Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers.

OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents.

Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.

Avalanche Survival After Rescue With the RECCO Rescue System: A Case Report.

We report a case of survival of a completely buried avalanche victim after being located with the radar-based RECCO Rescue System. In the winter of 2015, 2 off-piste skiers were completely buried in an avalanche near the secured ski area in Baqueira Beret, Spain. The first victim was located with the RECCO Rescue System in less than 35 minutes and was alive and conscious at extrication. This system emits radio waves and requires a specific reflector. It is a portable device that is used by more than 600 rescue organizations worldwide, especially in secured ski areas. The device should be brought to the avalanche site together with electronic avalanche transceivers, a probing team, and avalanche dogs. In the hands of experienced professionals, the device may allow rapid location of victims not carrying an electronic avalanche transceiver. Although it is not the first successful extrication of a victim with the RECCO Rescue System, it is the first case published in the medical literature and is intended to encourage data collection and to increase our understanding of the effectiveness of this device in avalanche rescue.

Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members.

Search and rescue teams and Antarctic research groups use protective cold-water anti-exposure suits (AES) when cruising on Zodiacs. Extremity tourniquet (ET) self-application (SA) donned with AESs has not been previously studied. Our study therefore assessed the SA of 5 commercial ETs (CAT, OMNA, RATS, RMT, and SWAT-T) among 15 volunteers who donned these suits. Tourniquet's SA ability, ease of SA, tolerance, and tourniquet preference were measured. All ETs tested were self-applied to the upper extremity except for the SWAT, which was self-applied with the rest to the lower extremity. Ease- of- SA mean values were compared using the Friedman and Durbin-Conover post hoc tests (P < 0.001). Regarding the upper extremity, OMNA achieved the highest score of 8.5 out of 10, while RMT, and SWAT received lower scores than other options (P < 0.001). For lower extremities, SWAT was found to be inferior to other options (P < 0.01). Overall, OMNA was the best performer. The RATS showed significantly lower tolerance than the other groups in repeated- measures ANOVA with a Tukey post hoc test (P < 0.01). Additionally, out of the 5 ETs tested, 60% of subjects preferred OMNA. The study concluded that SA commercial ETs are feasible over cold-water anti-exposure suits in the Antarctic climate.

Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue.

Roy, Steven, Inigo Soteras, Alison Sheets, Richard Price, Kazue Oshiro, Simon Rauch, Don McPhalen, Maria Antonia Nerin, Giacomo Strapazzon, Myron Allen, Alistair Read, and Peter Paal. Guidelines for mountain rescue during the COVID-19 pandemic: official guidelines of the International Commission for Alpine Rescue. High Alt Med Biol. 22: 128-141, 2021. Background: In mountain rescue, uncertainty exists on the best practice to prevent coronavirus disease 2019 (COVID-19) transmission. The aim of this work was to provide a state-of-the-art overview of the challenges caused by the COVID-19 pandemic in mountain rescue. Methods: Original articles or reviews, published until December 27, 2020 in Cochrane COVID-19 Study Register, EMBASE, PubMed, and Google Scholar were included. Articles were limited to English, French, German, or Spanish with the article topic COVID-19 or other epidemics, addressing transmission, transport, rescue, or cardiopulmonary resuscitation. Results: The literature search yielded 6,190 articles. A total of 952 were duplicates and 5,238 were unique results. After exclusion of duplicates and studies that were not relevant to this work, 249 articles were considered for this work. Finally, 72 articles and other sources were included. Conclusions: Recommendations are provided for protection of the rescuer (including screening, personal protective equipment [PPE], and vaccination), protection of the patient (including general masking if low risk, specific PPE if high risk), equipment hygiene (including disinfection after every mission), use of single-use products, training and medical measures under COVID-19 precautions, and psychological wellbeing of rescuers during the COVID-19 pandemic. Adapted COVID-19 precautions for low-and-medium-income countries are also discussed.

Epidemiological and medical aspects of canyoning rescue operations.

