Winter Sports Emergency Medicine: Avalanche Injuries and High-Speed Trauma

Winter sports present unique medical challenges that combine high-speed trauma with extreme cold exposure. From skiing accidents to avalanche burials, understanding winter-specific emergency medicine can save lives on the mountain.

Avalanche Injury Patterns

Avalanche victims face a deadly combination of trauma, hypothermia, and asphyxiation. The primary causes of death are:

Trauma (25% of deaths): Victims are thrown against trees, rocks, or terrain features at high speed. Expect multiple injuries including head trauma, spinal injuries, and internal bleeding.

Asphyxiation (65% of deaths): Snow blocks airways or creates an ice mask from exhaled breath. Brain death occurs within 15 minutes without oxygen.

Hypothermia (10% of deaths): Prolonged burial in snow rapidly drops core body temperature.

Immediate Avalanche Response

1. Mark the Last Seen Point
Send someone to mark where you last saw the victim. This becomes your primary search area.

2. Switch Transceivers to Search
Modern avalanche transceivers are essential. Follow the signal methodically using the grid search pattern.

3. Probe and Dig Strategically
Once you get a strong signal, use probes to locate the exact position. Dig from the downhill side to avoid collapsing snow onto the victim.

4. Assess ABCs Immediately

• Airway: Clear snow and ice from mouth and nose
• Breathing: Look for chest rise, listen for breath sounds
• Circulation: Check pulse, look for external bleeding

High-Speed Winter Trauma

Skiing and snowboarding accidents often involve high kinetic energy similar to motor vehicle crashes.

Common Injury Patterns

Head and Spinal Injuries

• Assume spinal injury in all high-speed crashes
• Maintain cervical spine immobilization
• Monitor for signs of increased intracranial pressure

Extremity Fractures

• Skier’s thumb (ulnar collateral ligament tear)
• Boot-top fractures of the tibia/fibula
• Shoulder dislocations from falls

Abdominal Trauma

• Blunt force from hitting trees or lift towers
• Internal bleeding may not be immediately apparent
• Monitor for signs of shock

Cold-Related Complications

Winter injuries are complicated by cold exposure:

Decreased Manual Dexterity

• Your ability to perform procedures diminishes rapidly
• Keep hands warm between assessments
• Have backup team members ready

Vasoconstriction Effects

• Cold makes finding pulses difficult
• Blood pressure readings may be inaccurate
• Bleeding may be temporarily reduced but resume with rewarming

Equipment Challenges

• Batteries die faster in cold
• Medical supplies may freeze
• Hypothermia affects medication absorption

Advanced Airway Management

Winter sports injuries often involve facial trauma and airway compromise:

Jaw-Thrust Technique
With potential spinal injury, use jaw-thrust instead of head-tilt/chin-lift to open airways.

Improvised Airways

• Remove broken teeth or dentures
• Use ski pole grips as bite blocks
• Consider emergency cricothyrotomy in extreme cases

Hypothermia in Trauma Patients

The "trauma triad of death" (hypothermia, acidosis, coagulopathy) is accelerated in winter conditions.

Prevention Strategies:

• Insulate from snow immediately
• Remove wet clothing when safe
• Apply heat packs to trunk, not extremities
• Cover head to prevent further heat loss

Recognition:

• Mild: Shivering, impaired judgment
• Moderate: Muscle rigidity, decreased mental status
• Severe: No shivering, cardiac arrhythmias

Evacuation Decisions

Winter evacuations are complex and dangerous:

When to Evacuate Immediately:

• Head injuries with altered consciousness
• Suspected internal bleeding
• Severe hypothermia
• Spinal injuries with neurological deficits

Improvised Evacuation Tools:

• Skis can be used as splints or stretcher rails
• Avalanche probes extend to make spine boards
• Ski poles create traction splints
• Backpacks become cervical collars

Prevention and Preparation

Essential Winter Medical Kit:

• Space blankets and bivvy sacks
• Chemical heat packs
• Thermometer that reads low temperatures
• Hypothermia thermometer
• Extra batteries (keep warm)
• Medications (prevent freezing)

Team Preparation:

• Practice scenarios in cold conditions
• Designate roles before incidents
• Know evacuation routes and helicopter landing zones
• Carry emergency communication devices

Special Considerations

Avalanche Transceivers and Medical Equipment
Keep transceivers away from electronic medical devices to avoid interference.

Altitude Effects
Many winter sports occur at altitude, compounding hypoxia with cold stress.

Group Psychology
Cold and stress impair decision-making. Designate a clear leader and follow established protocols.

When to Continue vs. Evacuate

Continue Treatment on Mountain:

• Stable vital signs
• Conscious and oriented
• Able to participate in own evacuation
• Weather permits safe descent

Immediate Evacuation Required:

• Unconscious or altered mental status
• Signs of internal bleeding
• Severe hypothermia
• Suspected spinal injury with deficits
• Deteriorating weather conditions

Winter sports emergency medicine requires quick thinking, proper equipment, and understanding of how cold affects both injuries and treatment. The key is preparation, practice, and knowing when the mountain environment becomes too dangerous for on-site treatment.

Remember: In winter conditions, your own safety and that of your team must come first. A second victim helps no one.