How to Treat an Avalanche Victim

Mountain climbing, hiking, and winter sports in mountainous regions can be beautiful and exhilarating. In the event of an emergency, however, you should know how to care for someone caught in an avalanche. Avalanche victims may have severe injuries, and there is a serious danger of hypothermia. Be prepared to treat an avalanche victim by preventing asphyxiation, treating hypothermia, and possibly providing life-saving CPR.

EditSteps

EditLocating and Accessing the Victim

1. Call for medical help right away. Any time you are traveling or adventuring in an avalanche area, you should have some way to communicate with the outside world with you. Whether using a cell phone or a radio, signal for emergency services as soon as possible after the avalanche.^[1]
   
2. Locate the injured or buried victim. When adventuring in areas that have a danger of avalanches, always pack basic safety equipment. Each person should have a rescue beacon that is battery powered and can send out a GPS coordinate. Bring a small snow shovel for digging, and a set of long, collapsible poles known as probes.^[2] Use your equipment to locate a buried or injured person by following the GPS signal or cries for help, and probing the snow with your poles to locate them.
   
   • Make sure the batteries are fresh in your rescue beacon. Also be sure you know how to use it properly.
3. Dig the victim out to prevent suffocation. A person buried with their head under the snow can asphyxiate. Deal with the immediate risk of suffocation by starting to dig to the person as soon as possible.^[3] Once their head is uncovered, the risk of suffocation is no longer your greatest concern. Do NOT try to pull the victim out – they may have serious injuries that can be worsened by moving them. It’s best to leave them as is until help arrives, unless they are unconscious.^[4]
   
   • If they are unconscious, try to dig around them as quickly as possible so you can gently lie them flat.
   • People uncovered within the first 10-18 minutes have around an 80% chance of survival, unless death is caused by traumatic injuries. After 35 minutes of burial, likelihood of survival decreases significantly.

EditProviding Immediate Assessment and Care

1. Asses the victim’s ABC's (Airway, Breathing, Circulation). The ABC’s of treating a trauma patient involve checking for an open airway, seeing if the patient is breathing, and checking for a pulse.
   
   • Airway: Check whether the victim has an open, unobstructed airway. Use your fingers to remove any debris that has gotten into their mouth. Tilt the victim’s head back slightly to lift the chin and better open the airway.^[5]
   • Breathing: Check whether the victim is breathing by listening at their mouth while watching to see whether their chest is rising and falling. Normal CPR suggests doing this for 5-10 seconds, but if the patient is hypothermic (which is likely), their breathing will be very slow, so check for about 30-45 seconds.^[6] Occasional gasping sounds do NOT count as breathing.
   • Circulation: While watching for breathing, check for a pulse at the carotid artery. Place two fingers on the victim's neck just off to the side a little, under the jaw line. Use your forefinger and middle finger, not your thumb, to feel for a pulse for at least 30 seconds. The victim may have a very slow heart rate and you will have cold fingers, so detecting a pulse may be very difficult and can take much longer than usual.
2. Provide good chest compressions, if needed. If the victim is breathing but has no pulse, only do chest compressions. If they are pulseless and not breathing on their own, incorporate rescue breaths, as well. Perform quality CPR chest compressions using these guidelines:^[7]
   
   • Place your hands in the middle of the person’s chest, one hand on top of the other, with the heel of your hand against their chest over the sternum (the flat bone between the ribs in the middle of the chest).
   • Lean forward over the person so your arms are straight. Use your body weight to help you do compressions.
   • Compress the victim’s chest with the heels of your hands to a depth of 2 inches (about 5 cm). Compress the chest 100 times per minute. This depth and rate can be tiring – you should feel resistance.
3. Give good rescue breaths during CPR. Do not do compression-only CPR – in an avalanche situation, oxygenation is very important.^[8] If the victim is not breathing for themselves, alternate 2 rescue breaths with every 10 chest compressions.
   
