By Jeff Boyd, UIAGM ACMG CCFPEM ABEM, Mountain Guide, Emergency Physician.
As a mountain guide, an emergency physician and a member of the CMH Operations Team I have been working with the International Commission for Alpine Rescue (ICAR) on an array of different projects. ICAR is the forum for rescue organizations from 56 countries, has been in the game for 61 years and incorporates 4 specialty commissions - Alpine Medicine, Avalanche Rescue, Air Rescue and Terrestrial Rescue. As the official Canadian delegate to the commission for Alpine Medicine - aka the ICAR MedCom - I work on a spectrum of research on avalanche safety, rescue and resuscitation.
In 2007 we completed and published a study examining for benefit from avalanche safety devices and found that transceivers and airbags reduced mortality in the European population analyzed.(1) The author group did, however, identify the limitation that “this study reflects the specific situation of avalanche accidents in the European Alps and should not simply be transferred to other regions, where a different set of risk factors may operate”. One of those factors would be a difference in the relative risk of mortality from asphyxia versus other causes such as trauma, as the airbag used in our study only protects against asphyxia by reducing complete burials.
Therefore, we put together a highly-qualified Canadian research team to determine, as a primary objective, the relative contributions of trauma and asphyxia to avalanche mortality in our setting. We were blessed with a very comprehensive database of avalanche details from the Canadian Avalanche Centre and I ploughed painstakingly through boxes of files at the BC Coroners Service and the Alberta Medical Examiners Office for mortality data. In the 21 years considered we found 204 fatalities, a series 4 times larger than any previous study and very robust for meaningful conclusions. We found trauma was the cause of death in 24% of fatalities but another 10% of supposed asphyxia deaths suffered lethal trauma bringing the total proportion of trauma to 34%. This is 6 times greater than the reported rate of trauma in Europe. Trauma victims hit trees in 68% of cases and single-system trauma is inflicted on the chest in 46% and the head in 42% of cases. Surprisingly, only 48% of trauma fatalities are buried while, of course, all asphyxia victims are buried.
Helicat (helicopter and snowcat) skiers and snowboarders are 7 times more likely to suffer trauma as we spend a substantial amount of time in treed terrain and the proportion of asphyxia is reduced by rapidity of rescue. Conversely, snowmobilers suffer less trauma due to their preference for open terrain.
Our study(2) was published in March 2009 and in an accompanying editorial Professor Hermann Brugger, the president of the ICAR MedCom, recommended an airbag design that protected the chest, neck and head and additionally the wearing of helmets.(3)
We presented our data to the ICAR General Assembly in Zermatt in September 2009 and received considerable interest from countries, such as Norway, where recreationists spend time skiing and boarding in the trees. Professor Brugger then presented an international overview and concluded “safety devices should aim to prevent asphyxiation, but also should be designed to avoid traumatic injuries”.
The Canadian Avalanche Centre has initiated a prospective study examining for benefit from all varieties of safety devices but this study will take some time to accrue sufficient data to make statistically significant conclusions. Our study on European data took 14 years of reporting to come to reliable findings.
The evidence to date, indirect as it is, indicates that the airbag design should incorporate protection from trauma if they are to be effective in our setting, specifically helicat skiing using treed terrain in Western Canada. Considering all this we should proceed thoughtfully in the adoption of technologies such as airbags.
In the end, no energy should be diverted from the sophisticated CMH avalanche safety program that minimizes avalanche involvement in the first place.
Have a very enjoyable heliski season!
1. Brugger H, Etter HJ, Zweifel B, et al. The impact of avalanche rescue devices on survival. Resuscitation. 2007 Dec;75(3):476-83.
2. Boyd J, Haegeli P, Abu-Laban RB, Shuster M, Butt JC. Patterns of death among avalanche fatalities: a 21-year review. CMAJ. 2009 Mar 3;180(5):507-12.
3. Brugger H. Should strategies for care of avalanche victims change? CMAJ. 2009 Mar 3;180(5):491-2.
(The full-text versions of both our study and the editorial by Professor Brugger can be found on the open-access Canadian Medical Association Journal
by searching with the term “avalanche”)
It would seem that Old Man Winter is slowly taking over the BC interior. I’ve received photos from almost every CMH Heli-Ski area this week and it is starting to look familiar again to our skiers and boarders. The flowers are gone. No more green grass. Lots and lots of white space! If you are a CMH Kootenay skiier, this pic here likely looks more familiar to you now than it would have 6 weeks ago!
