Frequency of Post Traumatic Stress Disorder and Associated Factors Among Survivors of Van Avalanche: 6-Month Follow-up Study. / Van Çig Afetinden Kurtulan Kisilerde Travma Sonrasi Stres Bozuklugu Sikligi ve Iliskili Faktörler: 6 Aylik Izlem Çalismasi.

OBJECTIVE: We aimed to evaluate the frequency of Post Traumatic Stress Disorder (PTSD), to determine the risk factors, and to monitor the change of symptoms after 6 months among individuals who survived the avalanche disaster in Van. METHOD: Face-to-face interviews were conducted with 35 people who were rescued from two consecutive avalanche disasters in Van 2 months and 6 months after the avalanche disaster. The socio-demographic and clinical data of the cases were evaluated. The Post Traumatic Stress Disorder Symptom Scale-Self Report version (PSS-SR) and clinical interviews were used for PTSD diagnosis. The level of trauma was assessed by using the Impact of Event Scale (IES). RESULTS: All participants were rescuers who went to the avalanche site for rescue mission. Of the cases, 16 were volunteers from the local community and 19 were professional rescuers. The frequency of PTSD was 71.4% in the early assessment, and 57.1% in the long term. Staying in avalanche for more than 30 minutes, the absence of a history of disaster exposure and being in the group of volunteers were found to increase the risk for PTSD development. CONCLUSION: There is a high risk of developing PTSD as a result of an avalanche. People who will intervene with the disasters should be educated and prepared in terms of preventing negative psychological consequences of the disaster. The relationship between the severity of trauma and PTSD was replicated in our study.

The recovery of parabolic avalanches in spatially subsampled neuronal networks at criticality.

Scaling relationships are key in characterizing complex systems at criticality. In the brain, they are evident in neuronal avalanches-scale-invariant cascades of neuronal activity quantified by power laws. Avalanches manifest at the cellular level as cascades of neuronal groups that fire action potentials simultaneously. Such spatiotemporal synchronization is vital to theories on brain function yet avalanche synchronization is often underestimated when only a fraction of neurons is observed. Here, we investigate biases from fractional sampling within a balanced network of excitatory and inhibitory neurons with all-to-all connectivity and critical branching process dynamics. We focus on how mean avalanche size scales with avalanche duration. For parabolic avalanches, this scaling is quadratic, quantified by the scaling exponent, χ = 2, reflecting rapid spatial expansion of simultaneous neuronal firing over short durations. However, in networks sampled fractionally, χ is significantly lower. We demonstrate that applying temporal coarse-graining and increasing a minimum threshold for coincident firing restores χ = 2, even when as few as 0.1% of neurons are sampled. This correction crucially depends on the network being critical and fails for near sub- and supercritical branching dynamics. Using cellular 2-photon imaging, our approach robustly identifies χ = 2 over a wide parameter regime in ongoing neuronal activity from frontal cortex of awake mice. In contrast, the common 'crackling noise' approach fails to determine χ under similar sampling conditions at criticality. Our findings overcome scaling bias from fractional sampling and demonstrate rapid, spatiotemporal synchronization of neuronal assemblies consistent with scale-invariant, parabolic avalanches at criticality.

Avalanche fatalities in Czech Republic: a 23-years retrospective study.

Avalanche fatalities are quite rare in the Czech Republic. Due to the presence of avalanche fields in the two Czech mountains, forensic pathologists at some forensic medicine departments may encounter this specific mechanism of accidental death. The authors summarize medicolegal aspects of deaths in avalanches in the territory of the Czech Republic for the twenty-three-year period between 1993-2015. Ten avalanche fatalities were recorded during study period. The studied group consisted of nine male and one female victims. The average age of the deceased was 27.9 years. Skiers or ski-alpinists died in the avalanche in five cases (50%), climbers in two cases (20%), snowboarders in one case (10%), cross-country skiers in one case (10%) and in one case it was a fatality of child playing on a snowy hill (10%). The cause of death was suffocation in four cases (40%), blunt trauma in four cases (40%), and in the remaining two cases it was the survival of trapped persons several hours after being rescued from the avalanche in the hospital; both victims subsequently died as a result of prolonged shock (20%) due to a combination of prolonged suffocation and hypothermia. The time interval from the fall of the avalanche to the rescue of the trapped person was in the range of minutes to 3 hours. The presence of alcohol or drugs was not detected in any studied case.

A critically prolonged avalanche burial with recorded cardiac electrical activity and complete recovery - a case report.

