ECMO Survival rate is very low (1.2%) of those who are in cardiac arrest that were buried. There is only 1 asystolic long-term survivor in the literature à too many being transported. Duration of burial <60min, or core temp>30 C à Universal ACLS Any signs of life à transport No sign of life and airway is blocked à D/C No SxS life à K+ Cardiac arrest + burial >60min + airway blocked: No CPR death from asphyxia October, 2016 ICAR Congress Borovets, Bulgaria 10

11 Checklists for Avalanche Burial. This is useful for MCIs as well. Taken from: Please note that this is an updated list from last year. Checklists 20% more information is obtained when using the checklist. Adapt to ERC Guidelines 2015 Checklist is being used in CHF, and FRA. Epitympanic thermometer measurements Epitympanic measurements were compared to esophageal measurements31 healthy subjects age years of age were enrolled to measure temperatures at +20 and -20C. There was a strong bias by human anatomy and inter user reliability. The devices that were used to measure epitympanic temperatures were not the devices purchased over the counter at the local drug store. Moreover, Monte Carlo Method of Triage The Monte Carlo simulation is based on rolling the dice, creating a normal distribution curve. Manuel contends that we roll the dice for size of the field and depth of burial. The likelihood of survival once CPR is initiated diminishes as time goes on with a traditional method. With the Monte Carlo method, there is a mild increase in survivability for the first 10 minutes for the first patient. There was some academic discussion of weather to perform CPR for 5-7 minutes is worthwhile or not, but further research is needed to make any solid recommendation. Performing CPR for >20 minutes is not likely to help, which was agreed upon by both the Avalanche and Medical Commissions October, 2016 ICAR Congress Borovets, Bulgaria 11

12 Mountain Safety Knowledgebase Again, there was much discussion about the concept of the MSK. Support from the IFGMA and collaboration with the UIAA has been established. There will be more discussion regarding this proposal. All organizations and individuals are welcome to give input to Manuel Genswein Avalanche Search and Recovery (case study) Brian Wester (Canada) Air Rescue, Technical, and Avalanche components were needed for a multi-day, complex rescue on Polar Circus, a 700m (9 pitch) ice climb. The climbers rappelled one of the pitches, and the first climber walked away from the ropes, and triggered a slab. The climber searched (without any avi equipment) for 2 hours, then left to report the accident. A 2 day storm covered the area. Control work was performed and 42/43 bombs triggered avalanches. The search was performed using dogs, random probing, and a Recco. A faint Recco signal and a dog signal coincided. Probing located the body 2.8m below the surface. The Recco reflection came from circuitry of a Mammut headlamp in the victim s pack. Rapid Assessment and improvised evacuation without harming the patient Goals of this session were to : define the term scoop and run, highlight the importance of the issue for different rescue operations, find a common term for: non-medical fast rescues. Usually, this means basic care in the field. Emphasis on speedy delivery of a casualty to the hospital. (Mcgill J Med In Mountain Rescue there is some degree of prolonged care. Helicopter ingress grab-and-go is not considered scoop and run since there is no medical assessment. Times that it might be ok to apply this technique is when there is: Treat and Run is a short time by comparison (10-15 minutes): Airway management, thoracentesis, circulation attention, relocations, etc. Stay and Play = full assessment (ABCDE + Body Check). A case report by Gephold was given thereafter. This was basically a run-down of medical decision-making. The term scoop and run has had different levels of acceptance among the medical community in the USA. The application of these techniques should be in-line with local medically accepted practices and standard of care. Poland TOPR Mountain Rescue More hypothermia cases - Lukasz Migiel, Tomasz Darocha One of 3 hikers that were on their way down from the summit had fallen, and was wearing a rope and a harness. 17:50 ECMO coordinator of Severe Hypothermia Treatment Center is notified. 20:57 TOPR rescuers arrives on site. 22:00, the main group of rescuers arrives. 22:30 rescuers reach the victim and the harness is around the ankles in -10C GCS= 9, no visible trauma. 23:43, patient goes into cardiac arrest. ETT, ventilation with BVM, PEA = :05, intermittent CPR. 00:45 at the end of steep terrain continuous CPR, and at 01:07 the patient is moved to accessible terrain so that a Slovik helicopter might be used, Tc = 17C. An Mi 17 helicopter is elected October, 2016 ICAR Congress Borovets, Bulgaria 12

