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Show 3. REVIVAL AND EVACUATION OF THE VICTIM Suppose an avalanche victim has been located and uncovered within an hour of the accident by an efficient First Stage rescue group employing the techniques outlined in Section 2. Will the victim survive? The answer may well be determined by what takes place in the next few minutes. The victim's appearance may be deceiving. The ordeal of being carried down by an avalanche and buried alive can give a ghastly appearance to the stoutest features. Mechanical injury may have been added to suffocation. To all external appearances, the victim may exhibit no signs of life. The rescuers must begin resuscitation measures even before the victim has been completely cleared of snow, regardless of initial appearance. Unless such unmistakable signs of death as rigor mortis are present, pronouncing the victim dead is better left to a physician ( who hopefully has reached the scene by at least Stage Two of the rescue). Resuscitation procedures should continue until either the victim has been revived- the efforts are obviously hopeless ( after at least an hour)- or a physician has pronounced him dead. If the victim is revived, intensive care and treatment are still vital to insure his ultimate survival. Normal first-aid measures for injury and shock are imperative. Special care must be exercised to restore the victim's body heat, for severe cooling often is a consequence of avalanche burial. The victim must be transported to a hospital with care and must be attended closely during transport in case of relapse or cessation of breathing. Review of current avalanche rescue practices and equipment in the United States suggests that the weakest part of procedures, training and equipment is in treatment of the recovered victim. The absence of adequate resuscitation equipment in avalanche caches, and the provision of no more than the first- aid supplies and transport equipment common to ski injuries, are now beginning to be remedied in many areas. In publishing these guidelines for modern avalanche rescue, we explicitly wish to place strong emphasis on the principles of adequate resuscitation measures and treatment of avalanche victims. The following sections have drawn heavily on the discussion of avalanche victim medical problems published as a paper entitled " Wiederbelebungsmassna-hmen bei Lawinenverschuetteten" (" Revival Measures for Persons Buried in Avalanches") in the Eigenmann Symposium Proceedings ( ll). This paper was written by Dr. G. Hossli, Director of the Anaesthesia Department, University Clinic, Zurich. For additional suggestions, comments, and review of these sections, we are also indebted to Burton Janis, M. D. and James Wilkerson, M. D., both from the faculty of the University of Utah Medical School. Dr. Janis is a member of the Mountain Empire Professional Ski Patrol. Dr. Wilkerson is the editor of a recently- published text on mountaineering medicine ( 12). 55 |