Positional probing

Sorry, accidently deleted the first thread.
At ICAR this year there was a new recommendation for positional probing in some burial situations: buried longer then 35 mins, flatish burial location, and plenty of resources available (ie not everyone is digging) The idea is to try to figure out the orientation of the patient in the snow so you can dig towards the torso and not a foot, etc. The technique is pretty simple to explain, when you get a probe strike you leave it in place, get a new probe, and using your preferred probing technique( spiral or grid) get another probe strike, and keep repeating until you get a good idea of the patients orientation and hopefully figure out where the torso is. There was a lot of discussion around this and questions of trying to do this in the chaos of a rescue. Thoughts?

My one thought is that it would take an incredible amount of self control to resist digging after the 1st strike. I do see the value in this.

Summit's response was good but your delete button ate it!

I don't have a professional level of avalanche education but my first two thoughts are...I don't know...it depends

I think about it this way. In the event of an avalanche burial, you are trying to save somebodies life. How are you going to do that? It depends.

You may need to only get to their airway. You may need to perform CPR in the hole. You may need to remove the person from the hole to prepare for transport. Whether this probing technique is a valuable use of time probably depends on which of the above applies. You, most likely, will not know the answer until the victim is unburried.

So it seem to be that it is a good tool to have in your chest but is not easy to incorporate into the flow chart of a rescue (Hey Halsted - make more of those grey plastic inclinometers things with the flow chart on the back).

As usual, more questions that answers:

a. beacon in harness vs. pants pocket? I want by beacon proximate to my airway. Does it matter?

b. Why torso not airway? How the fuck are you going to map that out in 3D with probes?

c. Is a second pinpoint search or flux line search suggested once you have the hole excavated?

Take aways:

a. Don't get caught in avalanches. Rescues even by well qualified teams can be very difficult and time consuming.

b. Practice "rescue scenarios" not "beacon searches". Too many people think that because they are "good with their beacon" (flat ground, shallow burial, skis off, etc.) that their training is complete.

In addition to the flatness factor, I would think the deeper the burial, the more it would make sense to spend extra time trying to determine the ideal place to dig

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Originally Posted by I've seen black diamonds!

In addition to the flatness factor, I would think the deeper the burial, the more it would make sense to spend extra time trying to determine the ideal place to dig

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Right, but how? Think about all the shapes and orientations that a body could assume under the snow. Then think about probing and ascertaining that shape. a. I think that is likely not possible b. even if you could determine the shape, how you gonna know where the airway is? Is that an arm on a leg? Their ass or their head, ski boot or helmet?

Realistically, would the time spent on the extra probing save time over just digging and dealing with the victim’s position when exposed? And what if the first probe strike is square in the chest? I’m leaning toward working with the first probe strike. The concept seems like overthinking to me.

Also, what not bunion said.

I assume there were additional stipulations like it being a deep burial? As someone else asked in the deleted thread, treading around on a shallow burial can collapse any airspace, which a victim must have if they are still viable at >35 minutes.

The question is if:
(time saved in reaching airway by technique * accuracy of technique - time spent on additional probing) > 0.

The accuracy piece could be a real monkey wrench. Who was proposing this idea and did they have any data to back it up? (I have a guess who this came from). Given a rescue so well resourced that you have people who aren't in the strategic digging rotation. That stipulation combined with the >35min burial means this is likely a non-beacon (delayed) find by organized rescue and/or is a mass casualty such that a lot of resources have arrived at the site. This strategy seems like a losing gambit applicable to few rescues just thinking about it, but I'm open to persuasion. I'll give this a try once I get some full sized manakins buried. That's my best attempt to recreate my post from the deleted thread.

im still shocked we probed up johnnys single ski after that slide
and damn glad mr toster and the cat didnt need theirs for john boy
the leave the probe in at contact lesson cost another 1/2 hour or so
http://i5.photobucket.com/albums/y19...pswumebmdt.jpg
http://i5.photobucket.com/albums/y19...psp7makepx.jpg
http://i5.photobucket.com/albums/y19...psrcnhhmuk.jpg
http://i5.photobucket.com/albums/y19...psq4wjyjw4.jpg
did you bring home one of them freedom avvy poodles?

It came from Manuel. You can also use the technique on a slope, but you need to think about it more and was more difficult to put into writing. There wasn't a depth requirement around it, but imagine if you get a shallow strike on an extended hand at 1 foot, probe some more and find the torso is at 3 feet.

Manuel G? That pretty much plays into my overthinking suspicion. Love the guy, but he does think about this stuff a lot.

Yep I figured it would be Manuel. He is a rescue genius and I would love to hear him out. That said, disagreed with him last ISSW when he and his grad student proposed triage modifications based on monte carlo sim with CPR recommendations not based on evidence.

So what was his rationale for 35min and excess resources? Would his proposed yime to airway gains not be magnified by thin resources and unaffected by time?

