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1.
Scand J Trauma Resusc Emerg Med ; 32(1): 11, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38347576

RESUMO

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.


Assuntos
Avalanche , Congelamento das Extremidades , Hipotermia , Masculino , Humanos , Pessoa de Meia-Idade , Hipotermia/complicações , Reaquecimento/efeitos adversos , Congelamento das Extremidades/terapia , Congelamento das Extremidades/complicações , Altitude
2.
Nat Commun ; 14(1): 6351, 2023 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-37816811

RESUMO

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.


Assuntos
Avalanche , Precursores de RNA , Óxido Ferroso-Férrico , Estereoisomerismo , Ribose/química
3.
Wilderness Environ Med ; 34(4): 457-461, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37726194

RESUMO

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.


Assuntos
Avalanche , Esqui , Humanos , Estados Unidos , New Hampshire , Viagem , Inquéritos e Questionários
4.
Healthc Policy ; 19(1): 114-129, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37695712

RESUMO

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.


Assuntos
Avalanche , Humanos , Carga de Trabalho , Colúmbia Britânica , Médicos de Família , Atenção Primária à Saúde
5.
Wilderness Environ Med ; 34(4): 606-609, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37696722

RESUMO

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.


Assuntos
Avalanche , Esqui , Esqui/lesões , Viagem , Estações do Ano , Redação
6.
JAMA ; 330(12): 1117-1119, 2023 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-37639240

RESUMO

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.


Assuntos
Avalanche , Narração , Empatia
7.
Environ Monit Assess ; 195(9): 1118, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37648891

RESUMO

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.


Assuntos
Avalanche , Inundações , Ecossistema , Rios , Monitoramento Ambiental , Camada de Gelo
8.
Sci Rep ; 13(1): 11311, 2023 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-37443331

RESUMO

Attacks on networks is a very important issue in developing strategies of eradicating spreads of malicious phenomena in networks, such as epidemics and fake information. This field of research is referred to as networks immunization. The traditional approach to evaluating the effectiveness of attacks on networks focuses on measuring macro parameters related to the entire attack, such as the critical probability of a percolation occurrence in the network [Formula: see text] and the relative size of the largest component in the network, known as the giant component, but not considering the attack on a micro perspective, which is the analysis of node removals, during an attack, themselves, their characteristics and results. In this paper we present and apply the last method of focusing on the micro scale of an attack. Based on the theory of percolation in networks, we analyze the phenomenon of an avalanche which results due to a single node removal from a network. An avalanche is a state in which a removal of a single node from the giant component of a network leads to the disconnection of additional nodes. This process significantly contributes to the fragmentation (immunization) of the network, comparing to the impact of the initial node removal alone. Specifically, we focus on the size parameter of an avalanche, which is the number of nodes that are disconnected from the giant component due to a single node removal. Relating to a random attack on a network of the type of Cayley tree, we derive analytically the distribution of the sizes of avalanches that occur during the entire attack on it, until the network is dismantled (immunized) and the attack is terminated.


Assuntos
Avalanche , Epidemias , Modelos Teóricos , Probabilidade , Imunização
10.
Phys Rev Lett ; 130(25): 250405, 2023 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-37418717

RESUMO

Many-body localized (MBL) systems fail to reach thermal equilibrium under their own dynamics, even though they are interacting, nonintegrable, and in an extensively excited state. One instability toward thermalization of MBL systems is the so-called "avalanche," where a locally thermalizing rare region is able to spread thermalization through the full system. The spreading of the avalanche may be modeled and numerically studied in finite one-dimensional MBL systems by weakly coupling an infinite-temperature bath to one end of the system. We find that the avalanche spreads primarily via strong many-body resonances between rare near-resonant eigenstates of the closed system. Thus we find and explore a detailed connection between many-body resonances and avalanches in MBL systems.