The probability of survival in avalanche accidents is time-dependent. Critically buried victims who undergo a long burial duration (over 60 min) face a possible mortality rate of over 80%. Understanding the physiological response during critical avalanche burial is crucial for improving rescue strategies and outcomes. We present the case of a 55-year-old male skier buried under an avalanche for 4 h and 51 min in the Italian Alps. Continuous heart rate monitoring revealed distinct phases of cardiac activity during burial. Despite severe hypothermia, the victim survived without extracorporeal rewarming. This case highlights the importance of continuous monitoring and appropriate on-site management in avalanche accidents. Factors such as the presence of an air pocket may positively influence survival. This case underscores the importance of comprehensive resuscitative measures and guidelines for managing avalanche victims with prolonged burial durations.

Prevalence of airway patency and air pocket in critically buried avalanche victims - a scoping review.

INTRODUCTION: Survival of critically buried avalanche victims is directly dependent on the patency of the airway and the victims' ability to breathe. While guidelines and avalanche research have consistently emphasized on the importance of airway patency, there is a notable lack of evidence regarding its prevalence. OBJECTIVE: The aim of this review is to provide insight into the prevalence of airway patency and air pocket in critically buried avalanche victims. METHODS: A scoping review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline extension for scoping reviews. MEDLINE and Cochrane databases, as well as additional manual searching was performed to identify literature reporting data on airway patency and the presence of an air pocket in critically buried avalanche victims. After eliminating duplicates, we screened abstracts and main texts to identify eligible studies. RESULTS: Of 4,109 studies identified 154 were eligible for further screening. Twenty-four publications and three additional data sources with a total number of 566 cases were included in this review. The proportion of short-term (< 35 min) to long-term burial (≥ 35 min) in the analysed studies was 19% and 66%, respectively. The burial duration remained unknown in 12% of cases. The prevalence of airway patency in critically buried avalanche victims was 41% while that of airway obstruction was 12%, with an overall rate of reporting as low as 50%. An air pocket was present in 19% of cases, absent in 46% and unknown in 35% of the cases. CONCLUSION: The present study found that in critically buried avalanche victims patent airways were more than three times more prevalent than obstructed, with the airway status reported only in half of the cases. This high rate of airway patency supports the ongoing development and the effectiveness of avalanche rescue systems which oppose asphyxiation in critically buried avalanche victims. Further effort should be done to improve the documentation of airway patency and the presence of an air pocket in avalanche victims and to identify factors affecting the rate of airway obstruction.

Snow avalanches are a primary climate-linked driver of mountain ungulate populations.

Snow is a major, climate-sensitive feature of the Earth's surface and catalyst of fundamentally important ecosystem processes. Understanding how snow influences sentinel species in rapidly changing mountain ecosystems is particularly critical. Whereas effects of snow on food availability, energy expenditure, and predation are well documented, we report how avalanches exert major impacts on an ecologically significant mountain ungulate - the coastal Alaskan mountain goat (Oreamnos americanus). Using long-term GPS data and field observations across four populations (421 individuals over 17 years), we show that avalanches caused 23-65% of all mortality, depending on area. Deaths varied seasonally and were directly linked to spatial movement patterns and avalanche terrain use. Population-level avalanche mortality, 61% of which comprised reproductively important prime-aged individuals, averaged 8% annually and exceeded 22% when avalanche conditions were severe. Our findings reveal a widespread but previously undescribed pathway by which snow can elicit major population-level impacts and shape demographic characteristics of slow-growing populations of mountain-adapted animals.

First experimental time-of-flight-based proton radiography using low gain avalanche diodes.

Objective.Ion computed tomography (iCT) is an imaging modality for the direct determination of the relative stopping power (RSP) distribution within a patient's body. Usually, this is done by estimating the path and energy loss of ions traversing the scanned volume utilising a tracking system and a separate residual energy detector. This study, on the other hand, introduces the first experimental study of a novel iCT approach based on time-of-flight (TOF) measurements, the so-called Sandwich TOF-iCT concept, which in contrast to any other iCT systems, does not require a residual energy detector for the RSP determination.Approach.A small Sandwich TOF-iCT demonstrator was built based on low gain avalanche diodes (LGADs), which are 4D-tracking detectors that allow to simultaneously measure the particle position and time-of-arrival with a precision better than 100µm and 100 ps, respectively. Using this demonstrator, the material and energy-dependent TOF was measured for several homogeneous PMMA slabs in order to calibrate the acquired TOF against the corresponding water equivalent thickness (WET). With this calibration, two proton radiographs (pRads) of a small aluminium stair phantom were recorded at MedAustron using 83 MeV and 100.4 MeV protons.Main results.Due to the simplified WET calibration models used in this very first experimental study of this novel approach, the difference between the measured and theoretical WET ranged between 37.09% and 51.12%. Nevertheless, the first TOF-based pRad was successfully recorded showing that LGADs are suitable detector candidates for Sandwich TOF-iCT.Significance.While the system parameters and WET estimation algorithms require further optimization, this work was an important first step to realize Sandwich TOF-iCT. Due to its compact and cost-efficient design, Sandwich TOF-iCT has the potential to make iCT more feasible and attractive for clinical application, which, eventually, could enhance the treatment planning quality.

