Avalanche Case Study

The Scene

A 50-year-old backcountry skier triggered an avalanche and was swept approximately 500 feet over a small cliff band and through a stand of spruce trees, coming to rest partially buried from the waist down. He was located by his partner several minutes later. His partner called 911. Mountain rescue was dispatched at 16:45.

The scene was within a few miles of town in a popular north and northeast facing sidecountry bowl at an elevation of 10,450’ (3185m). The weather was clear with temperatures in the low 20’s°F (-7°C) with light winds. Sunset would be at 17:51. The avalanche forecast called for moderate danger with skier-triggered avalanches possible on northwest through northeast aspects above and near tree line.

Mountain rescue arrived at the trailhead approximately 1 mile from the scene at 17:08. The mission coordinator (MC) was able to talk with the uninjured member of the party by phone. Neither the partner nor the patient had formal first aid training. The MC was able to talk the partner through performing a primary survey. The patient had a serious problem of a probable femur fracture and cold challenge in a cold, unstable snow environment.

A drone was launched in hopes of providing an overview of the scene but ran out of battery power and crashed while trying to return to the trailhead. With darkness approaching, an eyes-on scene survey became a high priority. The failure of the drone increased the sense of urgency.

Meanwhile, a hasty team was assembled consisting of an avalanche forecaster, ski patrol paramedic, and two other mountain rescue members, all equipped with skis and airbags. They were shuttled by snowmachine to the top of the bowl.

The first order of business was to assess the stability of the remaining snowpack and find a safe approach to the scene. A second team of two on snowmachines was dispatched to find a safe zone and observation point from the base below the run out.

The hasty team was able to determine that the risk of hangfire was low and the remaining base was stable for approach from above, at least as far as the patient’s location. They were unable to adequately assess the slope below. They made patient contact at 18:00.

Patient and Situation Assessment

  • A: Hazardous travel conditions and waning daylight
  • A: Fractured left femur
    • A’ distal ischemia
    • A’ compensated volume shock
  • A: Cold response
  • A’ hypothermia

Treatment Plan

  1. Femur fracture -> realign with moderate traction, monitor CSM, stabilize with vacuum mattress and secure in a rescue toboggan
  2. Cold response -> Commercial rescue hypowrap bag
  3. Pain management-> intranasal opioid
  4. Exposure, prolonged care -> provide energy gel packets and water

    The patient reported reduced pain, still complained of being cold, but was no longer shivering, and felt clear-headed.

Increasing Hazards

It was now completely dark, and the temperature was 9°F (-12°C). While discussing the evacuation route, it was noted that one of the mountain rescue members and the patient’s partner were not strong backcountry skiers, having fallen several times while getting to the scene.

The problem list was modified

  1. Hazardous travel conditions
  2. Dark, unable to adequately assess avalanche hazards
  3. Two skiers requiring monitoring and assistance
  4. Cold environment
    A’ hypothermia and frostbite
  5. Patient with a fractured femur
    A’ compensated volume shock
    A’ distal ischemia

Evacuation and Outcome

Fortunately, the observation team sent along the bottom of the slope were able to identify the least hazardous route down before complete darkness. In radio contact with the hasty team, they were able to provide limited guidance to the hasty team leader. Two ski patrollers handled the toboggan while the third monitored and assisted the two less experienced backcountry skiers. The temperature was now 0°F (-17°C).

The group reached the road intact at 19:31 and were extricated to the trailhead by snowmachine. The patient remained alert and oriented with stable vital signs throughout. He was transferred to EMS at 20:02.

Discussion

In this case, the patient’s medical problem proved to be just a small part of a larger and more complicated scene management problem. Initially, the mechanism of injury combined with a lack of confidence in reports from the scene motivated mountain rescue to prioritize early evaluation by medical personnel. This was accomplished once a relatively safe route to the patient was identified. 

The failure of the drone was a surprise to nobody, but waiting for the hoped for view from above delayed the field deployment of the hasty team and avalanche forecaster. About 10 minutes of valuable daylight was risked for the presumed benefit of a clear view of the scene and nearby terrain and snowpack. Even a favorable risk/benefit ratio is balance, not a certainty.

Sometimes the risk side of the ratio prevails. Curiously, this is often taken as a failure rather than an accepted part of the process. Sometimes there is a compulsion to pay for a perceived failure with harder, faster, and even riskier effort. As a result, the team’s frustration and sense of urgency increased, and it took considerable discipline to carefully plan the approach rather than rush to the scene before dark. Fortunately, the consequence of the delay was small.

Once properly assessed, the patient’s medical problems turned out to be quite simple. A closed fracture of the femur as an isolated injury in an otherwise healthy patient is not serious. The plan includes stabilization and pain management. Cold can become a problem if not managed early, especially when using opioids for pain control. Opioids can suppress shivering and impair the patient’s ability to generate body heat. This was a known risk and handled appropriately. The patient’s femur fracture was quickly deprioritized to the bottom of the overall problem list.

More significant concerns included hangfire avalanche, a demonstrably unstable snowpack, darkness, and the high-altitude temperature plunge that occurs after sunset. Fortunately, some risk was mitigated by the makeup of the field team and their familiarity with the terrain.  There was enough depth of skill and experience to accommodate the unexpected addition of two less experienced skiers to the problem list, while still allowing the hasty team leader to focus on the evacuation route.  This is a distinct advantage enjoyed by a community full of backcountry skiers, frequent avalanches, and a nearby professional ski patrol. Nevertheless, the mission coordinator and hasty team leader agreed that the rescue was one of the most hazardous in recent memory. Travelling in avalanche terrain after dark is foolish at best.

Was there a less risky alternative? Maybe. The team could have performed an uphaul from the top, thereby avoiding the snowpack below. They could have called for more supplies and spent the night with the patient on the mountainside waiting for daylight. Either would have involved a long exposure to sub-zero temperatures, but probably less risk overall. The patient’s medical problems were not serious and could be managed for a few hours in either scenario.

The ski out in the dark was successful and took far less time. The patient was in the hospital, and everybody was home by 21:30. Nevertheless, those who perform rescues like these always wonder if it was the right call, or if they just got away with it this time.

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