Assuntos
Avalanche , Temperatura , Vibração
11.
High Alt Med Biol ; 24(2): 149-151, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37262197

RESUMO

Libersa, Marie, Louis Marxer, Ken Zafren, Stephane Oggier, Lorenzo Pucci, and Mathieu Pasquier. Takotsubo cardiomyopathy following complete avalanche burial: a case report. High Alt Med Biol. 24:149-151, 2023.-Takotsubo cardiomyopathy is a transient left ventricular dyskinesia triggered by a stressful physical or emotional event. We report a case of mid-ventricular Takotsubo stress cardiomyopathy in an avalanche victim. The patient was a 41-year-old woman who was completely buried under 1.2 m of snow for 30 minutes. On arrival at the hospital, she was conscious and hypothermic (core temperature 33.7°C). Her ECG showed rapid atrial fibrillation (142 beats/min) that converted to sinus rhythm after rewarming and administration of crystalloids. Echocardiography showed akinesia of the left mid-ventricle with a left ventricular ejection fraction of 41%. At 48-hour follow-up, echocardiography showed an almost complete recovery. During her hospital stay the patient was diagnosed with an acute stress disorder with symptoms of dissociation. She was discharged home after 5 days. At 2-week follow-up echocardiography was normal. Psychological follow-up was normal at 7 months. The physical and psychological stress of the avalanche, as well as hypothermia, were all possible triggers of Takotsubo cardiomyopathy.


Assuntos
Avalanche , Hipotermia , Cardiomiopatia de Takotsubo , Humanos , Feminino , Adulto , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Volume Sistólico , Função Ventricular Esquerda , Ecocardiografia/efeitos adversos , Hipotermia/complicações
12.
Scand J Trauma Resusc Emerg Med ; 31(1): 29, 2023 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-37322530

RESUMO

BACKGROUND: A major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines as a parameter to aid in this differentiation However, the fastest cooling rate under the snow reported so far is 9.4 °C per hour, suggesting that it would take 45 min to cool below 30 °C, which is the temperature threshold below which a hypothermic cardiac arrest can occur. CASE PRESENTATION: We describe a case with a cooling rate of 14 °C per hour, assessed on site with an oesophageal temperature probe. This is by far the most rapid cooling rate after critical avalanche burial reported in the literature and further challenges the recommended 60 min threshold for triage decisions. The patient was transported under continuous mechanical CPR to an ECLS facility and rewarmed with VA-ECMO, although his HOPE score was 3% only. After three days he developed brain death and became an organ donor. CONCLUSIONS: With this case we would like to underline three important aspects: first, whenever possible, core body temperature should be used instead of burial duration to make triage decisions. Second, the HOPE score, which is not well validated for avalanche victims, had a good discriminatory ability in our case. Third, although extracorporeal rewarming was futile for the patient, he donated his organs. Thus, even if the probability of survival of a hypothermic avalanche patient is low based on the HOPE score, ECLS should not be withheld by default and the possibility of organ donation should be considered.


Assuntos
Avalanche , Reanimação Cardiopulmonar , Parada Cardíaca , Hipotermia , Masculino , Humanos , Hipotermia/diagnóstico , Hipotermia/etiologia , Hipotermia/terapia , Reaquecimento , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Ressuscitação
13.
JAMA Netw Open ; 6(5): e2313376, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-37184835

RESUMO

Importance: Approximately 70% of individuals critically buried in avalanche debris die within 35 minutes as a result of asphyxial cardiac arrest. An artificial air-pocket device (AAPD) that separates inhaled air from exhaled air may delay the onset of severe hypoxemia and eventual asphyxia during snow burial. Objective: To investigate the efficacy of a new AAPD during snow burial in a supine position. Design, Setting, and Participants: This comparative effectiveness trial was performed in winter 2016 with data analysis in November 2016 and November 2022. Each trial used a simulated critical avalanche burial scenario, in which a trough was dug in a snow pile and an additional air pocket of 0.5 L volume was punched into the lateral wall for each control trial. All participants were buried in a supine position. Trials could be voluntarily terminated at any time, with a maximum length of 60 minutes; trials were automatically terminated if the participant's peripheral oxygen saturation (Spo2) dropped to less than 84%. Exposures: Each participant conducted 2 trials, one in which they breathed into the AAPD (intervention trial) and the other in which they breathed into the prepared air pocket (control trial). Main Outcomes and Measures: Measurements included Spo2, cerebral oxygenation, ventilatory parameters, respiratory gas concentrations, and visual-analogue scales. Kaplan-Meier survival curves and rank test for matched survival data were used to analyze the total burial time in each trial. Results: A total of 13 volunteers (9 men; mean [SD] age, 33 [8] years) were exposed to the intervention and control trials. Intervention trials were terminated less often (2 of 13 trials) as a result of hypoxemia than control trials (11 of 12 trials). Similarly, survival curves showed a longer duration of burial in the intervention compared with the control trials for the time to reach an Spo2 less than 84% (rank test for matched survival data: P = .003). The intervention trials, compared with the control trials, also had slower rates of decrease in fraction of inspired oxygen (mean [SD] rate, -0.8 [0.4] %/min vs -2.2 [1.2] %/min) and of increase in fraction of inspired carbon dioxide (mean [SD] rate, 0.5 [0.3] %/min vs 1.4 [0.6] %/min) and expired ventilation per minute (mean [SD] rate, 0.5 [1.0] L/min2 vs 3.9 [2.6] L/min2). Conclusions and Relevance: This comparative effectiveness trial found that the new AAPD was associated with delaying the development of hypoxemia and hypercapnia in supine participants in a critical burial scenario. Use of the AAPD may allow a longer burial time before asphyxial cardiac arrest, which might allow longer times for successful rescue by companions or by prehospital emergency medical services.


