Triage: multiple burrials and one rescuer

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Originally Posted by Summit

How so?

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One more thing to remember and be trained in is added complexity in the rescue algorithm. Evaluating variables such as burial depth, location, etc. is an increase in complexity. Digging up the first person you find (the default behavior) is not a complex algorithm.

In reading over The Snowy Torrents (all of them) over the past month I haven't seen many commonalities between burials/rescues. There's at least one case (12/2/77) where digging up the first burial victim found saved the second because of the extra hand in digging (party of 3, 2 buried)

cj001f couldn't agree more... actually have a whole ot written on that right now... just too busy to post it... tonight probably...

re: gut feelings - they're worth what you paid for 'em, disagreement is appropriate.

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Originally Posted by Ermine

Still might be a good research topic?

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Maybe. If the vast majority of avy pros simply roll their eyes at the idea of triage strategies and outcome modeling, then it's probably not worth doing.

Two problems with this research proposal:

(1) Just putting already-understood flowcharts into mathematical form is of little value, since the formalization will require assumptions that most field practitioners will laugh at or not understand; nor will a mathematical description be a good educational tool.

(2) Given the nearly complete lack of data on how strategies affect results, it's a good bet that a formal model would not deliver any solid conclusions beyond the obvious and unsurprising ones.

So the only selling point is the faint hope that the model would clarify the linkages between education, strategies, and outcomes. Maybe it'd identify a weak point worthy of further research. Maybe it'd serve as an organizing platform or framework for further discussion & research. Or a dartboard for people to pick at - a good whipping boy.

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Originally Posted by Ermine

Unless there is an easy checklist, the basic avie classes would still rather teach avoidance than some flowchart. We're supposed to be skiing one-at-a-time anyway and making good trerrain choices on the uptrack?

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Yeah. My bet is that effort invested in prevention will have a much higher ROI. With that in mind, it bothers me that I can easily spend $1000 on avalanche rescue devices - beacon, probe, shovel, ABS pack, avalung - but all of that together is probably less effective than a $200 three-day Avy I field class.

Should an individual spend $600 on an ABS pack or $300 on an Avy II class? Or a couple of guided field days with an Avy pro? I'm thinkin' the latter is the wiser choice.

I haven't read the whole thread yet but am going to. Here are my thoughts which may change after reading the thoughts of the TGR collective brain trust.

I would follow LeeLau's protocol for searching. I would only enter a triage mode if I knew exactly how many people were not accounted for. I would hate to leave someone I've located to search for more beacons when I didn't know how many or what I am searching for. I would be really pissed if I dug a dog out (people do sometimes put beacons on dogs which I don't agree with) if there were any people I may have forgone treatment with to keep searching.

The new beacons help here but my DSP still ghosts and I haven't played with the new offerings.

As for once I get to the victim, I would get to their face (not digging out their whole body) and clear the airway. If they were not breathing, two breaths and if that doesn't kick start anything, onto the next person. Chances are, if that person is not breathing, their pulse probably isn't doing the job so you would have to dig them out and start CPR. For this to be any good, you are most likely abandoning the other burials because you will have to maintain compressions and breathing.

Plus, there is a percentage I cannot remember exactly but it's over 90% and it says in a trauma situation, if the trauma is the cause of the heart stopping, over 90% of those hearts will not be started through CPR again.

If a person is incoherent but breathing, I would dig enough to make sure they have room to keep breathing and continue the search. After everyone is accounted for or you know that you are not going to find the others (timeframes start to apply here), then I would go back to the breathers and dig them out, treat for injuries, hypothermia, etc. Then stabilize as best as possible and either help transport, get help, or get ready to hunker down for the night.

This is a tough situation that shouldn't happen if you follow propper travel practices but it has happened in the past. I doubt/hope none of us will ever be in this situation but probably not bad to talk about. It's better than working.

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Originally Posted by David Witherspoon

Should an individual spend $600 on an ABS pack or $300 on an Avy II class? Or a couple of guided field days with an Avy pro? I'm thinkin' the latter is the wiser choice.

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This is a macabre thought and a digression from the topic but I'll throw it out anyway.

I read somewhere - can't recall where (Tremper, Fresler/Fredston) - a study which discussed the fact that being caught in an avalanche is a matter of percentages. I'm glossing over a lot but essentially it came down to this- the more time you spend in the backcountry, the greater your chances of getting caught in a slide.

Of course, that's incredibly trite but the data was presented in the context of an avalanche professional using standard safety protocol and then calculating their odds of getting caught.

I'm a long way from spending 200 + days in the field per year but I still get maybe 60 - 80 days in the field per year. I guess what I'm trying to say is that, FOR ME, no matter how careful or smart I think I'm being, I will get caught at some point and time.

It was Tremper that had those numbers.

So I have just spoken with Dave McClung, and he thinks that this the idea of triage is worth looking into. It may lead to nothing but on the other had the findings might save some lives. One change is that I am now going to look at multiple burrials senarios where the number of victims is greater than the number of rescuers. If you look at the history of avalache incidents this is a senario that happens (globablly) a couple of times a season, and usually involves fatalities.

