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International Commission for Mountain Emergency Medicine (ICAR MEDCOM) FALL MEETING 2017 SOLDEU ANDORRA OCTOBER 19-21, 2017 AlisonSheetsandKenZafrenThetinycountryofAndorrawasthegracioushosttothe2017ICARconferenceattendees.TheskitownofSoldeuprovidedmodernconferencefacilitieswithjustenoughoftheoldPyrennesetownremainingasanelegantbackdrop.Thelocalbombadiersorganizedanexcellentconferenceanddemonstratedtheirtechnicalskillsfromthelocalskiliftsandconstructioncranes!ThefollowingMEDCOMreportisnotcomprehensivebutcoversthepresentationsanddiscussionsmostrelevanttotheMRAmembership.FurtherdetailsoftheMEDCOMactivitiesareavailableintheformalminuteswhichcanbefoundontheMRAwebsite.

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PresidentFidelElsensohn(picturedabove)welcomedthemembersoftheCommissionandguests.Therewere69membersinattendance,thelargestnumberofparticipantsinanICARMEDCOMmeetingyet.PRESIDENT’SREPORTFidelannouncedthedeathsof4Commissionmembersandlong-timerescuers.AlfredThomasofGermanyandMarcelEscodaofAndorradiedin2003.JoseRamonMorandeiraofSpaindiedin2012.BrunoDurrerofSwitzerlanddiedin2016.HermannBruggergaveashorttributetoBrunoDurrer.ChangeofleadershipandhonorsAfter8yearsasPresidentoftheInternationalCommissionforMountainEmergencyMedicineFidelElsensohnwillpassthebatontoJohnEllertonoftheUK.Heconcluded,“THANKYOUICARMEDCOMFRIENDS.ThankstoallmembersoftheExecutiveBoardofICARfortheirsupportandtoallmembersanddelegatesofICAR.”FidelwashonoredwithlifetimeICARmembershiplaterintheconference,aswasourownKenZafrenforhismanyyearsofserviceandconsiderablecontributions.ICARBUSINESSMembershipcategoriesandvotingprivilegeswerediscussedintheAssemblyofDelegates.Newcategories(A,B,C,D)wereproposedthatwillconcentratethevotingpowertoorganizationswheremembersperformmountainrescueyetallowaglobalanddiverseICARmembership.ThiswasacceptedbytheAssemblyandwillgointoeffectin2018.MRAremainsatypeAmember.MountainSafetyKnowledgeBase(MSKB):WorkinggroupledbyManuelGenswein.AMemorandumofUnderstandingwasadoptedinAugustatameetingofallthestakeholders(ICAR,UIAAandothers).ThegoalsasdiscussedhereandinthereportsfromtheotherICARCommisssions,includeestablishingbestpracticesinmountainsafety.Thesearenotintendedtobeformalrecommendationsorpolicies(toaddressliabilityconcerns).Rather,theywillrespectmemberorganizationsandculturalpractices.Althoughcommercial,theMSKBwillbeanot-for-profitorganizationwithayearlysubscriptionmodelasthemethodforfinancingongoingwork.Workinggroupsandwriterswillbelimitedtoorganizationswithaglobalpresence,suchasICAR,UIAAandIFMG.PROPOSEDPAPERSANDPROJECTSINDEVELOPMENTMultipletraumamanagementinalpineenvironments.PeterPaalThisproposedpaperbuildsonthe2009paperregardingfluidmanagementinmountainrescue.ItwillbeasystematicreviewwithPICOquestionsscoredbytheAmericanHeartAssociation

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(AHA)evidence-basedscoringsystem.Theintentionistoaddressallaspectsoftraumaevaluationandtreatmentinthemountainrescuesetting.ThepublicationwillbeOpenAccess.ThefirstauthorwillbeGüntherSumannandtheseniorauthorwillbePeterPaal.Theotherinitialauthorswillbe:MikeGreene,BruceBrink,GiacomoStrapazzonMonikaBrodmann,DidierMoens,MathieuPasquierPoulKongstad,AlisonSheets,DarylMacias,KenZafren,KazueOshiroandpossiblyauthorsfromNepalandSouthAfrica.ICARMEDCOMrecommendationsonsuspensionsyndrome.HermannBruggerThepathophysiologicalmechanismofsuspensionsyndromehasbeendebatedfordecades.PartialresultsofanewItalianstudyattheEURACInstituteofMountainEmergencyMedicine(IMEM)incollaborationwiththeMedicalUniversityofInnsbruckwerepresentedbyGiacomoStrapazzon.Methods:Thesubjectsweresuspendedeitherafterrestingorafterclimbingonaclimbingwall.Thesubjectswereinstructedtostayasstillaspossible.Multiplephysiologicmeasurementsweremade.Results:Therewere20subjects.Presyncopeoccurredin30%ofsubjects.Thereweremarkedincreasesinvenouspoolinganddecreasesinheartrateinthesubjectswithpresnycopebutnotinsubjectswithoutpresyncope.Resultsweresimilarwithregardtobloodpressure.Conclusion:Themostlikelycauseofpresyncopeinsuspendedsubjectsisneurallymediated(vagusnerve).Recommendations;Syncopemaybeavoidedbyactivemovement.Victimsofsuspensionsyndromeshouldberescuedasrapidlyaspossibleandplacedinthesupineposition.Thereisnoevidenceinfavorofasemi-recumbentposition.Adiscussionfollowed.Thereisstillthemisconceptionthatpatientswithsuspensioninjuryshouldnotbeallowedtolieflat.Strapazzon,Beverlyandotherresearchershavefoundnoevidencetosupportthisandinfact,stronglyrecommendsupinepositionforpatientsassoonaspossible.Also,basedoncasereports,suspensionvictimsshouldbetreatedasemergent.InonerecentcasereportfromEuropethevictimhadbeenhangingfromaparagliderharnessaftergettingcaughtinskiliftcablesfor45minutesandwasuninjured.Thepatientwentsilentforrescuersafterlikelysyncope.Thepatientwasrescuedshortlyafterwards,wasfoundincardiacarrestanddidnotsurvive.ICARMedComrecommendationswillbedevelopedforsuspensionsyndromebasedontheselimitedstudies.TherecommendationsshouldbereadyforreviewinFall2018.Psychosocialhealthofskipatrollersandmountainrescuers.MarieNordgrenUlrikaTranaeusandMarieNordgrenfromSwedenhavebegunaqualitativeprojectinterviewingskipatrollersandmountainrescuers.Themeanageis37.5years.Swedish,ItalianandUKstudiesfoundthatvolunteerrescuerscopedbetterthanprofessionalrescuers,possiblyduetoasensethattheywereperformingaworthwhileservice.Theywillcontinueresearchto

