Emergency medicine for an avalanche survivor

10 December 2019

Interview with 

Lawrence Jones; Mark Diggins, Scottish Avalanche Information Service; Jim McElwaine, University of Durham

HELICOPTER

A yellow helicopter in flight above a mountainous region.

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When we last left Lawrence Jones he had been trapped for twelve minutes, upside-down and buried deep in a snowdrift. And luckily, his companions had brought some of the crucial kit...

Lawrence: The transducers played an important part in everything and obviously locating me. Mine obviously was left on and the guide Stephan, he kept his on and I think you flip it to another mode, which is to search for the one that is lost and, and everybody else has to switch theirs off. And then what they do is they get a very, very long pole, almost like a tent pole, one of these modern tentpoles that's quite bendy, and they'll go around prodding, looking for me. Well two things that I brought on that trip that I would never go anywhere off piste ever again, one was a heart surgeon and the other one was a casualty doctor. They were digging with snowboards and their hands and the two doctors were giving out the instructions exactly what was going to happen, what everyone was to do when they were to find me because obviously I was completely unconscious and needed to be resuscitated.

The helicopter came and picked us up and when it did arrive and they came out with the stretcher and had the worst headache you could ever imagine, and Danny was explaining to me, it's because my brain will have expanded with a lack of oxygen and would have been touching the outskirts of my skull.

Phil Sansom asks Chris Smith whether this is true...

Phil: Chris, based on your medical knowledge, is that true?

Chris: Yeah, the brain has the highest metabolic rate of pretty much any tissue in your body. And as soon as you start to deprive it of oxygen, either because you're not breathing in enough oxygen, or because your circulatory system stops, then the brain cells become more excited than they should do. And as a result, they swell and they swell because they take on water out of the bloodstream for various reasons. And that swelling - because the skull is a closed space, if your finger swells, your finger swells into the air of the room. If your brain swells, there's nowhere for it to go because it's enclosed within your skull. So you do end up with a higher intracranial pressure, at least for a short while. And that's probably why Lawrence had a bad headache. Apart from the fact he'd also been probably hit by 600 tons of snow, which probably didn't help.

Phil: That might do it. Is that something that the paramedics need to treat, or is that just a side effect?

Chris: Well we alluded to with Mark just now the fact that when you are deprived of oxygen, then this is a serious threat to your health because people will have brain damage because of the lack of oxygen reaching the brain. If this goes on for a period of a significant period of time. But lowering the temperature can help as we mentioned. And equally, if people are resuscitated promptly and you can restore a circulation, then actually usually the outcome can be pretty good. But it does rely on you being found quickly and resuscitated effectively and quickly. And obviously there's a chance that that's not going to happen. And so that's why, as Mark and Jim was saying, the outcome often is dismal for people because they get buried and it takes a long while to find them.

Phil: It is an incredible story from Lawrence. It sounds like he's very lucky. Mark have you ever dealt with a case like this?

Mark: Yes, unfortunately it was not a good outcome because the victims were buried to quite a significant depth and it was a longer period of time of extraction. But in terms of hearing of people that have been resuscitated after being buried for 10 minutes or so, then they were revived, it concurs with what was just said now is that they actually had a really significant rash on their forehead, which was a sign that obviously the brain had been swelling through lack of oxygen. It's very hard to always talk about the grim aspects of going into the mountains and hopefully we try and talk about the positive things as well.

Phil: And Jim, any thoughts further on what we heard from Lawrence?

Jim: Well, it sounds like he was skiing in a group of all guys. So the safest way to avoid avalanches to ski with a lot of women because they have almost no accidents.

Phil: You're joking!

Jim: No, absolutely. Well the most dangerous group is a group of all guys with one or two women. There's a lot of emphasis now on safety and group safety while other than on the physics and it's a question of communication and how decisions are made and it's like Lawrence says, he was feeling scared but felt he should go anyway because of his friends and they were probably all feeling the same and the guys were not wanting to discuss their concerns and their worries about the avalanche safety by the sounds of it and that's a classic pattern of why these things occur.

 

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