Restricted accessReview articleFirst published online 2018-06
Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018.
Introduction:
Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas.
Materials and Methods:
Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue.
Results:
We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents.
Discussion:
General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings.
Conclusions:
Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
Get full access to this article
View all access options for this article.
References
1.
AbrahamsenHB. (2015). A remotely piloted aircraft system in major incident management: Concept and pilot, feasibility study. BMC Emerg Med, 15:12.
2.
AgrestiB. (2013). Mountain Rescuers death during rescue mission, risk analysis. PGHM/CRS; International Commission for Alpine rescue (ICAR). Plain meeting; Bol, Croatia.
3.
AltevogtBM, StroudC, and WizemannT. (2012). Barriers to Integrating Crisis Standards of Care Principles into International Disaster Response Plans. Institute of medicine. Workshop summary. The National Academies Press, Washington, DC.
4.
AmmonsMA, MooreEE, PonsPT, MooreFA, McCroskeyBL, and ClevelandHC. (1988). The role of a regional trauma system in the management of a mass disaster: An analysis of the Keystone, Colorado, chairlift accident. J Trauma, 28:1468–1471.
5.
Arcos GonzalezP, Castro DelgadoR, Cuartas AlvarezT, Garijo GonzaloG, Martinez MonzonC, Pelaez CorresN, Rodriguez SolerA, and Turegano FuentesF. (2016). The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents. Scand J Trauma Resusc Emerg Med, 24:63.
6.
AssaA, LandauDA, BarenboimE, and GoldsteinL. (2009). Role of air-medical evacuation in mass-casualty incidents—A train collision experience. Prehosp Disaster Med, 24:271–276.
7.
BekelisK, MissiosS, and MackenzieTA. (2015). Prehospital helicopter transport and survival of patients with traumatic brain injury. Ann Surg, 261:579–585.
8.
Ben-IshayO, MitaritonnoM, CatenaF, SartelliM, AnsaloniL, and KlugerY. (2016). Mass casualty incidents—Time to engage. World J Emerg Surg, 11:8.
9.
BlancherM, BauventY, BareS, WuytsB, FilletY, BrunJ, AlbasiniF, and BouzatP. (2017). Multiple casualty incident in the mountain: Experience from the Valfrejus avalanche. Resuscitation, 111:e7–e8.
10.
BogleLB, BoydJJ, and McLaughlinKA. (2010). Triaging multiple victims in an avalanche setting: The Avalanche Survival Optimizing Rescue Triage algorithmic approach. Wilderness Environ Med, 21:28–34.
11.
BoueY, PayenJF, BrunJ, ThomasS, LevratA, BlancherM, DebatyG, and BouzatP. (2014). Survival after avalanche-induced cardiac arrest. Resuscitation, 85:1192–1196.
12.
BouzatP, AgeronFX, BrunJ, LevratA, BerthetM, RancurelE, ThouretJM, ThonyF, ArvieuxC, PayenJF; TRENAU group. (2015). A regional trauma system to optimize the pre-hospital triage of trauma patients. Crit Care, 19:111.
13.
BrownDJ, BruggerH, BoydJ, and PaalP. (2012). Accidental hypothermia. N Engl J Med, 367:1930–1938.
14.
BruggerH, DurrerB, ElsensohnF, PaalP, StrapazzonG, WinterbergerE, ZafrenK, BoydJ, and IcarM. (2013). Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): Intended for physicians and other advanced life support personnel. Resuscitation, 84:539–546.
15.
BruggerH, SumannG, MeisterR, Adler-KastnerL, MairP, GungaHC, SchobersbergerW, and FalkM. (2003). Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: Implications for avalanche survival. Resuscitation, 58:81–88.
16.
CarteAE, AndersonRB, and CooperMA. (2002). A large group of children struck by lightning. Ann Emerg Med, 39:665–670.
17.
CarterH, and AmlotR. (2016). Mass Casualty Decontamination guidance and psychosocial aspects of CBRN incident management: A review and synthesis. PLoS Curr, 8:1–31.