Prolonged critical avalanche burial for nearly 23 h with severe hypothermia and severe frostbite with good recovery: a case report.

BACKGROUND: Accidental hypothermia with severe frostbite is a rare combination of injuries with a high risk for long-term sequelae. There are widely accepted recommendations for the management of avalanche victims and for frostbite treatment, but no recommendation exists for the treatment of frostbite in severe hypothermic patients, specifically for the management of hypothermic avalanche victims presenting with frostbite. CASE PRESENTATION: We present a case of a previously healthy, 53-year-old male skier who was critically buried by an avalanche at 2300 m of altitude at an ambient temperature of - 8 °C for nearly 23 h. The victim was found with the right hand out of the snow and an air connection to outside. He was somnolent with Glasgow Coma Scale 11 (Eye 4, Verbal 2, Motor 5) and spontaneously breathing, in a severely hypothermic state with an initial core temperature of 23.1 °C and signs of cold injuries in all four extremities. After rescue and active external forced air rewarming in the intensive care unit, the clinical signs of first-degree frostbite on both feet and the left hand vanished, while third- to fourth-degree frostbite injuries became apparent on all fingers of the right hand. After reaching a core body temperature of approximately 36 °C, aggressive frostbite treatment was started with peripheral arterial catheter-directed thrombolysis with alteplase, intravenous iloprost, ibuprofen, dexamethasone and regional sympathicolysis with a right-sided continuous axillary block. After ten months, the patient had no tissue loss but needed neuropathic pain treatment with pregabalin. CONCLUSION: The combination of severe accidental hypothermia and severe frostbite is rare and challenging, as drug metabolism is unpredictable in a hypothermic patient and no recommendations for combined treatment exist. There is general agreement to give hypothermia treatment the priority and to begin frostbite treatment as early as possible after full rewarming of the patient. More evidence is needed to identify the optimal dosage and time point to initiate treatment of frostbite in severely hypothermic patients. This should be taken into consideration by future treatment recommendations.

Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study.

Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.

Surviving 20 Hours of Critical Avalanche Burial and a Core Temperature of 22.5 °C.

A 24-year-old male snowboarder was buried in an avalanche for 20 h and rescued on the next day at a depth of 2.3 m below the snow surface. A large air pocket was noted in front of his mouth and nose. He was responsive but moved restlessly and uncoordinatedly. The epitympanic temperature was 22.5 °C. He was bradycardic (35/min), and a right bundle branch block with Osborn waves was noted. Rewarming (1 °C/h) was initiated with continuous hemodialysis; core temperature raised to 29.8 °C within 4 h. At 30 °C he became conscious. With rewarming, the heart rate increased to 90 beats per minute and the ECG changes disappeared; nonfreezing cold injuries were noted. On the next day, his pulmonary function deteriorated-fluid overload of 9 L since admission was diagnosed. With spontaneous diuresis, the situation improved. On Day 4, the neurologist reported subtle polyneuropathy in both legs secondary to hypothermia, without tendency to regress. This case occurred more than 20 years ago but has not been reported yet. To this day, this is the third-longest critical avalanche burial ever reported. We discuss the circumstances of this accident, the clinical course, and how treatment has changed since 2000.

Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update.

To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.

Chirality-induced avalanche magnetization of magnetite by an RNA precursor.

Homochirality is a hallmark of life on Earth. To achieve and maintain homochirality within a prebiotic network, the presence of an environmental factor acting as a chiral agent and providing a persistent chiral bias to prebiotic chemistry is highly advantageous. Magnetized surfaces are prebiotically plausible chiral agents due to the chiral-induced spin selectivity (CISS) effect, and they were utilized to attain homochiral ribose-aminooxazoline (RAO), an RNA precursor. However, natural magnetic minerals are typically weakly magnetized, necessitating mechanisms to enhance their magnetization for their use as effective chiral agents. Here, we report the magnetization of magnetic surfaces by crystallizing enantiopure RAO, whereby chiral molecules induce a uniform surface magnetization due to the CISS effect, which spreads across the magnetic surface akin to an avalanche. Chirality-induced avalanche magnetization enables a feedback between chiral molecules and magnetic surfaces, which can amplify a weak magnetization and allow for highly efficient spin-selective processes on magnetic minerals.

Avalanche Education Is Associated with Increased Avalanche Safety Practices in the New Hampshire Backcountry.

