The impact of a dedicated checklist on the quality of onsite management of critically buried avalanche victims in cardiac arrest in a Swiss helicopter emergency medical service

Abstract

Abstract Background The management of avalanche victims in cardiac arrest (CA) is a challenging situation for rescuers. Despite existing specific management algorithms, previous studies have reported poor compliance with international guidelines and incomplete documentation and transmission of the information required for patient management. The Avalanche Victim Resuscitation Checklist (AVRC) was developed in 2014 in response by the International Commission for Mountain Emergency Medicine. Our aim was to assess the impact of the AVRC on the quality of onsite management of critically buried avalanche victims in CA, i.e. the compliance of management with international guidelines and the completeness of documentation of avalanche specific information. Methods We assessed compliance and documentation in a Swiss helicopter emergency medical service (HEMS) between January 2010 and April 2020. Victims buried for more than 24 h were excluded. Results In the 10-year study period, 87 critically buried avalanche victims in CA were treated by the HEMS, 44 of them after the introduction of the AVRC. Enough information was available to assess management compliance in over 90% of cases (n = 79). Inadequate management (n = 25, 32%) and incomplete documentation occurred more often in patients with a long burial duration. After the introduction of the AVRC, the compliance of patient management with the guidelines increased by 36% (from 59 to 95%, p < 0.05) and led to complete documentation of the required information for patient management. Conclusions The use of the AVRC improves the quality of management of critically buried avalanche victims in CA and ensures complete documentation of avalanche specific information. Quality improvement efforts should focus on the management of avalanche victims with a long burial duration. The use of the AVRC enables identification and appropriate treatment of patients with hypothermic cardiac arrest.

Keywords

• Avalanche
• Cardiac arrest
• Checklist
• Quality
• Compliance
• Documentation