Abstract
To the Editor,
We thank Lorenzati et al for their valuable comments. 1 We agree that the survey participants are part of a selected sample. Most of the survey participants were either advanced life support or basic life support providers or members of mountain rescue services. 2 The regions of Italy where the survey was held 1) have helicopter emergency medical service specialized in search-and-rescue missions with a mountain rescue technician as part of the team, and 2) host areas of Italian Alps and Apennines where the medical and mountain rescue personnel are at risk of being involved in the management of avalanche patients on site or in the hub/spoke hospitals, 3 including the authors’ institutions. Providers operating in such areas should be able, especially if an avalanche victim is found in cardiac arrest, to administer proper pre- and in-hospital management and triage based on the duration of complete burial (or core temperature), presence of vital signs, airway status, and data about the air pocket. Even if the courses were opened to participants from all areas of Italy, most of the survey participants were operating in these areas.
Avalanche recommendations and tools such as the Avalanche Victim Resuscitation Checklist, in combination with a dedicated education programs, can improve knowledge and good clinical practice regarding principles of avalanche management. 4 However, dissemination should be adapted to different emergency medical service systems, and surveillance of outcome measures should be promoted. Moreover, dedicated standard operating procedures for avalanche accidents should be implemented within emergency medical services and tailored to local and nearby extracorporeal cardiopulmonary resuscitation capacity.
Finally, bystanders should not be forgotten because they are a crucial step in the chain of avalanche survival. 4 Thus, even if laypersons surveyed in our study are likely enthusiastic about mountain medicine, proper transfer of know-how should also focus on them. The immediate extrication of completely buried avalanche victims by bystanders before helicopter emergency medical service crew arrival seems to offer an excellent chance of survival, and the appropriate transfer of information included in the Avalanche Victim Resuscitation Checklist could improve outcome, based on a correct decision-making process both on site and in the hospital.