It also means wrapping up the maintenance projects. Putting away the paint cans and putting the finishing touches on the long list of things to do to get the lodges ready to receive guests again.
Staff has been hired, training sessions are planned, pre-season meetings have been scheduled, the food (and wine!) has been sent up to the lodges and the shops are almost set up.
How many days until you climb into a 212?
And how many of you are looking ahead to Heli-Skiing and Heli-Boarding in 2011already? Next Thursday, November 12 marks the start of our 2011 selling season. Yes, that’s right. For those of you after specific weeks and lodges, you need to pick up the phone at 8:30AM MST on November 12.
I asked CMH Reservations Manager, Nicole Koester if she has any tips for skiers and boarders for November 12. Besides the obvious of have your credit card ready, as a deposit is due at the time of booking, her number one piece of advice – have more than once choice of dates to avoid disappointment.
So it’s time to start working on your Heli-Ski & Heli-Boarding Wish List for 2011. Before you do, you’ll need to download the 2011 CMH pricelist.
Dr. Delia Roberts is an Exercise Physiologist who has worked with Canadian Olympic athletes and CMH Heli-Ski guides to design an injury prevention program. Here she offers some advice on preparing, physically, for a Heli-Ski vacation.
How to Build Your “Legs (and Back) of Steel”
“Legs – don’t fail me now!” Ever felt that way when faced with a steep tree-run? Or had to go in early on a perfect powder day because your back is aching? Luckily some pre-season exercises can help keep you feeling strong for your entire CMH Heli-Skiing adventure.
Here are some things even the busiest of us can do to prepare for a great ski season:
- Powder skiing relies on your thigh and butt muscles. Walking or running stairs is an excellent way to work on these. Going up will increase your endurance; going down will strengthen your legs. Take the stairs whenever you can, working up to 6 repetitions of 8 flights of stairs.
- Lower back pain is among the most common reasons for sitting out a day. Skiing requires a strong central core, as your back and abdominal muscles create the platform (fulcrum) for weight transfer during turns. Good programs for core strength include Pilates and Yoga, but focus on proper technique, rather than big strength gains, so your body learns the correct muscle patterns.
- Even the strongest skier is susceptible to injury with sudden force increases, i.e. falling or landing a jump. To improve your protective reflexes, imagine you are in the centre of a box with an X in it. Run or hop 2 steps forward along the X, to the top corner of the box, then 2 steps back to the centre. Repeat this along all limbs of the X, moving backwards along the limbs that are behind you.
These will help you prepare for your best skiing experience ever. However, it is always wise to consult with your physician prior to beginning any new training regimen.
What are you doing to prepare for the upcoming Heli-Ski season? Share your tips here with your fellow skiers. For more information on these exercises or more advanced programs, contact Dr. Delia Roberts at firstname.lastname@example.org or leave your comments here.
Last week I had a beer with everybody's favourite CMH Shop Guy, Bruce Rainer and we chatted about how to get the best out of a Heli-Boarding trip.
Bruce had some great suggestions on little things that will make a big difference.
- If you are using your own board, set your bindings as far back on the deck as possible to keep your nose/tip high out of the pow. This will save your front leg muscles.
- Bring a binding tool and check every screw and bolt on your board every morning, once at lunch and at the end of the day.
- Have a spare parts kit with you out on the hill for your board and bindings. Make sure you have one of every screw, bolt, buckle, ratchet, ladder and strap.
- In deep pow, though it is tempting, stay within one or two turns of another ski or board track so if you hit a flat spot you can duck into it and maintain your speed.
- The secret to having fun in the pow is terrain recognition. At all times be aware and look far ahead for terrain traps and potential traverse areas. Stay near the back of your group and if you see your guide breaking trail, stop immediately, stay as high upslope as possible and let the group make a trail. When they are done, and hopefully off the traverse, jet. This will help you from having to unstrap and posthole and/ or walk and exhausting yourself.
Like everything in life, don't be afraid to ask questions. Ask the shop manager and your guide for other hints, tips and suggestions that will improve your Heli-Boarding experience.
What else would you like to learn from Bruce? Who else would you like to hear from? Drop us a line and let us know what you'd like us to investigate.