Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Schön, Corinna A.; Gordon, Les; Hölzl, Natalie; Milani, Mario; Paal, Peter; Zafren, Ken

doi:10.1016/j.wem.2020.06.013

Cited by 14 publications

(13 citation statements)

References 76 publications

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“…In a hypothermic patient with CA, CPR should not be started or should be terminated if there is a valid “do not resuscitate” order, clear signs of irreversible death, including fixed dependent lividity (livor mortis), danger to or exhaustion of the rescuers, or avalanche burial longer than 60 min with asystole and a completely obstructed airway [ 3 , 34 , 39 , 76 , 85 ]. In a hypothermic patient, rigidity (apparent rigor mortis) is not a reliable sign of death [ 36 ].…”

Section: Treatmentmentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

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Section: Treatmentmentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

Self Cite

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“…Confirming death by the absence of vital signs is unreliable; hence, correctly recognising death immediately after death is extremely difficult. 8 The classification of being alive can still be uncertain, thereby possibly affecting the number of alive subjects on rescue arrival. In addition, although all deaths were confirmed by physicians or coroners, autopsy was not performed for all, which may influence the cause of death of an unwitnessed cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…In a mountainous prehospital setting, on-site physicians and technical support such as cardiac monitoring, which confirms death, are generally unavailable in Japan. Confirming death by the absence of vital signs is unreliable; hence, correctly recognising death immediately after death is extremely difficult 8. The classification of being alive can still be uncertain, thereby possibly affecting the number of alive subjects on rescue arrival.…”

Section: Discussionmentioning

confidence: 99%

Causes of death and characteristics of non-survivors rescued during recreational mountain activities in Japan between 2011 and 2015: a retrospective analysis

Oshiro

Murakami²

2022

BMJ Open

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ObjectivesThis study aimed to describe the cause of death and characteristics at the prehospital setting associated with care and rescue processes of non-survivors rescued in the mountain of Japan.DesignRetrospective analysis.SettingPrehospital setting of mountain searches and rescues in Japan. A total of 10 prefectural police headquarters with >10 cases of mountain death from 2011 to 2015.ParticipantsData were generated from the existing records. Of the total 6159 rescued subjects, 548 mountain deaths were caused by recreational activities.ResultsAmong the 548 mountain deaths, 83% were men, and major causes of death were trauma (49.1%), hypothermia (14.8%), cardiac death (13.1%) and avalanche-related death (6.6%). The alive rate at rescue team arrival in all non-survivors was 3.5%, with 1, 4 and 14 cases of cardiac, hypothermia and trauma, respectively. Cardiac deaths occurred in 93.1% (67/72) of men and individuals aged >41 years, and 88.7% (63/71) were found on mountain trails. In hypothermia, callouts were made between 17:00 and 6:00 at 49% (40/81) and by persons not on-site in 59.7% (46/77). People with >6 hours in trauma or >1 hour in cardiac death already died on rescue team arrival, but some with hypothermia after 6 hours were alive.ConclusionThis study is one of the first large-scale retrospective analyses of prehospital non-survivors in mountain emergencies. The alive rate at rescue arrival in all mountain deaths was only 3.5%. These data showed that the circumstances related to onset and the process until the rescue team arrives have different characteristics, depending on the cause of death. Survival may be enhanced by targeting better use of the time before rescue team arrival and by providing further education, particularly mountain rescue-related medical problems to rescuers including bystanders.

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“…28 International guidelines on the determination of death in the wilderness environment detail the difficulties experienced in patient examination, access, poor patient history, and access to cardiac monitoring. 29…”

Section: Discussionmentioning

confidence: 99%

Rescue Activity of a Civilian Helicopter Emergency Medical Service in the Western Cape, South Africa: A 5-Year Retrospective Review

Park-Ross

Howard

Hodkinson

2022

Wilderness & Environmental Medicine

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Introduction-Helicopter search and rescue (SAR) in Africa is conducted primarily by military organizations. Since 2002, the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial, and aquatic rescue. To our knowledge, this is the first description of the operations of an African helicopter rescue service.Methods-A 5-y retrospective review of the terrestrial and aquatic helicopter rescue activity of a civilian-operated HEMS in the Western Cape, South Africa, from January 1, 2012 through December 31, 2016, was conducted. Data were extracted from the organization's operational database, aviation documents, rescue reports, and patient care records. Patient demographics and activity at the time of rescue, temporal and geographical distribution, crewing compositions, patient injury, triage, clinical interventions, and rescue techniques were analyzed.Results-A total of 581 SAR missions were conducted, of which 451 were terrestrial and 130 were aquatic rescues. The highest volume of rescues was conducted within the urban Cape Peninsula. Hoisting using a rescue harness was the most common rescue technique used. A total of 644 patients were rescued, with no or minor injuries representing 79% of the sample. Trauma (33%, 196/644) was the most common medical reason for rescue, with lower limb trauma predominant (15%, 90/644). The most common clinical interventions performed were intravenous access (n=108, 24%), spinal immobilization (n=92, 21%), splinting (n=76, 17%), and analgesia administration (n=58, 13%).Conclusions-The rescue techniques utilized are similar to those described in high-income settings. Uninjured patients comprised the majority of the patients rescued.

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Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Cited by 14 publications

References 76 publications

Accidental Hypothermia: 2021 Update

Accidental Hypothermia: 2021 Update

Causes of death and characteristics of non-survivors rescued during recreational mountain activities in Japan between 2011 and 2015: a retrospective analysis

Rescue Activity of a Civilian Helicopter Emergency Medical Service in the Western Cape, South Africa: A 5-Year Retrospective Review

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