multi-victime avalanche accidents
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1 multi-victime avalanche accidents Human factors a four years experience G. Zen-Ruffinen - R. Richard P.Fauchere Air-Glaciers / Maison du Sauvetage Sion
2 Mass-casuality accidents in mountains ICAR medcom form 2015 type of accident country CH year total N casualities dead severely injured injured problems winter Valsorey caught 10 burried 5 4 2? residual danger too many helicopters Ayer Barneuza caught 4 burried 3 0? lack of medical material (AED) Bec Etagnes caught pediatric victims Masserey caught 4 burried Pte Ronde caught 1 burried summer!! Pte Mourti caught 3 burried Col des Mines caught 1 burried psychological adversity medical material meteo-logistic no beacon=40 rescuers terrestrial 2 1 unexpected no beacon meteo no beacon relational diff Pigne d Arolla caught 4 burried meteo accu LUCAS Pte Tsavolyre caught 3 burried 2 Gd St.Bernard caught 4 burried meteo access
3 Valsorey
4 Masserey h25 ACR VAS + AED: AESP ACLS:intub, io, V.jug.ext Thorcostomy bilat VFIB: 4 defib, Adr, Cordarone.. AESP Trsp Martigny K+ no, T no Echo dcd ED 15h25 ACR VAS + AZ: intub- Autopuls Dcd ED Alarm 14h46 14h58 ACR VAS + MCE AED: VFIB: 5 def ACLS:io,A,C Asyst,Trspt 55 ROSC 8 ED 15h09 ACR VAS + 4 insuff MCE unique Trspt ROSC 8 ED All 4 ACR transported 2 cardiac rythme o/site VFIB / AESP 2 ROSC at ED after 8 2 ad ICU 2 organ donors
5 Mourti
6 Grd St.Bernard PC arrière PMA petite noria PC front «Toute» petite noria Pre- Triage Grande noria > 35 min Inconsc VAS + Descendu à ski. ACR VAS + MCE Trsp sledge-b3- PMA:intub-Lukas Hosp K+15 ACR VAS + MCE Trsp sledge-b3- PMA:intub-Lukas Hosp K+15 ACR VAS + MCE- Fastrack Trsp sledge-b3- Hosp K+4-6 /CEC ACR VAS? (vomit) dcd
7 multi-victime avalanche accidents a four years experience human factors!! time is pressing multi-victim = several severe patients in one single intervention logistical challenge
8 why human factors?
9 training
10 you can anticipate everything
11 level of experience level of material risk behavior.. Human Factors Victim
12 HF: dispatch center lack of avalanche accidents knowledge no daily business = supplemental stress difficult localisation difficult communication lot of rescue services (guide-heli-dog-..) time is brain
13 HF : rescue service intern «dispatch-center» lack of avalanche accidents knowledge no daily business = supplemental stress difficult communication lot of team members (guide-heli-dog-..) time is brain there are other missions on-going anticipation : number of helicopters fuel
14 HF: rescuers HF «by victim» psychological state of the implicated age of victims personal acquaintance rescuers-victim victim s equipment (beacon-airbag ) burrial time (rapid access vs terrestrial ) stress of dispatch center repercussion
15 HF : rescue team pilot type of helicopter weather conditions difficult localisation difficult access experience of rescue team number of helicopters : number of rescuers : number of rotations : type of rotations: sling, winch, dogs.. vitim s number and medical conditions
16 HF : rescue team guide weather conditions avalanche localisation difficult access residual risk : recco flight comprehension of mechanism : witness inquiry cumulation of fonctions : multi-tasking management, technical, medical.. communication : rescue channel experience of rescue team: localisation : beacon, Recco, dog extraction : technical, medical number and type of rescuers : management type of intervention: sling, winch, anticipation: night mission? every avalanche has its own dynamic (vs highway MVA )
17 HF : rescue team medical access to the site : personal mountain experience, terrestrial, sling, access to the victime : localisation phase extraction phase rapid access to head lack of equipment : hostile environnement for BLS-ACLS inadequacy of equipment : wind-cold-insufficient number unclear victims conditions : patent airways, time, T? health conditions: either severe (REA=1doc+AED/pat) or minime anticipation: dispatch to hospital, no direct communication, via dispatch center
18 HF : task specialists task specialists : dog handler ski-patroller mountain rescuers : mountain guides, probers task specialists : non-professionnel not experienced rare occasions to be dispatched
19 multi-victim avalanche level of performance V.Lischke, Training Center, Bad Tölz, 2012
20 HF in multivictim avalanche (1) MVA stratégies highway vs avalanche : in 5 y never engaged MVA-container professional (routine, organized) vs non-professional (rare, no pre-established hirarchy, relationship between diff groupes) time is life geography acces localisation extrication : small noria by helicopters technique saves life : technical kits are ready, confidence in technical skills = garant of success?
21 HF in multivictim avalanche (2) ACLS comes second : 1 medical kits/patient not ready doc, AED,ACLS,carrier, 1+-Autopuls communication diff channels between type of rescuers helicopters: number, diff compagnies, language via dispatch center, not directly multi tasking management : we can not anticipate everything
22 but we have to deal with it
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