AIM: To describe the characteristics of canyoning rescue operations (CRO), type and severity of injuries or illnesses, and on-site medical procedures. PATIENTS AND METHODS: A retrospective analysis of all CRO data from an emergency medical rescue team in Aragon, Spain, between 1 August 1999 and 31 July 2009. RESULTS: A total of 520 patients were identified, with a male to female ratio of 1.4. The median age was 32 years (range 10-73 years). The median time from the emergency call to admission to an acute care facility (or evacuation for uninjured patients) was 90 min (range 10-860 min). In 329 (63.3%) cases technical skills or ability in the terrain with some grade of difficulty was required. Accessibility of the incident site was associated with type of rescue (p<0.0001), where patients in incident sites with moderate to extremely difficult access were more often rescued by ground rescue alone or supported by air rescue than by air rescue alone. 419 (80.6%) patients had trauma-related injuries. The most common injuries involved the lower extremities (74%). The percentage of patients with a NACA score ≥4 was higher for medical/environmental illnesses than traumatic injuries (p<0.0001), despite that the total number was smaller. 175 (33.7%) patients received analgesics. 370 (71.2%) patients required splinting/immobilization. Major life-saving medical interventions were rarely performed on-site. CONCLUSIONS: The length and exposure to environmental factors validates the importance of emergency physicians and paramedics in CRO. Physicians and paramedics should be familiar with Pre-hospital Trauma Life Support, medical procedures related to environmental, topographical and logistical conditions, and helicopter rescue operations including winch operations.

Medicalizar los equipos de rescate en montaña: justificación socio-económica en base a la evolución de la mortalidad en el Pirineo Central / Medicalization of mountain rescue teams: social and economic approach based on mortality evolution in Central Pyrenees

Introducción: El montañismo mejora la salud física y mental de las personas que los practican contribuyendo a lograr un menor gasto socio-sanitario. Todos los deportes tienen efectos colaterales no deseados: accidentes y lesiones. Las operaciones de rescate en montaña implican dificultades logísticas y ambientales que exponen a numerosos e importantes riesgos, pero se han incorporado sanitarios en estas operaciones de rescate ya que acortar los tiempos de intervención médica y el tratamiento apropiado in situ disminuyen la morbi-mortalidad de los accidentados. En España hay muchas Comunidades Autónomas (CCAA) sin rescate en montaña medicalizado. La realidad de los accidentes de montaña: En España hay 5,4 muertos por cada 100 rescatados en montaña. En Aragón, se contabilizan 3,5 muertos/100 accidentados rescatados. El 11,3% de los rescatados en Aragón entre 1999 y 2008 presentaba un índice Glasgow entre 13 y 9 y el 12,9% tenían un Glasgow < 9 (grave). Un 6,3% de los pacientes rescatados sufrieron politraumatismos. Un 63,7% de los rescatados presentaban un índice de gravedad NACA≥III que hace referencia a pacientes que requieren asistencia médica en el lugar del accidente. En Aragón se medicaliza el rescate en montaña desde 1998. También están medicalizados estos rescates en Asturias, Cantabria y Castilla-León. Los efectos de la medicalización del rescate en montaña: Existen claras diferencias entre las prestaciones que establecen unas CCAA y otras. La "medicalización del rescate" supone un médico o enfermera específicamente formado en Medicina de Urgencias en Montaña integrado en los equipos de rescate. Esto mejora la eficacia del primer tratamiento en el lugar del accidente, por difícil que sea el acceso, mejorando la supervivencia y disminuyendo la morbilidad. En Aragón, la tasa de mortalidad media ha pasado del 9,32% antes de la medicalización del rescate al 3,45% en los 15 años de rescate medicalizado con médicos y enfermeras CUEMUM, lo que supone una disminución del 62%. Mientras que la tasa de mortalidad media en España en el mismo periodo ha pasado del 8,8% al 6,8%; lo que supone una disminución del 12,5%. La relación coste-beneficio: Calculamos a la baja que los accidentes de montaña en España cuestan más de 375 millones Euros al año. En Aragón estimamos que superan los 50 millones Euros al año. La disminución de la tasa de mortalidad en un 62% ha supuesto un ahorro de más de 175 millones Euros. Conclusiones: La medicalización del rescate es un derecho y un deber con claros beneficios socio-sanitarios. La asistencia médica in situ disminuye la morbi-mortalidad y el gasto público. España debe mejorar la prevención, además de garantizar la medicalización de los rescates en todo el territorio con sanitarios formados en Medicina de Urgencias en Montaña