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identifyrisksofdevelopingPTSDandpreventionstrategies.Aworkinggroupreportinginthe2018SpringandFallmeetingswithaviewtopublishingapaperwasproposed.MedicalResourceWebsiteNatalieHölzlNatalieoutlinedtheformationofaworkinggrouptodevelopaknowledgebaseforICARMEDCOMthatwasapprovedbyconsensusatthe2017Springmeeting.Theknowledgebasewillbeaninternet-basedlibrary.Thesiteshouldbeuser-friendlyforthecontributorsaswellasforthoseaccessingtheknowledgebase.AlthoughsimilarinintenttotheMSKB,thiswebsitewillbespecificallymedicaltopicsandcarryonthealreadyextensiveworkoftheICARMEDCOMalreadyavailableinmultiplepublicationsandontheICARwebsite.SHORTPRESENTATIONSKnowledgeofavalanchechecklist.GiacomoStrapazzonReference:StrapazzonG,MiglaccioD,FontanaD.KnowledgeoftheAvalancheVictimResuscitationChecklistandUtilityofaStandardizedLectureinItaly.WildernessEnvironMed2017[epubaheadofprint].AretrospectivestudyinItalyhadshownlowadherencetoavalancheguidelines.Thisstudywasapre-andpost-lecturesurveyduring8mountainrescuecoursesinItaly.Priortothecourse36%oftheparticipantsknewthecorrectburialtimecutoffforwithholdingCPRinacompletelyburiedvictimwithanobstructedairway.Thisincreasedto84%afterthecourse.SurveyofManagementofSevereHypothermiabyMountainRescueTeams.AndreijGorkaReference:PodsiadioP,DarochaT,KosinkiS,etal.Severehypothermiamanagementinmountainrescue:asurveystudy.HighAltMedBiol2017[epubaheadofprint].Aim:Toassesswhethermountainrescueteams(MRTs)areabletofollowguidelines.Methods:Aquestionnairewassentto123MRTsin27countries.Results:Therewasalowrateofreturnofquestionnairesandalowincidenceofseverehypothermia.Manyteamswerenotequippedwithelectrocardiographic(ECG)monitoring,automatedexternaldefibrillators(AEDs)orlow-readingthermometers.Somepatientsweresenttolocalhospitalsratherthantohospitalscapableofextracorporealrewarming(ECLS).ThemajorityofMRTsarenotequippedtoprovideAdvancedLifeSupport(ALS)especiallyinvictimswhoareincardiacarrest.OptimizingavalancherescuestrategiesusingaMonteCarlosimulationapproach.PeterPaalandManuelGensweinThisisapaperoutliningastatisticalsimulationtodeterminebestchanceofsurvivalformultiplevictimsofavalancheburial.Gensweinhasarguedthatperforming20-30minutesofCPR(asinmostexistingprotocols)onanavalanchevictimincardiacarrestsignificantlyreducesthe

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chancesofsurvivalforotherburiedvictimsinthesameaccident.HearguesthatCPRshouldbeattemptedfor5-7minutesonlyandifthereisnoreturnofspontaneouscirculation,attemptstofindothervictimsshouldtakepriority.Thisisforcircumstanceswhentherearemorepatientsthanrescuers.Expecttohearmoreonthistopicinfuturerescucitationguidelines.CausesofdeathinavalanchefatalitiesinColorado:atwenty-yearreviewAlisonSheetsThestudydeterminedtheproportionofavalanchedeathsduetotraumainColoradofrom1995-2015.Theresultsshowedthat29%offatalitieswerefromtrauma,higherthaninanypreviousstudy.Multisystemtraumaandheadtraumacausedoverhalfoftraumadeaths.MostEuropeandatahadmuchlowerratesoftrauma.ThedifferencemaybemorerelatedtoresearchtechniquesthantotheactualavalanchetraumafatalityratesinEurope.FORTHCOMINGICAREVENTS2018April25-28:ICARMedComSpringmeeting;Tromsø,Norway.Lead:JuliaFieler(juliafieler@gmail.com);maintopic–hypothermia.October17-20:ICARGeneralAssembly;Chamonix,FranceNotetheextendedformat–conferencestartsonWednesday.„Pre-conference“workshopwillbeonFriday.Itisthe70thanniversaryofICARNovember21-24:ISMMWorldCongressofMountainMedicine;Kathmandu,Nepal.ICARwilltaketheleadinestablishingtheMountainEmergencyMedicineprogramme.2019Spring(datesTBD):ICARMedcommeeting;Bolzano,ItalyProposedtobeatthenewTerraXcubeenvironmentalsimulationchamber.October9–13:ICARGeneralAssembly;Zakopane,Poland(Classicformatwithpre-conferencedayonWednesday)