A 30-study review of avalanche victims and their outcomes “confirms the soundness” of the survival prognostic factors—duration of burial, presence of an air pocket or patent airway, core temperature and in-hospital serum potassium level—developed by the Medical Commission of the International Commission for Alpine Rescue (ICAR MedCom), reports Jeff Boyd, MBBS, and colleagues at Mineral Springs Hospital in Banff, Alberta, Canada. However, the review also points out some need for clarification. Boyd and colleagues suggest the following:
- That resuscitation be attempted, if physically possible, for all avalanche victims (with no signs of obvious death) found within 35 minutes of burial.
- After 35 minutes under snow, survival depends more on the patient having a patent airway than the presence of an air pocket, which could be destroyed or overlooked during rescue.
- When burial time is unknown, resuscitation should be attempted regardless of airway patency when a patient’s core temperature is above 32° C (89.6° F).
- If transport to a hospital for cardiopulmonary bypass or extracorporeal membrane oxygenation rewarming is feasible, resuscitation should be attempted for victims with core temperatures below 32° C provided they are not found in asystolic cardiac arrest with an obstructed airway.
Boyd’s team also highlights the need to modify the ICAR MedCom avalanche treatment algorithm to reflect 2010 BLS and ALS guidelines. — Resuscitation 81(6):645–652, June 2010.
Breathing Ultrafine Particles Not Heart-Healthy
Not wearing SCBA during all phases of firefighting raises the risk of inhaling ultrafine air particles, report C. Stuart Baxter, Ph.D., and colleagues at the University of Cincinnati Academic Medical Center in Ohio. When measured during seven fire scenarios—an attic, bedroom, kitchen, living room, composite wood deck, wood deck and automobile passenger compartment—invisible-to-the-human-eye ultrafine particles (less than 0.1 micrometer) made up more than 70 percent of all particles. Plus, ultrafine particles were equally or more prevalent during fire overhaul scenarios, when firefighters may remove SCBA, compared with fire knockdown stages, when SCBA use is standard.
The body responds to inhaled ultrafine particles by releasing inflammation-related factors into the blood that circulate to internal organs such as the heart, causing damage, Baxter told Research Monitor. In light of recent research also linking high concentrations of ultrafine air particles from fuel exhaust with coronary heart disease among city dwellers, Baxter’s team suggests further investigation of ultrafine particle inhalation as a contributing factor to firefighters’ coronary heart disease risk. — Journal of Occupational and Environmental Medicine 52(8):791–796, August 2010.
