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 Post subject: Multiple burials and priorities
PostPosted: Thu Jan 24, 2013 4:59 am 
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If 2 in a group of 4 gets caught in a slide and the first is located relatively shallow should both start to dig to get the victim out quickly or should one go straight to search for the last victim?

What If 2 in a group of 5 get caught?

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 Post subject: Re: Multiple burials and priorities
PostPosted: Thu Jan 24, 2013 5:54 am 
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Too many unknowns.

Can you dig the first victim out in two minutes? Or 15 minutes?

How much time did you spend locating the first victim? 5 minutes, 20 minutes?

You don't know how deep the second victim is buried do you? He may be even easier to dig out.

The second victim may be really difficult to locate, how big is the slide? Have you seen him get caught?

Is help on the way? You may have to start doing CPR on the first victim immediately after you get him out, that takes two people really... The second victim may be breathing on his own...

So I guess it's different in a lot of situations.

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 Post subject: Re: Multiple burials and priorities
PostPosted: Thu Jan 24, 2013 6:33 am 
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Good question! Awful situation, problems in every scenario.

I personally would want two people to stat digging and as soon as they strike gold the 2nd guy goes on a search and let's the first guy finish up, then apply resources as needed from there on.

My reasoning is that CPR so rarely does any good and fast recovery is so important that you may as well get on with it. That said, there was a case recently in the Wasatch were someone caught in a pretty gnarly slide stopped breathing and was brought back (!).


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 Post subject: Re: Multiple burials and priorities
PostPosted: Thu Jan 24, 2013 7:35 am 
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I think that if the first person isnt too deep,a lot of resources should be put on getting him/her out as quickly as possible. when that victim has free airways one should start the next search.

Bringing an unconsius non breathing person back just with basic CPR has a low success rate without a heart starter,and CPR basically is a way to help basic body functions until the arrival of proffesionals.

Multiple burials would be an awful situation,i think its wise to think about different scenarios and discuss it with your touring buddies.arrange a sitution like this for training might be a good idea.

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 Post subject: Re: Multiple burials and priorities
PostPosted: Mon Jan 28, 2013 11:26 pm 
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Location: Truckee/San Francisco/Lassen
Let's hope we're all making good decisions and that we never find ourselves digging out one partner, let alone two!

Like most things in life, I don't think there is a clear-cut answer. Like Ieism said, there are a lot of variables.

Modern thinking, recognizing that digging is the most time consuming part of the companion rescue process, is to triage the digging based on burial depth. Find everyone first, keep a probe on each victim, then dig out the more shallow buried victim first.

But...if the first victim is only buried 40 cm...dig! get him/her out fast!

How good are the rescuers at multiple burial searches? If you suck, or if the second signal is going to confuse you, it may make sense to dig the first victim out, turn off their beacon, then go on to the second victim.

Of course the priorities may change with the number of rescuers. Or with the number of rescuers who are proficient with companion rescue. Do you have 3 people who can all perform multiple burial rescues? Or 3 people who saw a video once, and only play "hide and seek" with a beacon? You have to be able to think it through on your own, given the unique set of circumstances you find yourself in.

Do you know the "three circle method" of beacon searching for multiple burials? You should learn it. Even if you have a fancy, schmancy beacon with a marking feature. It works with all beacons. It works with the beacon you borrow because you left your fancy marking beacon at home. Check out this paper, written by Steve Christie of Backcountry Access Two things stand out to me in this paper. First, Steve repeatedly says the focus on education should be on single burials, and practicing those until you are proficient. Second, in the conclusion he says, "It is unlikely a single searcher can save multiple lives in a multiple burial if they are in a remote area without helicopter assistance. This is because the majority of time spent on an avalanche rescue is spent excavating the victim. Without additional manpower, it is difficult for a single rescuer to make more than one live recovery."

Me? I'd rather travel with someone who is super-proficient with single burial companion rescue, than someone who kind of gets it, and practices multiple burials rather than getting good with a single burial.

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 Post subject: Re: Multiple burials and priorities
PostPosted: Tue Jan 29, 2013 4:09 am 
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Good inputs! I think to triage the digging would only be option in a smaller slide?.in a bigger i would think the moving around would take too much time unless you immediatly get a signal after flagging the first.

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 Post subject: Re: Multiple burials and priorities
PostPosted: Tue Jan 29, 2013 7:43 am 
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Richard Bothwell wrote:
...Modern thinking......Find everyone first, keep a probe on each victim, then dig out the more shallow buried victim first.....


Is this true, can anyone confirm? \Perosnally I think finding all victimes before any digging is a bad move.

The last few classes I've taken I've been told the accepted thing is to dig as soon as you find a victim (the instructor actually added a disclaimer, and said that if you dig out the other guy before him, no hard feelings but he would come back from the grave and "haunt your ass").

Personally, I would take 30 seconds to scan the area and make sure there isn't any really obvious clues for a near-surface or partial burial (hand, foot, etc). If so, I would leave the deeper burial (probe in place) and work on the easier victim, and hope I'll one day find peace with myself.