   • Tilt the victim’s head back slightly and lift their chin to open the airway. Pinch their nose closed with one hand. Put your mouth over the victim’s mouth to make a seal and blow into their mouth. Blow into the victim’s mouth. Watch to be sure their chest rises when you give a breath – if not, exhale more forcefully.^[9]
   • If you have a second uninjured person present, use the Jaw Thrust maneuver to open the victim’s airway rather than tilting their head back – this can be safer for spinal injury victims. Kneel at the top of the victim’s head, and place your hands one on each side of their face with your fingers hooked under the angle of their jaw. Lift upward (toward you) with both hands.^[10] The other uninjured party will provide chest compressions and rescue breaths.
4. Continue administering CPR for at least 30 minutes. If the patient has no pulse and/or is not breathing, start CPR right away. Spend a lot longer than traditional cardiopulmonary resuscitation would suggest because the victim is likely suffering from hypothermia. The old adage, “A patient isn’t dead until he’s warm and dead” applies here, to an extent. If a victim was buried for longer than 35 minutes, their chance of survival is low even with CPR. If they were dug out early enough, however, providing CPR for as long as possible, at least 30 minutes, can save a life.
   
   • CPR can be tiring, especially in severe climates. If you have a companion, switch off doing high-quality CPR every 2 minutes.
5. Suspect a spinal cord injury. Move the victim only if it is absolutely necessary; otherwise, keep them where they are and dig around them. Avalanches can carry trees, boulders and other large objects that can hit a body and possibly cause severe trauma, including a spinal cord injury. Until you are certain that these types of injuries are not present, you should not move an accident victim.
   
   • Treat anyone with a head, neck, or back injury as if they have a spinal injury.^[11]
   • If possible, stabilize the patient using a neck brace and back-board.
   • If you have to move the victim to ensure their safety and you have no stabilizing equipment, pull them by their clothing or by both arms or legs, and pull them in a straight line. This can keep spinal movement to a minimum. Do NOT twist their body or pull them by only one side of their body – this can move the spine out of alignment and worsen spinal injuries.

EditPreventing Hypothermia

1. Keep the victim moving if they are up and conscious. Someone with stage 1 hypothermia will be conscious and shivering. If the victim is uninjured enough to be standing, have them move around to keep as warm as possible. Insulate their body with more clothes or thermal wraps (you should pack these when adventuring in cold climates), and shield them from the wind. Give them warm fluids to drink, if you have any.^[12]
   
   • The goal is not to actively re-warm them at this time, but to prevent any further drop in core body temperature.^[13]
2. Insulate and warm a semiconscious victim. In stage 2 hypothermia, the victim will be partly conscious (i.e. half awake, unconscious but able to be aroused, or in and out of consciousness) and will probably not be shivering. Insulate their body as much as possible and apply any heat packs or warming mechanisms you have to them, especially around their core.^[14]
   
   • Administer oxygen, if you have it, and get them to a hospital with an Intensive Care Unit (ICU) as soon as possible.^[15]
3. Keep a close eye on ABC’s if the victim is unconscious. For stage 3 hypothermia, in which the patient is unconscious, do everything as in stage 2 hypothermia. Additionally, continually monitor their airway, breathing, and circulation. At this temperature, a victim can develop an irregular heartbeat or their heart can stop beating at any time.^[16] If possible, provide warmed, humidified oxygen.^[17]
   
4. Give shocks if the victim has no vital signs. In stage 4 hypothermia, the victim is unconscious and has no vital signs – they aren’t breathing and/or they don’t have a pulse. Most likely, you will not have a defibrillating device with you, in which case provide CPR for as long as you can, giving good rescue breaths. If you do have a defibrillating device, check the person’s ECG. If they are in ventricular fibrillation (V Fib), give them up to 3 shocks to try to restore a regular heartbeat.^[18]
   
   • If you are a medical professional and you are able to establish an IV line, infuse fluids warmed to 42°-44°C (108°-111°F). The standard is 0.9% NaCl or 5% glucose.
5. Prevent post-rescue collapse by handling the victim gently. Post-rescue collapse can occur if you successfully rescue a patient with hypothermia but then they suffer a life-threatening issue once they start to re-warm. Do what you can to prevent post-rescue collapse by handling the victim in the following ways during your rescue attempt:^[19]
   