Witherspoon brings up two important problems with my idea, and I think that responding to them will help clarify what I actully plan on doing

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Originally Posted by David Witherspoon

Two problems with this research proposal:

(1) Just putting already-understood flowcharts into mathematical form is of little value, since the formalization will require assumptions that most field practitioners will laugh at or not understand; nor will a mathematical description be a good educational tool.

(2) Given the nearly complete lack of data on how strategies affect results, it's a good bet that a formal model would not deliver any solid conclusions beyond the obvious and unsurprising ones.

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(1) isn't exactly what I was planning on doing. I was thinking of looking over some historical accident reports and then doing a statistical anaylsis to solve try and find a corelation between survival likley hood and burrial characteristics - this adresses the lack of data problem (2) since it would allow me to hypothesis on if or how diffent strategies would effect survival likleyhood. If there is some correlation (and I'm not assuming that there is yet) then I may be able to use this data and in game theory framework to build a decsion matrix which could then be used to prescribe forms of triage depending on situation. I don't want to speculate on what these rules might be... I think we have covered a couple of them in this thread already (See leelau's first post, and my earlire posts among others), however the key will be on keeping them general and as simple as possible.

Wither spoon makes another good point

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Originally Posted by David Witherspoon

Yeah. My bet is that effort invested in prevention will have a much higher ROI.

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I totally agree. However as Lee said, if you spend a lot of time in the backcountry the odds are not in your favor.

Summit; going back to the idea we were discussing earlier about correlation between burrial depth and burrial location along the deposit. After doing some thinking and reasearch, I think we need to discard it. There appears to be no models which accuratley predict depositional depth with location. The reason for this is that althought some dynamics models indicate that there should be, the effect of variations in the terrain under the runnout overwelm the expected depths. As far as I can see it the only way to acuraltey determine burrial depths is with a probe, or estimating it from your beacon. Although since the reading of a beacon at this close range are highly dependent on the orientation of the buried beacon I am inclined to say that probing is really the only way.

Anybody else have any ideas about estimating burrial depths?

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Originally Posted by eirikainersharp

Summit; going back to the idea we were discussing earlier about correlation between burrial depth and burrial location along the deposit. After doing some thinking and reasearch, I think we need to discard it. There appears to be no models which accuratley predict depositional depth with location. The reason for this is that althought some dynamics models indicate that there should be, the effect of variations in the terrain under the runnout overwelm the expected depths. As far as I can see it the only way to acuraltey determine burrial depths is with a probe, or estimating it from your beacon. Although since the reading of a beacon at this close range are highly dependent on the orientation of the buried beacon I am inclined to say that probing is really the only way.

Anybody else have any ideas about estimating burrial depths?

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DAMNIT! That was a cool idea! Oh well... I wrote up a protocol that used it... it wouldn't have been any good for recreationists but it might have been usefull for a organized rescue hasty team.

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Originally Posted by Conundrum

I would only enter a triage mode if I knew exactly how many people were not accounted for.

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I strongly agree, but you don't have to know the exact number missing. If you know OR DISCOVER that two or more beacons are buried, you enter triage mode until you are nolger aware of any more buried transceivers.

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The new beacons help here but my DSP still ghosts and I haven't played with the new offerings.

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This would be a dangerous error in some triage protocols.

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As for once I get to the victim, I would get to their face (not digging out their whole body) and clear the airway.

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Don't forget the chest... air has to have room to go, not just a place to enter.

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If they were not breathing, two breaths and if that doesn't kick start anything, onto the next person. Chances are, if that person is not breathing, their pulse probably isn't doing the job so you would have to dig them out and start CPR. For this to be any good, you are most likely abandoning the other burials because you will have to maintain compressions and breathing.

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Which is why we PROBABLY shouldn't be doing CPR until *everyting* and *everyone* else has been cared for appropriately in a multivictim avalanche.

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Plus, there is a percentage I cannot remember exactly but it's over 90% and it says in a trauma situation, if the trauma is the cause of the heart stopping, over 90% of those hearts will not be started through CPR again.

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<1% prehospital arrests due to blunt trauma are resuscitated. You can be the number is even worse in the wilderness. (arrests secondary to penetrating trauma have a much better save rate but penetrating trauma is not so common in avalanche victims)

CPR will NEVER EVER EVER NOT EVER "start" a heart. It merely maintains the body so that it might be able to be restarted by edison medicine and or certain drugs.

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You may want to give slightly more than a guaranteed airway to your unburied victims. If you spend the next hour out away from a helpless shocky victim who you didn't do anything for... they may have gone from pt with compensated shock shocky and mild hypothermic to decompensated shock and profound hypothermia... those two problems only make each other worse. Hypothermia of the unburied victim might be easily and quickly mitigated

It's really hard to traige unburied critical patients against unknown patients who are still buried...

I need to get that thing I wrote up

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Originally Posted by Summit

It is hard to tell anything becaues there is no information on the order of rescue and burial depths and times... etc...

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I know, it's gonna be hard to research w/ these reports. They were "experienced" BC skiers. Doesn't mean they're experienced at rescue, but they were prepared and it didn't matter.