Medical aspects of avalanche accidents

Median annual mortality from snow avalanches in the Alps is 100, with mortality rate of 52% in completely-buried, versus 4% in partially buried persons. Survival probability in completely-buried victims plummets from 91% 18 min after burial to 34% at 35 min. Then it remains fairly constant until a second drop after 90 min. Strategy of rescuers is primarily governed by the length of snow burial and victim's core temperature, in the absence of fatal injuries. With a burial time <= 35 min survival depends on preventing asphyxia by rapid extrication and cardiopulmonary resuscitation. With a burial time > 35 min combating hypothermia becomes of paramount importance. Gentle extrication, ECG and core temperature monitoring are mandatory; pulse-less victims with core temperature < 32 degrees C (prerequisites being free airways) should be transported under continuous cardiopulmonary resuscitation to a special unit for extracorporeal re-warming.