North-Norwegian avalanche victims: a retrospective observational study

Abstract

Rescue and treatment of Norwegian avalanche victims is based on international guidelines from Central European and North American studies. However, the distribution of death causes in avalanches in our country has never been investigated earlier. For this reason we studied the 30 avalanches with fatal outcome in North Norway and Spitzbergen during 1996-2012. We wanted to assess the feasibility of retrospective record research to study the causes of death. We searched reports from the rescue teams and the medical records from institutions that received the avalanche victims to determine the most likely cause of death. During the 16 years studied, 48 persons died in 30 avalanche accidents. 39 of theses (81%) were killed during outdoor recreational activities, 5 (10%) in vehicles on roads and 4 (8%) in buildings. Only 5 (10%) casualties underwent autopsy. Asphyxia was the most common cause of death with 22 (46%) of the fatalities. Trauma was the main cause of death in 8 (16%) cases, drowning in 5 (10%), and the diagnosis mors subita was used in 2 cases (4%). We could not find appropriate documentation from 9 (19%) fatalities. The majority of the casualties in the outdoor activity group were men (77%) and the mean age was 38 years. The study shows a correlation between being caught in topographical traps and severe trauma, and between not being buried in the snow and trauma. 35 casualties were pronounced dead at the scene, and the clinical documentation of these cases was in several cases not sufficient to reassess the cause of death. Despite some missing data, we conclude that the incidence of severe trauma in Norwegian avalanche casualties is higher than previously expected. This may suggest that a relatively high proportion of the fatalities cannot be rescued alive, even with rapid extrication from the avalanche. A prospective national systematic registry, focused on the patophysiology of avalanche injuries with post mortem imaging studies and autopsies could help to improve our knowledge of death mechanisms in the future.