Assuntos
Avalanche , Desastres , Parada Cardíaca , Adulto , Humanos , Masculino , Asfixia , Hipóxia/etiologia , Hipóxia/terapia , Pesquisa Comparativa da Efetividade
14.
Sci Rep ; 13(1): 4871, 2023 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-36964158

RESUMO

A new statistical analysis of large neuronal avalanches observed in mouse and rat brain tissues reveals a substantial degree of recurrent activity and cyclic patterns of activation not seen in smaller avalanches. To explain these observations, we adapted a model of structural weakening in materials. In this model, dynamical weakening of neuron firing thresholds closely replicates experimental avalanche size distributions, firing number distributions, and patterns of cyclic activity. This agreement between model and data suggests that a mechanism like dynamical weakening plays a key role in recurrent activity found in large neuronal avalanches. We expect these results to illuminate the causes and dynamics of large avalanches, like those seen in seizures.


Assuntos
Avalanche , Modelos Neurológicos , Ratos , Camundongos , Animais , Potenciais de Ação/fisiologia , Rede Nervosa/fisiologia , Neurônios/fisiologia
15.
Wilderness Environ Med ; 34(2): 187-192, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36925387

RESUMO

INTRODUCTION: Backcountry skiers and snowboarders are increasingly using avalanche airbags to improve safety. New safety devices can cause risk compensation, the concept in which users take more risks given the larger safety margin provided by the device. This may limit overall benefits. We sought to elucidate attitudes toward risk-taking behaviors and risk compensation in backcountry users relating to avalanche airbags. METHODS: A convenience sample of 144 backcountry skiers and snowboarders was surveyed after a backcountry tour in the Wasatch Mountains of Utah and the Tetons of Wyoming during the winter 2020-21 season. Demographic and experiential data were compared with risk propensity scores and attitudes toward risk compensation. Respondents were stratified into high-, medium-, and low-risk groupings based on risk propensity scores and whether an airbag was carried. RESULTS: Thirty-two (22%) respondents carried an airbag. Airbag users were more likely to endorse risk compensation behavior, ski terrain over 30 degrees, and fall into the high-risk cohort. The high-risk cohort was also more likely to endorse risk compensation behavior than medium- and low-risk individuals. CONCLUSIONS: Risk compensation was more prevalent in 2 groups: 1) those carrying an airbag and 2) those falling within the high-risk cohort. Given the prevalence of avalanche airbags, risk compensation should be considered alongside other human factors in avalanche safety and education so that users can mitigate these effects. Although risk compensation appears to be occurring, the magnitude of this effect remains unknown and likely does not obviate the safety benefits of the airbag altogether.


Assuntos
Avalanche , Esqui , Humanos , Esqui/educação , Equipamentos de Proteção , Utah , Atitude
16.
Resuscitation ; 184: 109708, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36709825

RESUMO

INTRODUCTION: The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims. METHODS: ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system. RESULTS: We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%). CONCLUSIONS AND RECOMMENDATIONS: For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.