Introduction: Mountaineering improve the physical and mental health of people who practices it. All sports have a collateral not wished effects: accidents and sport injuries. Although mountain rescue operations involve logistic and environmental difficulties that expose everybody to important risks, alpine countries have joined sanitary people in these rescue operations because they know shorten times of medical intervention and an appropriate treatment in place diminish mortality and sequels, and consequently, social and sanitary expenses. Many mountain regions in Spain have not medical services in mountain rescue teams. The facts of mountain casualties: There were 5,4 fatalities for every 100 rescued people in mountains in Spain. There were 3,5 fatalities for every 100 rescued people in Aragon. 6,3% of rescued patients suffered polytraumatisms. 63,7% of rescued people in mountains in Aragon presented a NACA index ≥ III (that means they need medical assistance in the place of the accident). 11,3% of people rescued in Aragon between 1999 and 2008 had a Glasgow Index among 13 and 9 and 12,9% had a Glasgow Index < 9. Mountain rescue operations are medicalized in Aragon since 1998. Also, mountain rescues are medicalized in Asturias, Cantabria y Castilla-León. Effects of medicalized mountain rescue operations: There are important differences between some regions in Spain about medical services in mountain rescues. Medicalization means to have a doctor or nurse specifically trained in Mountain Emergency Medicine integrated in rescue teams. This improves the efficiency of first treatments on the field, despite the difficulties of access, improving survival and diminishing morbidity. In Aragon, the rate of average mortality has changed from 9,32% before the medicalization of mountain rescue to 3,45% during medicalization with CUEMUM physicians and nurses, which supposes a decrease of 62% in 15 years. Whereas the rate of mortality in Spain was changed to 8,8% to 6,8% in the same period what supposes a decrease of 12,5%. Cost-benefit analysis: We calculate downwards that mountain casualties in Spain costs more than 375 million Eurosper year. They overcome 50 million Euros per year in Aragon. This region has save of more than 175 million Euros with this decrease of mortality of 62%. Conclusions: Medicalization of mountain casualties is a human right and a duty with clear social and sanitary benefits. The medical assistance on the field diminishes morbidity and mortality and the public expenditure. Spain must to improve the prevention and to guarantee the medicalization of mountain rescues in the whole Spanish regions with nurses and physicians trained in Mountain Emergency Medicine

Medical standards for mountain rescue operations using helicopters: official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.

Equipment of medical backpacks in mountain rescue.

We conducted a survey of equipment in medical backpacks for mountain rescuers and mountain emergency physicians. The aim was to investigate whether there are standards for medical equipment in mountain rescue organizations associated with the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). A questionnaire was completed by 18 member organizations from 14 countries. Backpacks for first responders are well equipped to manage trauma, but deficiencies in equipment to treat medical emergencies were found. Paramedic and physicians' backpacks were well equipped to provide advanced life support and contained suitable drugs. We recommend that medical backpacks should be equipped in accordance with national laws, the medical emergencies in a given region, and take into account the climate, geography, medical training of rescuers, and funding of the organization. Automated external defibrillator provision should be improved. The effects of temperature on the drugs and equipment should be considered. Standards for training in the use and maintenance of medical tools should be enforced. First responders and physicians should only use familiar tools and drugs.

Diferencias en el patrón de las lesiones de surf de nieve y de esquí: análisis de 9.147 víctimas durante cinco temporadas / Differences in the pattern of injuries between snowboarding and alpine skiing: an analysis of 9.147 casualties during five seasons