18.
ChanTC, KilleenJ, GriswoldW, and LenertL. (2004). Information technology and emergency medical care during disasters. Acad Emerg Med, 11:1229–1236.
19.
ColesE. (2014). Learning the lessons from major incidents: A Short Review of the Literature. Emergency planning college, June2014, N°10, pp. 19–20.
20.
CooperMA. (1980). Lightning injuries: Prognostic signs for death. Ann Emerg Med, 9:134–138.
21.
CooperMA, AndrewsCJ, HolleRL, BlumenthalR, and Navarette AldanaN. (2017). Lightning-related injuries and safety. In: Auerbach's Wilderness Medicine, 7th ed. AuerbachP. Elsevier, Philadelphia, pp. 71–117.
22.
CourtneyB, HodgeJGJr., TonerES, RoxlandBE, PennMS, DevereauxAV, DichterJR, KissoonN, ChristianMD, PowellT; Task Force for Mass Critical Care; Task Force for Mass Critical Care. (2014). Legal preparedness: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest, 146:e134S–e144S.
23.
CulleyJM, SvendsenE, CraigJ, and TavakoliA. (2014). A validation study of 5 triage systems using data from the 2005 Graniteville, South Carolina, chlorine spill. J Emerg Nurs, 40:453–460.
24.
DavisC, EngelnA, JohnsonEL, McIntoshSE, ZafrenK, IslasAA, McStayC, SmithWR, CushingT, and Wilderness MedicalS. (2014). Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med, 25:S86–S95.
25.
DonahueAK. (2006). Lessons We don't learn a study of the lessons of disasters, why we repeat them, and how we can learn them. Homeland Security Affairs, vol II, No. 2.
26.
FattahS, RehnM, ReierthE, and WisborgT. (2013). Systematic literature review of templates for reporting prehospital major incident medical management. BMJ Open, 3:1–8.
27.
FEMA. The national incident management system. Federal emergency management agency. The US department of Homeland security. www.fema.gov/national-incident-management-system (last accessed November9, 2017).
28.
FreitasRL. (2016). Scene safety and situational awareness in disaster response. In: Ciottone's Disaster Medicine, 2nd ed. Elsevier, Philadelphia, Chapter 39, pp. 255–262.
29.
FrykbergER. (2002). Medical management of disasters and mass casualties from terrorist bombings: How can we cope?. J Trauma, 53:201–212.
30.
GarrisonHG. (2002). Keeping rescuers safe. Ann Emerg Med, 40:633–635.
31.
GuéantC. (2011). Circulaire du 6 juin 2011 relative aux orientations générales pour la mise en oeuvre des moyens publics concourante au secours en montagne et sa formalisation dans le cadre d'une disposition spécifique ORSEC. French Mininisrty of the Interior.
32.
GuyattG, GuttermanD, BaumannMH, Addrizzo-HarrisD, HylekEM, PhillipsB, RaskobG, LewisSZ, and SchunemannH. (2006). Grading strength of recommendations and quality of evidence in clinical guidelines: Report from an american college of chest physicians task force. Chest, 129:174–181.
33.
HammondJ. (2005). Mass casualty incidents: Planning implications for trauma care. Scand J Surg, 94:267–271.
34.
HaverkortJJ, BoumanJH, WindJD, and LeenenLP. (2016). Continuous development of a major incident in-hospital victim tracking and tracing system, withstanding the challenges of time. Disaster Med Public Health Preparedness, 2017; 11:244–250
35.
JohnsenAS, FattahS, SollidSJ, and RehnM. (2013). Impact of helicopter emergency medical services in major incidents: Systematic literature review. BMJ Open, 3:e003335.
36.
JohnsenAS, FattahS, SollidSJ, RehnM. (2016). Utilisation of helicopter emergency medical services in the early medical response to major incidents: A systematic literature review. BMJ Open, 6:e010307.
37.