With all due respect to the professionals that do the research for the benefit of us recreationalists...sounds like an academic circle jerk for the sake of having an academic circle jerk.

When shoveling, what are we actually trying to do and how will this help us do it?

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Originally Posted by Foggy_Goggles

Right, but how? Think about all the shapes and orientations that a body could assume under the snow. Then think about probing and ascertaining that shape. a. I think that is likely not possible b. even if you could determine the shape, how you gonna know where the airway is? Is that an arm on a leg? Their ass or their head, ski boot or helmet?

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This was my first thought as well.

my first thought was to wonder how many burials (>35minutes, flatish, lots of rescuers) this would apply to. in North America I would think very few. It might apply to professional rescue groups in the Alps. It seems like something that would need practice and coordination to execute efficiently, quickly and accurately enough to be better than just starting digging. So I'm trying to wipe the idea from my mind.

OK I thought about this on a bike ride. I had read this as the probing meant to be done before the digging. Maybe I wasn't understanding it right. Is the digging to begin with no delay, then extra rescuers probe to help direct digging direction? Because that would make more sense.

I also assumed that the goal would be to go for the airway/head directly and the insanity of thinking this could be reliably determined by probe. Perhaps what was meant was to refine the center of the buried person and dig towards the center, then determine the direction of the head and go that way? That would eliminate the issue of accidentally digging a hand, or a ski... might pay off... might break even... but makes more sense and be more reliable.

It's a little hard to judge this concept without seeing the paper. Still have the potential problem of collapsing an air space from the prober tromping around overhead and the paucity of applicable scenarios. I've been on a bunch of avalanche rescues, but only one that this could have been applied on, and it would not have helped in that instance.

tldr; it would make more sense with no delay in digging, then extra rescuer probes to determine the center of the buried patient, digging direction is fine tuned, but still has potential risk vs benefit and limited application even for organized rescue while adding complexity to the rescue.

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Originally Posted by Foggy_Goggles

b. Why torso not airway? How the fuck are you going to map that out in 3D with probes?

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No way to tell head from feet by probe in my opinion, but you could probably guess center of mass. There is a benefit that while asphyxia is primarily occlusive/obstructive (airway full of snow / no airspace) some people die of constrictive asphyxia (cannot take a full breath because their chest is compressed by the debris).

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c. Is a second pinpoint search or flux line search suggested once you have the hole excavated?

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We do teach a repeat of the fine search and pinpoint search for deep burials after some excavation when you cannot get a probe strike initially.

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b. Practice "rescue scenarios" not "beacon searches". Too many people think that because they are "good with their beacon" (flat ground, shallow burial, skis off, etc.) that their training is complete.

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Your whole post was good but this part is so on the money!

At least on an incline, wouldn't strategic shoveliing (Bruce Edgarly) render positioal probing to be less efficient?

... Thom

Yeah that was definitely most fuck moment of my life.

Agree on the practice the rescue part. Want to move like you know what the next move is.

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Originally Posted by Foggy_Goggles

b. Practice "rescue scenarios" not "beacon searches". Too many people think that because they are "good with their beacon" (flat ground, shallow burial, skis off, etc.) that their training is complete.

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Agree with everything you and Summit said in all your posts but re-emphasizing this. With modern beacons, the beacon search is the easy part.

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Originally Posted by Summit

I also assumed that the goal would be to go for the airway/head directly and the insanity of thinking this could be reliably determined by probe.

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^This is where I am after thinking about it.

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Originally Posted by adrenalated

With modern beacons, the beacon search is the easy part.

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And ^this. Got CPR? Practice much?

The concept sounds interesting .. and perhaps in professional rescue circles it may gain some traction ...

But really ... in a deep burial with a bunch of recreationalists, you are going to be luck to have a single probe long enough to probe the victim, let alone several ...and generally there a shortage of personal , not a surplus that would allow for this type of effort.

to validate this type of recovery, over traditional methods would be extremely challenging.

So a couple of additional points:
ICAR recommendations are for professional rescue groups and are not intended for companion rescue.
You wouldn't have to delay dogging while you probe, I imagine in reality while you do the additional probing the digging team would be moving towards you and organizing. I imagine the 35 min burial time is a nod to if the patient is still alive an extra minute or two or probing won't statistically change the outcome. You can also use this technique on a slope, but you need to think about it more because you may end up digging the saw way. There is also a recommendation coming out for conveyor belt digging .

Just curious... in general, what is the standard for an organization like ICAR when it comes to validating these recommendations?

I could imagine that reproducing multiple studies about efficient of shoveling would be relatively straightforward, yet validating something like this probe theory would be extremely complex.

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Originally Posted by cmcrawfo

But really ... in a deep burial with a bunch of recreationalists, you are going to be luck to have a single probe long enough to probe the victim, let alone several ...and generally there a shortage of personal , not a surplus that would allow for this type of effort.