Objeto: El objeto de este estudio es evaluar si la práctica del surf de nieve ésta asociada con un patrón diferente de lesiones, en comparación con la práctica del esquí alpino. Métodos: Fueron analizadas todas las fichas de asistencia médica de los accidentados atendidos en el Centro Médico de la estación de esquí de Masella, durante cinco temporadas (2003-2008). Los grupos de surf de nieve y esquí alpino se compararon utilizando la prueba de chi-cuadrado o el test de Fischer para las variables categóricas y la prueba de t de Studento la prueba de Mann-Whitney para variables continuas. El análisis de varianza (ANOVA) se utilizo para la comparación de más de dos grupos. Cuando las variables no cumplían los supuestos de normalidad, se aplico la prueba de Kruskal-Wallisse aplico. La significación estadística se fijo en P <0,05. Resultados: Durante este periodo, fueron atendidas 9.147 víctimas (6.101 fueron esquiadores y 2.789 eran practicantes de surf de nieve). En comparación con los practicantes de esquí alpino, entre los accidentados durante la práctica de surf de nieve se observo que había un mayor número de principiantes (49,5 vs 41,5%),el uso del casco protector era menor (37,8% vs 44,9%), tenían menos heridas incisas y contusas (5,8 % vs 8,5%), menos lesiones de las extremidades inferiores (21,2% vs 47,4%), menos lesiones del dedo pulgar (3,2% vs 7,8%), y menos esguinces de rodilla (2,8% vs 14,7%). Por otra parte, presentaban un mayor porcentaje de fracturas oseas (18,6% vs 6,7%), de lesiones de extremidades superiores (57% vs 29,2%), de lesiones de muñeca en general (16,8% vs 2,5%), de fracturas distales de radio (12,3% vs 1,6%) de luxaciones de hombro (2,9% vs 1,6%), de fracturas de clavícula (2,4% vs 1,4%), y de lesiones, del tronco (2,8% vs 2%). Todas estas comparaciones fueron estadísticamente significativas (P <0,05). Conclusión: Los resultados de este trabajo demuestran que el surf de nieve tiene un patrón de lesiones distinto del que se observa en la práctica del esquí alpino, el conocimiento de las cuales puede influir en la prevención de accidentes de surf de nieve. Las estrategias propuestas para reducir las lesiones consisten en una revisión de la metodología de aprendizaje y entrenamiento, el uso rutinario del casco y la evaluación de los protectores de espalda para adaptarlos a los deportes de nieve (AU)

Purpose: The purpose of this study was to assess whether the practice of snowboarding is associated with a different pattern of injuries as compared with alpine skiing. Methods: All consecutive patients with snow sports injuries attended at the Medical Center of Masella ski resort, during five ski seasons (2003-2008) were analyzed. A comparison was made of the groups of alpine skiers and snowboarders, using the chi-square (x2) test or the Fisher’s exact test for categorical variables, and the Student’s test or the Mann-Whitney U test for continuous variables. The analysis of variance (ANOVA) was used for the comparison of more than two groups. When variables did not fulfill assumptions of normality, the Kruskal-Wallis test was applied. Statistical significance was set at P <0.05. Results: During this period, a total of 9.147 accident victims were attended (6.101 were alpine skiers and 2.789 weres nowboarders). When injured snowboarders were compared with injured alpine skiers, it was noted that the percentage of beginners was larger (49.5% vs 41. 5%) and snowboarders were less likely to use helmet (37.8% vs 44.9%), to have lacerations (5.8% vs 8.5%), to have lower extremity injuries (21.2% vs47.4%), to have thumb lesions (3.2% vs 7.8%), and to have knee sprains (2.8% vs 14.7%). In addition snowboarding was associated with higher percentages of bone fractures (18.6% vs 6.7%), upper extremity injuries (57% vs 29.2 %), wrist injuries in general (16.8% vs 2.5%), distal radius fractures (12.3% vs1.6%), shoulder dislocations (2.9% vs 1.6%), clavicle fractures(2.4% vs 1.4%), and trunk injuries (2.8% vs 2%). All these comparisons were statistically significant (P < 0.05). Conclusion: This study show that snowboarding has a different pattern of injuries seen in alpine skiing, the knowledge of which could influence snowboarder accident prevention. Strategies for prevention consist of training courses, the routine use of helmets, and the evaluation of back protectors in order to adapt to snow sports. Conclusion: This study show that snowboarding has a different pattern of injuries seen in alpine skiing, the knowledge of which could influence snowboarder accident prevention. Strategies for prevention consist of training courses, the routine use of helmets, and the evaluation of back protectors in order to adapt to snow sports (AU)