International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents

Abstract

Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue

“…A recent review compared the use of intravenous and intraosseous access in providers wearing high-precaution PPE, and suggested that in this context intraosseous access is achieved faster (Drozd et al, 2021 ). Intraoesseous access may have limitations during prolonged rescues or in aqueous environments (Strapazzon et al, 2018 ). Additional routes of drug administration have been suggested in mountain rescue.…”

Canyoning Accidents in Austria from 2005 to 2018

“…From our data, we cannot conclude whether the risk for tissue infection is increased compared to any other trauma. ICAR-MEDCOM recommends that wounds be cleaned and systemic antibiotics given for open fractures [9]. Tetanus vaccinations should be up to date and are recommended, ideally prior to performing canyoning.…”

“…In 2017, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) defined consensus guidelines for the on-site management and transport of patients in canyoning accidents, as well as summarising, commenting on and grading the literature available [9]. Although regional data have been reported, no long-term national data on canyoning have been published to date.…”

COVID-19 Pandemic in Mountainous Areas: Impact, Mitigation Strategies, and New Technologies in Search and Rescue Operations

“…Therefore, it seems safe and feasible for healthy individuals to perform short-term moderate-strenuous aerobic physical activity while wearing face masks and performing SAR activities such as cardiopulmonary resuscitation (CPR) (Rauch et al, 2021 ), ground transport, and winch operations. PPE could however increase the burden of increased body temperatures and heat-related illnesses, especially in a hot climate or in canyoning rescues (Strapazzon et al, 2018 ; Lipman et al, 2019 ). In addition, when wearing PPE, the face is partially covered and therefore communication among rescuers could be less effective (Hüfner et al, 2021), especially during acute management (Lim et al, 2020 ).…”

“…New PPE protocols against airborne infectious diseases should be compatible with technical equipment and specific environments such as snow and water in an avalanche, canyoning, or cave rescue (Schneider et al, 2016 ; Strapazzon and Brugger, 2018 ; Strapazzon et al, 2018 ). Disposable garments are fragile and do not stand up to the wear and tear of the prehospital wilderness environment.…”