JoyntGM, LooS, TaylorBL, MargalitG, ChristianMD, SandrockC, DanisM, LeonivY, and SprungCL, European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster. (2010). Chapter 3. Coordination and collaboration with interface units. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med, 36Suppl 1:S21–S31.
KilnerTM, BraceSJ, CookeMW, StallardN, BleetmanA, and PerkinsGD. (2011). In ‘big bang’ major incidents do triage tools accurately predict clinical priority?: A systematic review of the literature. Injury, 42:460–468.
40.
KingDR, PatelMB, FeinsteinAJ, EarleSA, ToppRF, ProctorKG. (2006). Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center. J Trauma, 61:943–948.
41.
KochFX, TorresJ, GodartJ, EscallierC, and MenthonnexE. (1997). Accident catastrophique à effets limités de niveau 1 en montagne: à propos d'un cas de fulguration collective. French society of disaster medicine. Volume XVI, pp. 103–107.
42.
KottmannA, BlancherM, SpichigerT, ElsensohnF, LetangD, BoydJ, StrapazzonG, EllertonJ, and BruggerH. (2015). The Avalanche Victim Resuscitation Checklist, a new concept for the management of avalanche victims. Resuscitation, 91:e7–e8.
43.
LennquistS. (2008). Protocol for reports from major accidents and disasters in the International Journal of Disaster Medicine. Eur J Trauma Emerg Surg, 34:486–492.
44.
Lennquist MontanK, HreckovskiB, DobsonB, OrtenwallP, MontanC, Khorram-ManeshA, and LennquistS. (2014). Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters. Eur J Trauma Emerg Surg, 40:429–443.
45.
LernerEB, McKeeCH, CadyCE, ConeDC, ColellaMR, CooperA, CoulePL, LairetJR, LiuJM, PirralloRG, SasserSM, SchwartzR, ShepherdG, and SwientonRE. (2015). A consensus-based gold standard for the evaluation of mass casualty triage systems. Prehosp Emerg Care, 19:267–271.
46.
LorietteJJ. (2015). Germanwins. Plane crash. PGHM-UCTM; International commission for alpine rescue (ICAR). Plain meeting Killarney, Rep of Ireland.
47.
LynnM, GurrD, MemonA, and KaliffJ. (2006). Management of conventional mass casualty incidents: Ten commandments for hospital planning. J Burn Care Res, 27:649–658.
48.
MaguireBJ, HuntingKL, SmithGS, and LevickNR. (2002). Occupational fatalities in emergency medical services: A hidden crisis. Ann Emerg Med, 40:625–632.
49.
MarresGM, TaalL, BemelmanM, BoumanJ, and LeenenLP. (2013). Online Victim Tracking and Tracing System (ViTTS) for major incident casualties. Prehosp Disaster Med, 28:445–453.
50.
MoroderL, MairB, BruggerH, VoelckelW, and MairP. (2015). Outcome of avalanche victims with out-of-hospital cardiac arrest. Resuscitation, 89:114–118.
51.
NewsTheLocal. (2008). Two runners dead after storm overtakes extreme Zugspitze race. In The Local. www.thelocal.de/20080714/13051 (last accessed November9, 2017).
52.
NicholasRA, and OberheideJE. (1988). EMS response to a ski lift disaster in the Colorado mountains. J Trauma, 28:672–675.
53.
PaalP, GordonL, StrapazzonG, Brodmann MaederM, PutzerG, WalpothB, WanscherM, BrownD, HolzerM, BroessnerG, and BruggerH. (2016). Accidental hypothermia-an update: The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Scand J Trauma Resusc Emerg Med, 24:111.
54.
PeckDF, RobertsonA, and ZeffertS. (1996). Psychological sequelae of mountain accidents: A preliminary study. J Psychosom Res, 41:55–63.
55.
PelegK. (2013). Disaster and emergency medicine—A conceptual introduction. Front Public Health, 1:44.
56.