13 to be used at 03:53. CPR is restarted once inside the helo. Tc = 15.2C in the ER, and ECMO is initiated. FAST USG exam showed no signs of internal injury. Normothermia achieved, but the patient had a high K+ level and expired in the ER. From Theory to Terrain A presentation of an avalanche response by the French Air-Glaciers and Sauvetage was given to help demonstrate where to dig when a probe is impossible. This was a difficult and complex search as probe strikes were not obtainable. Stress was placed on understanding the theory behind the tools and to increase training so that the rescuer can be more proficient when the time comes to perform. In this case, there were multiple burials, close burials, and a deep burial. The medical training tests the management strategies, tests the field applications of the guidelines, tests of new material, and to drill the rescue team. The medical standards include a doctor with skis, beacon, shovel, probe, and airbag. Doctor should be present as the head is reached. For complete burial and cardiac arrest: ventilation if >60 minutes. From the doctor s perspective of this event, his patient was is cardiac arrest upon extrication. An ETT was placed and core temp via OG was placed, and an IO. The choice was to take the patient to the next further facility because of ECMO. While en-route to the ER, the patient regained spontaneous cardiac activity. The other two subjects: one had a K+ of 10.6, and the other was transported, but became an organ donor. Theories are nothing without training. Training is an essential intermediate step to become effective. Simple PCDS The new ruling for having hoisting and for external cargo, with or without 2 people. This was a 6 year effort to be able to use the harness systems that are already in place. MCI A Bavarian Train Wreck A very interesting approach to this MCI involving 80 patients, and the incorporation of Mountain Rescue teams. The Mountain Rescue teams are incorporated as some of the tasks that are needed to be performed are beyond the scope of the terrestrial fire departments. Cross training should be incorporated to a certain extent. There is some mandatory training (1x/year). Having indoor helicopter training, even once, is of great benefit. Swill Alpine Rescue Andres Bardill Operational resources are becoming more and more available. Drone pilots, and other potential added searchers, although with good intention, can complicate the search efforts. Hobby organizations have a very useful place in the area of mountain rescues. Accidental Hypothermia Peter Paal Peter went over his Journal of Trauma paper on accidental hypothermia, and gave some quick insights and pearls of how to treat hypothermic patients. Until Tc <28C, other etiologies for cardiac arrest should be considered October, 2016 ICAR Congress Borovets, Bulgaria 13

14 Case report: 57 y/o female with 16.9C Tc, with a HR of 6 BPM from 2000m of extrication. Intermittent CPR was performed the entire way, and survived without neurological deficits. If core temp <28C, use icpr If core temp <20C then, A national protocol should really be enacted upon in light of the most recent findings, according to Paal. EURAC Research - Article Review from J. Emerg Med Giacomo Strapzzon, et al. Again, initial triage was utilized, and the typical ICAR recommendations were followed. 80% of cases had CPR on-site, and only 15% of cases were transported, and 4 cases were placed on EMCO, but no survivors. 1) The duration of burial was documented in 91% of the cases 2) The rate of reporting airway status in cases of long and u/k duration of burial is low. 3) Rate of CPR and transport to the ER was lower in long burials. 4) An ER Dr. was associated with higher rates of CPR (OR = 3.7) 5) BLS providers should not make the decision to stop CPR. 6) No avalanche victim with an airway is dead until warm and dead. EURAC Research International Avalanche Registry, Monika Brodmann Maeder Making the case that low incidence and high impact of avalanche victims is difficult to assess since there is a primary endpoint, but a secondary impact that is yet intangible. The case is made that information of medical information is of importance, but also the technical information is also important. The Institute of Mountain Emergency Medicine has a simple and user-friendly database. The presenter states that the information takes approximately 10 minutes to complete. EURAC is housed in Bolzano, Italy. This is a new registry that is looking to start a pilot phase starting 12/16-4/17. The proposal is to start the international registry is proposed to start in June/July 2016, in which all countries will be able to participate. EURAC Research Recco case report. Giacomo Strapzzon, et al. Case report of an in-bounds burial of 2 subjects without beacons. A Recco was used and the subject was found quickly by reflecting a cell phone, within 2-3 minutes. The second subject was also found thereafter. Bystandar rescue before heli = n=35 An Avalanche MCI in Savoie François Albasini A triage system, similar to the USA START Triage, was integrated with the ICAR recommendations. A MCI bag is utilized, and holds 90 of these cards. A registry is also used. The case report of about 52 people involved, 20 army members, 15 were extricated by self rescue. 5 Died. The point of this talk was that the Dr. (presenter) had prepared for an MCI well in advance, and over the past 4 years October, 2016 ICAR Congress Borovets, Bulgaria 14

15 The 2016 ICAR Congress was held October in Borovets, Bulgaria. The Bulgarian Red Cross and the Mountain Rescue Services of Bulgaria provided an excellent venue for ICAR, and we thank them for their hospitality, as well as sharing some of their cultural food and dance. The ICAR flag was officially transferred from Mountain Rescue Bulgaria to Andorra, who will host ICAR On a personal note, I would like to say thank you for opportunity to be the National MRA Avalanche Delegate to the ICAR Congress for this term. I have grown greatly as a function of my participation. I hope that the MRA continues to provide representation for all USA member teams. Respectfully Submitted, James Marc Beverly, PhD, PA-C, IFMGA Albuquerque Mountain Rescue Council U.S.A. MRA ICAR Avalanche Commission Delegate October, 2016 ICAR Congress Borovets, Bulgaria 15