AvaLife—A New Multi-Disciplinary Approach Supported by Accident and Field Test Data to Optimize Survival Chances in Rescue and First Aid of Avalanche Patients

Abstract

Snow sports in the backcountry have seen a steep increase in popularity, and therefore preparedness for efficient companion and organized rescue is important. While technical rescue skills are widely taught, there is a lack of knowledge regarding first aid for avalanche patients. The stressful and time-critical situation for first responders requires a rule-based decision support tool. AvaLife has been designed from scratch, applying mathematical and statistical approaches including Monte Carlo simulations. New analysis of retrospective data and large prospective field test datasets were used to develop evidence-based algorithms exclusively for the avalanche rescue environment. AvaLife differs from other algorithms as it is not just a general-purpose CPR algorithm which has been slightly adapted for the avalanche patient. The sequence of actions, inclusion of the ≥150 cm burial depth triage criterion, advice to limit CPR duration for normothermic patients to 6 min in case of multiple burials and shortage of resources, criteria for using recovered subjects as a resource in the ongoing rescue, the adapted definition of “injuries incompatible with life”, reasoning behind the utmost importance of rescue breaths, as well as the updated BLS-iCPR algorithm make AvaLife useful in single and multiple burial rescue. AvaLife is available as a companion rescue basic life support (BLS) version for the recreational user and an advanced companion and organized rescue BLS version for guides, ski patrols and mountain rescuers. AvaLife allows seamless interoperability with advanced life support (ALS) qualified medical personnel arriving on site.

Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update

“…54 AvaLife contains a search and excavate module (Figures 3 and 4) as well as medical modules. 135 Mountain rescue teams should be prepared to manage accidents with multiple burials according to recommendations of the International Commission for Mountain Emergency Medicine. 136 Good communication on site is essential for an efficient, safe rescue.…”

“…The modules follow a step-by-step approach to technical and medical avalanche rescue. From Genswein et al 135 Used under Creative Commons CC-BY license.…”

“…The guidelines were published as AvaLife. 135 AvaLife limits CPR to 6 min in mass casualty incidents for victims who are normothermic and buried ≥150 cm deep.…”

“…These criteria are required to distinguish victims who should be excavated immediately from cases when excavation should be postponed. From Genswein et al 135 Used under Creative Commons CC-BY license.…”

On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom)

“…We did not address multiple triage situations. 107,108 Although organ donation by brain-dead avalanche victims was not included in the analysis when formulating the recommendations, it may be an important consideration. 38,109…”