PriceCL, Brace-McDonnellSJ, StallardN, BleetmanA, MaconochieI, and PerkinsGD. (2016). Performance characteristics of five triage tools for major incidents involving traumatic injuries to children. Injury, 47:988–992.
57.
ReiwegerI, GensweinM, PaalP, and SchweizerJ. (2017). A concept for optimizing avalanche rescue strategies using a Monte Carlo simulation approach. PLoS One, 12:e0175877.
58.
RimstadR, and SollidSJ. (2015). A retrospective observational study of medical incident command and decision-making in the 2011 Oslo bombing. Int J Emerg Med, 8:4.
59.
SaccoWJ, NavinDM, FiedlerKE, WaddellRK2nd, LongWB, and BuckmanRFJr. (2005). Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med, 12:759–770.
60.
StrapazzonG, PlankensteinerJ, MairP, RuttmannE, Dal CappelloT, ProcterE, and BruggerH. (2017). Prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest: A retrospective study in Tyrol, Austria. Eur J Emerg Med, 24:398–403.
61.
TaussigHB. (1968). “Death” from lightning—And the possiblity of living again. Ann Intern Med, 68:1345–1353.
62.
TaussigHB. (1969). “Death” from lightning and the possibility of living again. Am Sci, 57:306–316.
63.
ThordardottirEB, ValdimarsdottirUA, HansdottirI, ResnickH, ShipherdJC, and GudmundsdottirB. (2015). Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors. J Anxiety Disord, 32:103–111.
64.
TomazinI, EllertonJ, ReistenO, SoterasI, AvbeljM; International Commission for Mountain Emergency M. (2011). Medical standards for mountain rescue operations using helicopters: Official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol, 12:335–341.
65.
TomazinI, KovacsT, and International Commission for Mountain Emergency M. (2003). Medical considerations in the use of helicopters in mountain rescue. High Alt Med Biol, 4:479–483.
66.
TorresB. (2004). MCI in the clouds: The beauty of the clouds & terrain of the Grand Teton masks the obstacles rescuers faced in the response, care & transport of multiple victims of a lightning strike. JEMS, 29:34–36, 38, 40 passim.
67.
TruhlarA, DeakinCD, SoarJ, KhalifaGE, AlfonzoA, BierensJJ, BratteboG, BruggerH, DunningJ, Hunyadi-AnticevicS, KosterRW, LockeyDJ, LottC, PaalP, PerkinsGD, SandroniC, ThiesKC, ZidemanDA, NolanJP; Cardiac arrest in special circumstances section Collaborators. (2015). European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation, 95:148–201.
68.
Van TilburgC, GrissomCK, ZafrenK, McIntoshS, RadwinMI, PaalP, HaegeliP, SmithWW, WheelerAR, WeberD, TremperB, and BruggerH. (2017). Wilderness Medical Society Practice guidelines for prevention and management of avalanche and nonavalanche snow burial accidents. Wilderness Environ Med, 28:23–42.
69.
VassalloJ. (2003). Combined UK/US field hospital management of a major incident arising from a chinook helicopter crash in Afghanistan, 28 Jan 2002. J R Army Med Corps, 149:47–52.
70.
VassalloJ, HorneS, BallS, and WhitleyJ. (2014). UK Triage the validation of a new tool to counter an evolving threat. Injury, 45:2071–2075.
71.
WildnerM, and PaalP. (2015). A large-scale accident in Alpine terrain. Med Klin Intensivmed Notfmed, 110:21–26.
72.
ZafrenK. (2010). Avalanche triage: Are two birds in the bush better than one in the hand?. Wilderness Environ Med, 21:273–274; author reply 274–276.
73.
ZafrenK, DurrerB, HerryJP, BruggerH, Icar, and UiaaM. (2005). Lightning injuries: Prevention and on-site treatment in mountains and remote areas. Official guidelines of the International Commission for Mountain Emergency Medicine and the Medical Commission of the International Mountaineering and Climbing Federation (ICAR and UIAA MEDCOM). Resuscitation, 65:369–372.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