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 Post subject: Re: Multiple burials and priorities
PostPosted: Tue Jan 29, 2013 1:24 pm 
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...the can of worms is opened.... I'm going to try to keep this short, so the quick answer is that the "modern thinking" I referenced was from a paper submitted at the 2008 ISSW by Genswein, et al, which is linked below. They say to leave deep victims and find and excavate shallow victims, if resources are limited. Hey, if you have 10 people looking for 2 people, dig 'em all out as you find them. If you and one other person are looking for multiple burials, triage by burial depth.

The longer answer...

I'm going to start and finish this post by saying the key to success in finding buried victims is to practice (and apply) the complete companion rescue process. Not just playing hide and seek with a beacon. Practice is the key.

Think about this for a minute or two.. The average burial depth is roughly 1.2 meters (about 4 feet) . The amount of snow you have to move to excavate someone buried 1.2 meters is about 1.5 tons. that's 3000 pounds. 1362kg. 214 stone. However you measure it, it's a lot of snow, and it takes a lot of time. Shoveling is the slowest part of the average rescue.

As hard as it may be to "walk away" from a (deep) probe strike, think how devastating it would be to find out that you spent 10 minutes digging that deeply buried victim out, who was found dead while the second victim, also found dead, was only 30 cm under the surface, and most likely would have lived if he/she was excavated first. If you have enough rescuers to start digging that first victim while you're looking for the second, go for it! but if you find the second is buried shallow, focus on digging him/her out first!

The universal answer in an avalanche class is "it depends". What's important to us is what it depends on. As several people have pointed out, there are many variables, which makes the decision making process very situational. How big is the search area? How many rescuers are there? How many missing? How long have victims been buried? How deeply? Are there visual clues to victims' locations? Searching for one victim is a crappy situation to be in. Searching for multiples? I sincerely hope I never have to.

Check these papers out:
Bruce Edgerly's paper, "Revisiting Multiple Burial Statistics; US Avalanche Incidents 1995-2007"
and
Genswein et al, Remote Reverse Triage in Avalanche Rescue
In this paper, on page 67, section 6 it lays out their recommendations as:
6. RECOMMENDATION FOR REMOTE REVERSE TRIAGE IN AVALANCHE RESCUE
In case a rescue mission suffers from a shortage of resources, the application of remote reverse triage is recommended in the following sequence:
1: Prioritize sectors of the avalanche with higher survival chances: No forest, no crevasses, no seracs, and no high cliffs
2: Life saving measures for non- or partially buried subjects
3: Search for buried subjects with “increased survival chances” based on vital signs (where available).
4: Excavate buried subjects with “increased survival chances” in shallow to medium burial depth.
5: Search and excavate buried subjects with “unknown survival chances” in shallow to medium burial depth.
6: Excavate buried subjects with “increased survival chances” in high burial depth.
7: Excavate buried subjects with “unknown survival chances” in high burial depth.

So, they are saying to excavate shallow to medium burial depth victims (steps 4 and 5) before going on to excavate high burial depth victims (steps 6 and 7)

And on page 68, section 8 they say, "Entering the field from below, the closest buried subject was very deep so that the companion rescuers decided to directly proceed to the remaining two buried subjects. The head access times speak slearly: Starting to dig at the first buried subject with high probability would have lead to a very bad outcome for all three buried subjects.
Thanks to a properly applied triage decision, two subjects benefited from head access times with reasonable chances of survival."

In other words they are saying that by skipping the deeply buried victim, and focusing on the shallower victims, they had good results for the two shallow victims, and if the searchers had focused on the closest victim, who was buried deeply, it was likely to be bad for all three.

singlewhitecaveman wrote:
Personally, I would take 30 seconds to scan the area and make sure there isn't any really obvious clues for a near-surface or partial burial (hand, foot, etc). If so, I would leave the deeper burial (probe in place) and work on the easier victim, and hope I'll one day find peace with myself.

Agreed! Searching for visual clues is an important step in the complete companion rescue process. If you're not familiar with it, download a copy of the AIARE Companion Rescue Process here: Companion Rescue Reference Card This companion rescue process chart is also inside the blue AIARE field book, which is probably the single best tool we have to plan and execute backcountry trips in avalanche terrain.

If you have the resources, send one person to check on all the clues. If you pull on a ski pole and it pulls back...you found Jimmy (Jimmy is my victim in all my classes). If Jimmy is on the surface or partially buried you have it easy..turn off his beacon and now you're just doing a single burial search.

Regardless of whether it's one, two, or 10 victims, it's a crappy situation. Quoting Doug Chabot," if an avalanche happens, mistakes were made...you blew it. Now you're just doing mop up work." Let's avoid doing the mop up work.

It may or may not be relevant to note that I am an AIARE level 1 and 2 instructor. I'm not teaching a class though, I'm just another splitboarder, putting in my 2¢ on an online forum. We're all being educated, whether we're first time splitboarders, guides, or instructors. The learning process never ends.

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