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      Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

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          Abstract

          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.

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          Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

          Gordon Guyatt, David Gutterman, Michael H Baumann … (2006)
          While grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical guidelines, the profusion of guideline grading systems undermines the value of the grading exercise. An American College of Chest Physicians (ACCP) task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process. The working group examined currently available systems, and ultimately modified an approach formulated by the international GRADE group. The grading scheme classifies recommendations as strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C) according to factors that include the study design, the consistency of the results, and the directness of the evidence. For all future ACCP guidelines, The College has adopted a simple, transparent approach to grading recommendations that is consistent with current developments in the field. The trend toward uniformity of approaches to grading will enhance the usefulness of practice guidelines for clinicians.
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            Occupational fatalities in emergency medical services: a hidden crisis.

            Richard Maguire, Gordon C. S. Smith, N Levick … (2002)
            We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.
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              Medical management of disasters and mass casualties from terrorist bombings: how can we cope?

              Eric R Frykberg (2002)
              Article 0 comments Cited 62 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): High Alt Med Biol
                Journal ID (iso-abbrev): High Alt. Med. Biol
                Journal ID (publisher-id): ham
                Title: High Altitude Medicine & Biology
                Publisher: Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Print): 1527-0297
                ISSN (Electronic): 1557-8682
                Publication date (Print): 01 June 2018
                Publication date (Electronic): 01 June 2018
                Publication date PMC-release: 01 June 2018
                Volume: 19
                Issue: 2
                Pages: 131-140
                Affiliations
                [ 1 ]Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France.
                [ 2 ]The French Mountain Rescue Association (ANMSM) , Grenoble, France.
                [ 3 ]Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
                [ 4 ]ICAR MedCom , Roethis, Austria.
                [ 5 ]Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.
                [ 6 ]Alaska Mountain Rescue Group , Anchorage, Alaska.
                [ 7 ]Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany.
                [ 8 ]Department of Emergency Medicine, Canmore, Canada.
                [ 9 ]Department of Emergency Medicine, University of Calgary , Calgary, Canada.
                [ 10 ]Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.
                [ 11 ]Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming.
                [ 12 ]Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada.
                [ 13 ]Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy.
                [ 14 ]Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England.
                [ 15 ]Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria.
                Author notes
                Address correspondence to: Marc Blancher, MD, Emergency Department, Centre Hospitalier Universitaire Grenoble-Alpes Grenoble F-38043, France

                E-mail: mblancher@ 123456chu-grenoble.fr
                Article
                Publisher ID: 10.1089/ham.2017.0143
                DOI: 10.1089/ham.2017.0143
                PMC ID: 6014052
                PubMed ID: 29446647
                SO-VID: 40ea629a-0039-49f5-9654-55d54b24119f
                Copyright © © Marc Blancher et al., 2018; Published by Mary Ann Liebert, Inc.
                License:

                This article is available under the Creative Commons License CC-BY-NC ( http://creativecommons.org/licenses/by-nc/4.0). This license permits noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Permission only needs to be obtained for commercial use and can be done via RightsLink.

                History
                Date received : 10 November 2017
                Date accepted : 05 January 2018
                Page count
                Figures: 2, Tables: 3, References: 73, Pages: 10
                Categories
                Subject: Reviews

                Keywords: avalanche,emergency medicine,lightning,multi-casualty incidents,mountain rescue,wilderness medicine
                Data availability:
                Keywords: avalanche, emergency medicine, lightning, multi-casualty incidents, mountain rescue, wilderness medicine

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