Assuntos
Avalanche , Reanimação Cardiopulmonar , Hipotermia , Humanos , Complexo Ferro-Dextran , Asfixia/terapia , Estudos Retrospectivos , Estudos Prospectivos , Hipotermia/terapia
17.
J Comput Neurosci ; 51(1): 149-172, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36280652

RESUMO

We investigate spontaneous critical dynamics of excitatory and inhibitory (EI) sparsely connected populations of spiking leaky integrate-and-fire neurons with conductance-based synapses. We use a bottom-up approach to derive a single neuron gain function and a linear Poisson neuron approximation which we use to study mean-field dynamics of the EI population and its bifurcations. In the low firing rate regime, the quiescent state loses stability due to saddle-node or Hopf bifurcations. In particular, at the Bogdanov-Takens (BT) bifurcation point which is the intersection of the Hopf bifurcation and the saddle-node bifurcation lines of the 2D dynamical system, the network shows avalanche dynamics with power-law avalanche size and duration distributions. This matches the characteristics of low firing spontaneous activity in the cortex. By linearizing gain functions and excitatory and inhibitory nullclines, we can approximate the location of the BT bifurcation point. This point in the control parameter phase space corresponds to the internal balance of excitation and inhibition and a slight excess of external excitatory input to the excitatory population. Due to the tight balance of average excitation and inhibition currents, the firing of the individual cells is fluctuation-driven. Around the BT point, the spiking of neurons is a Poisson process and the population average membrane potential of neurons is approximately at the middle of the operating interval [Formula: see text]. Moreover, the EI network is close to both oscillatory and active-inactive phase transition regimes.


Assuntos
Avalanche , Modelos Neurológicos , Neurônios/fisiologia , Potenciais da Membrana/fisiologia , Sinapses , Potenciais de Ação/fisiologia
18.
J Travel Med ; 30(4)2023 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-36349697

RESUMO

BACKGROUND/OBJECTIVE: The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment. This study provides a review of the available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations. RESULTS: Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing the chances of critical burial, the most determining risk factor. However, there is a scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education and risk compensation. CONCLUSIONS: Avalanche airbags seem to be an important tool in reducing mortality in the backcountry expeditions. However, more research and standardized data collection are needed to fill the knowledge gap, and mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels; and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia and trauma.


Assuntos
Avalanche , COVID-19 , Montanhismo , Humanos , Pandemias , COVID-19/prevenção & controle , Asfixia/epidemiologia , Asfixia/prevenção & controle
19.
Wilderness Environ Med ; 34(1): 113-119, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36526516

RESUMO

In 1755 in Bergemoletto, Italy, an avalanche buried 4 people (2 women, a girl, and a boy) and several animals in a stable. After 37 d in a pitch-dark confined space, 3 of the 4 people were rescued alive. The 3 survivors had only goat milk, a few chestnuts, a few kg of raw kid meat, and meltwater for nutrition. We describe the longest-known survival in an avalanche burial and discuss the medical and psychological problems of the survivors. The boy died. When they were extricated, all 3 survivors were exhausted, cachectic, and unable to stand or walk. They were severely malnourished and were experiencing tingling, tremors, and weakness in the legs; constipation; changes in taste; and amenorrhea. One of the women had persistent eye problems and developed symptoms consistent with post-traumatic stress disorder. The survivors were given slow refeeding. It took from 1 to 6 wk before they could walk. We compare this case to other long-duration burials, especially mining accidents, and describe the rescue and patient care after long-duration burials. This case demonstrates that people can overcome extremely adverse conditions and survive.


Assuntos
Avalanche , Feminino , Humanos , Acidentes , Asfixia , Morte , Fatores de Tempo
20.
Ambio ; 52(4): 711-732, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36324022

RESUMO

In mountain territories, snow avalanches are a prevalent threat. Long-term risk management involves defining meaningful compromises between protection and overall sustainability of communities and their environment. Methods able to (i) consider all sources of losses, (ii) account for the high uncertainty levels that affect all components of the risk and (iii) cope for marked non-stationarities should be employed. Yet, on the basis of a literature review and an analysis of relations to Sustainable Development Goals (SDGs), it is established that snow avalanche risk assessment and mitigation remain dominated by approaches that can be summed up as deterministic, hazard oriented, stationary and not holistic enough. A more comprehensive paradigm relying on formal statistical modelling is then proposed and first ideas to put it to work are formulated. Application to different mountain environments and broader risk problems is discussed.


Assuntos
Avalanche , Neve , Medição de Risco , Gestão de Riscos , Desenvolvimento Sustentável
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