INTRODUCTION: Avalanche risk can be mitigated by adhering to certain safety practices. Previous studies of these practices have focused on western United States and European cohorts. We conducted a survey of backcountry users in the White Mountains of New Hampshire to determine local adherence to 5 previously studied avalanche safety practices. We assessed whether participants were carrying transceiver, probe, and shovel (TPS); had formal avalanche education; had awareness of the day's avalanche danger level; had a route plan; and were traveling in a group. METHODS: Backcountry users in the White Mountains were directed to an online survey from December 2020 to June 2021. The survey was completed individually and queried demographics and avalanche safety practices. RESULTS: A total of 133 users participated. Not all surveyed participants answered all questions. Avalanche training was reported by 87% of users, 86% checked the avalanche forecast prior to recreating, 93% had a travel plan, 87% traveled in a group, and 59% carried TPS. All 3 items were carried by all group members only 48% of the time. Only 28% of users met all 5 safety practices. CONCLUSIONS: White Mountains backcountry users are less likely to meet avalanche safety practices than users in previous studies. There is an association between meeting these defined safety practices and formal avalanche education.

Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care.

Background: In Canada, family physicians (FPs) per capita have increased but so have access challenges. We explored changes in population characteristics, service delivery and FP practice that may help understand these trends. Methods: We used linked administrative data in British Columbia to describe changes in patient ages and comorbidities, hospitalizations and receipt of services that may require FP coordination, review and/or follow-up: prescriptions dispensed, laboratory tests, diagnostic imaging (radiology and ultrasound), specialist visits and emergency department visits. We estimate the number of FPs delivering community-based comprehensive care and report changes in service volume per community-based FP visit. Results: Between 1999/2000 and 2017/2018, people experienced fewer days in hospital, but the number of treated comorbidities, day surgeries and other services requiring FP coordination increased over and above the expected levels attributed to population aging. While the total number of FPs per capita have increased, numbers in community-based care have not and visits per physician have fallen. Increases in services that may involve FP coordination per community-based FP visit ranged from 32.2% for diagnostic radiology to 122.1% for lab tests. Conclusion: Findings suggest substantially increased coordination workload per FP visit. Ongoing impacts of population aging and changing service delivery on primary care workload require further examination.

History of Avalanches in the Eastern Spanish Pyrenees.

Avalanches have caused injuries and deaths in mountain areas throughout history. We have examined the historical effects of avalanches on communities in the eastern Spanish Pyrenees. Surviving written records began in the year 1444 when an avalanche destroyed the village of Gessa. Many other avalanches since then have destroyed houses and other buildings and have caused injuries and deaths. In the 20th and 21st centuries, many villages evolved from agrarian areas to destinations for winter sports. The first known deaths during winter recreation likely occurred in 1930. Because of avalanche mitigation efforts, including relocating settlements, physical barriers, avalanche control measures, efforts to increase avalanche awareness, and avalanche warnings, avalanches now seldom affect inhabited areas in the eastern Spanish Pyrenees. Avalanche injuries and fatalities are now mainly limited to backcountry skiers and others traveling out of bounds near avalanche-controlled ski resorts.

Stuck in an Avalanche-A Graphic Story.

This Arts and Medicine feature tells the story of a patient with undiagnosed illness caught in the futile administrative cycles of the US health care system.

Debris flow simulation and modeling of the 2021 flash flood hazard caused by a rock-ice avalanche in the Rishiganga River valley of Uttarakhand.

The high mountain ecosystem of the Indian Himalayas has frequently been experiencing primary hazards (like earthquakes, avalanches, and landslides). Often, these events are followed by the triggering of secondary hazards (like landslide dams, debris flows, and flooding), thereby posing massive risks to infrastructure and residents in the region. This study was taken up to understand the dynamics of an extraordinary debris flood disaster in the Rishiganga River valley, Chamoli district of Uttarakhand on 7th February 2021. Rapid mass movements (RAMMS)-debris flow software was employed to recreate the entire sequence of the hazard consisting of a rock-ice slide, mass deposition and erosion along the channel, and subsequent debris flood. Forty-nine scenarios were analyzed for accurate calibration of dry-Coulomb type friction coefficient (µ) and viscous-turbulent friction coefficient (ξ). Consequently, the geomorphologic characteristics of the debris flow were validated using high-resolution satellite image interpretation and field photographs. The volume of detached rock-ice mass was estimated to be 26.42 × 106 m3. At the same time, the RAMMS-derived model outputs for velocity, flow depth, and momentum were found in good agreement with the extent and height of actual debris on the ground. The study highlights an urgent need to identify the glaciers with a high risk of ice avalanches in the Indian Himalayas. The presented modeling approach may be applied in dynamic mountain ecosystems to simulate potential flash floods due to avalanches. Moreover, the information reported in this study can be vital input for improving the district-level disaster management plan.