   • Handle the victim as gently as possible and keep jostling them to a minimum. Avoid unnecessary movement of their trunk and large joints like hips, knees, and shoulders.^[20] When the heart gets very cold, rough handling can induce a deadly arrhythmia.
   • Keep hypothermic patients horizontal. Standing them upright can cause a serious drop in blood pressure.
   • Remove the victim’s wet clothes and wrap them in a water-resistant and windproof outer shell that has heating pads, when possible.
   • Administer oxygen if you have it available, or as soon as possible.

EditGiving Follow-Up Care and Getting the Victim to Safety

1. Provide basic first aid. If the victim is not buried, and has vital signs (i.e. is breathing and has a heart beat), then proceed to give basic first aid. Remember to treat the person as if they have a spinal injury, to be safe.^[21]
   
   • For severe bleeding, apply pressure to the wounded area. Apply a tourniquet proximal to the injury, i.e. closer to the body, by tightly tying a belt or strip of cloth above the area.
   • Only splint a broken extremity if you have to move the victim for their, or your, safety. Otherwise, keep the person still and calm until help arrives. Speak in a soothing voice and calmly tell them to keep still and that everything is okay.
   • Provide basic first aid by cleaning and covering wounds, if possible.
2. Splint an injured limb. In the event of a broken arm or leg or injured joint, try to apply a splint to minimize pain and further injury and make safe travel easier. Follow these basic guidelines for splinting an injured limb:^[22]
   
   • Locate a strong, straight object to use as a splint. It can be a log, branch, rolled up towel, or anything else at your disposal. If using something from nature that may splinter, wrap it in extra clothing.
   • Gently wrap the injured limb in padding, such as extra clothes.
   • Apply the splint so it overlaps the joints above and below the injury. For instance, if the lower leg is injured, the splint should overlap both the knee and the ankle. Place the splint on the uninjured side of the limb (i.e. not over the injury), if possible.
   • Secure the splint with ties or tape above and below the joints. Do not tie something directly over the injury, and try not to tape directly on the victim’s skin.
   • Move the injured limb as little as possible.
   • If the person expresses pain, numbness, or tingling in the extremity after splinting, remove the splint and try again. Impeding blood flow with a splint can cause long-term damage to the limb.
3. Evacuate a minimally-injured victim immediately. If the victim is unharmed enough to walk, assist them in leaving the area. Keep them as warm as possible by insulating them and using heating packs, removing wet clothes and replacing them, and giving them warm fluids to drink. Take them to the nearest hospital.
   
   • If help is on the way, stay where you are. They will be able to reach you quickly and will do a comprehensive exam on the victim to ensure they have no serious injuries you cannot see. Only evacuate if you are unable to contact emergency services.
   • If you need to move to a safer location, help the injured person walk by supporting their weight on the side of their injury.
   • If the person must be dragged to safety, pull them by both ankles with equal tension to keep their spine straight. Use your body weight to pull them to avoid hurting yourself.^[23] If they have leg injuries, lift their arms over their heads and pull them from below their elbows.

EditTips

• Keep yourself safe when adventuring in cold, snowy areas by packing the appropriate supplies:
  • Insulating/thermal wraps
  • Avalanche rescue beacons to signal your location^[24]
  • Small shovel and long probe to locate buried parties
  • An emergency first aid kit
  • A small, portable defibrillating device
• Look for signs indicating the local hazard level in your area, which is rated 1-5. Though a rating of 3 seems average, it actually indicates considerable danger. The hazard level can change quickly in a given area.^[25]

EditWarnings

• Before your expedition, keep an eye out for red flags for the possibility of an avalanche: Obvious instability or recent avalanche activity, recent snowfall of 10-20cm or more, and quickly rising temperatures.^[26]

EditRelated wikiHows

• Rule Out a Spinal Cord Injury During First Aid

EditSources and Citations

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