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This is basically what happened at Sheep Creek with the deepest victim. When we (Loveland Ski Patrol) arrived we had 12' steel probe poles. All we could do was pinpoint on the victim and start digging because the probe was too short to touch the victim. Once we had dug down about 10' we could probe. That's when we touched the victim. This victim was buried approx 14' - 16'.

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Originally Posted by cmcrawfo

Just curious... in general, what is the standard for an organization like ICAR when it comes to validating these recommendations?

I could imagine that reproducing multiple studies about efficient of shoveling would be relatively straightforward, yet validating something like this probe theory would be extremely complex.

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Someone comes forward with a proposal and it is discussed in the committees. The committee then votes if it should move forward as a draft with a 9 month comment period. After the comment period it voted upon for final approval. (or that's my understanding, it was my first year). So people in the committees are the likes of the president of Canadian Ski guides, US Ski patrol, Chef of the French avalanche association (ANENA), Swiss rescue teams, etc.

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Originally Posted by Hacksaw

This is basically what happened at Sheep Creek with the deepest victim. When we (Loveland Ski Patrol) arrived we had 12' steel probe poles. All we could do was pinpoint on the victim and start digging because the probe was too short to touch the victim. Once we had dug down about 10' we could probe. That's when we touched the victim. This victim was buried approx 14' - 16'.

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That had to be rough on the rescue crew.

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Originally Posted by Meadow Skipper

That had to be rough on the rescue crew.

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It was....

Here is the draft text of the recommendation:

Draft Recommendation Proposal on Position Probing

Rationale:
Position Probing allows to quickly gain information about the approximate orientation of the buried
subject in order to define an optimal excavation strategy and gain head access more rapidly.
The application of position probing is recommended in cases where more information about the
position of the buried subject has the potential to minimize head access time.
While position probing is performed, the remaining rescuers already start excavation with a certain
distance to the expected burial area.
Apply a spiral probing technique, each probe hit immediately becomes the center of the next probing
spiral. Leave every probe with a probe strike in place and use an additional probe to proceed.
Continue until the outline of the buried subject is evident and adapt the further excavation effort
accordingly.

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Position Probing allows to quickly gain information about the approximate orientation of the buried subject in order to define an optimal excavation strategy and gain head access more rapidly.

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Wait...where’s the data on this?

Intended for a party of 4 or larger with one burial?

I'd love to see the logic of this as compared to conveyor belt shoveling, especially from folks a whole lot more experienced than me.

... Thom

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Originally Posted by galibier_numero_un

Intended for a party of 4 or larger with one burial?

I'd love to see the logic of this as compared to conveyor belt shoveling, especially from folks a whole lot more experienced than me.

... Thom

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These are recommendations for professional rescue groups...

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Originally Posted by sfotex

These are recommendations for professional rescue groups...

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Thanks. I thought that was the emphasis but wasn't sure if it was being generalized beyond that.

... Thom

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Originally Posted by sfotex

Apply a spiral probing technique, each probe hit immediately becomes the center of the next probing
spiral. Leave every probe with a probe strike in place and use an additional probe to proceed.
Continue until the outline of the buried subject is evident and adapt the further excavation effort
accordingly.

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How many probes do they estimate (or better yet have found from experiment) it will take to make the outline of the buried subject 'evident'?

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Originally Posted by nickinbc

How many probes do they estimate (or better yet have found from experiment) it will take to make the outline of the buried subject 'evident'?

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this seems like it would be a big number to me...

https://vimeo.com/303429488

go to 14:30 for a detailed description

From the video:

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...based on a very special case scenario..."

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...you have to very many rescuers on the field. It's not supposed to be used within this window of opportunity where you're fighting time against asphyxia time, so it is beyond 35 minutes of burial time...

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Thanks, that explained it well.

OK, but in my opinion all this adds is one more complexity to a very stressful situation.

I am sure that in one out of 10 or 100 or 1000 scenarios this would be of value but if I am ever buried, please just dig me the hell up.

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Originally Posted by Not bunion

OK, but in my opinion all this adds is one more complexity to a very stressful situation.

I am sure that in one out of 10 or 100 or 1000 scenarios this would be of value but if I am ever buried, please just dig me the hell up.

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^^^ this. I can't believe we're even having a discussion about directional probing.

That video helped clarify it. From an organized rescue perspective, I still say this seems like it would be rarely used and offer little gain. I continue to worry about rescuers crushing the victims airspace.

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Originally Posted by Not bunion

OK, but in my opinion all this adds is one more complexity to a very stressful situation.

I am sure that in one out of 10 or 100 or 1000 scenarios this would be of value but if I am ever buried, please just dig me the hell up.

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That's the rub for me with some of these recommendations. When they DOT first launched the EMT program they discovered that EMT's were delaying transporting critical patients so they could do a complete patient assessment vs. load n' go. I worry that giving people more shit to think can delay the digging, etc.