Food for thought
Wilderness Medicine Case Study 1
You are skiing with a friend in the backcountry when you witness an avalanche that sweeps through another party in the drainage across from you. It appears from your vantage point that at least two members of the group were caught. It takes you roughly sixty-five minutes to reach them.
When you arrive, you see a young women sitting at the side of the slide holding her knee and the remaining three group members searching for the second person. You join the search and after another twenty minutes locate the second victim. He was found buried upside down three feet beneath the surface with no air pocket, unresponsive, with no pulse or respirations. CPR is initiated and you are asked to evaluate the first victim, Anne George, and then take control of the scene.
Anne says when she felt the snow start to slide, she tried to ski to the side of the avalanche but the snow pulled her under; and, as she tumbled she felt her skis release. She recalls releasing her airbag and it floated her to the top of the moving snow where she rode on the slide's surface until the snow stopped moving. She feels lucky to be alive. On exam, Anne has a painful (3) and tender right knee with slightly restricted range-of-motion and good distal CSM; she thinks she can stand but is concerned about skiing. During the focused spine assessment she reports her neck is stiff and sore (2) with some tenderness around C-5. Her pulse is 74 and regular, respirations 18 and easy, her skin is pink, cool, and dry; her blood pressure, oxygen saturation, and temperature were not taken. As you finish your assessment, Anne says she is starting to get cold.
By the time you finish examining Anne, CPR has been on-going on the second victim for 32 minutes. You are out of cell phone range and a storm is moving in. While you and the remaining people in the other party have extra layers, no one is prepared to spend the night. It's 2 PM and you are roughly three miles from your snow mobiles and an hour's ride to your vehicles at the snow park; it's an additional three hours to the nearest hospital
