Do alpine skiers and snowboarders wear protective equipment more often after an accident?

QUESTIONS UNDER STUDY/PRINCIPLES: Analysis of changes in the behaviour of wearing protective equipment by alpine skiers and snowboarders after injury, performed at a level I trauma centre in Switzerland.

Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage?

Background Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols. Methods Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern. Results Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001). Conclusion The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority.

The Bernese Hypothermia Algorithm: a consensus paper on in-hospital decision-making and treatment of patients in hypothermic cardiac arrest at an alpine level 1 trauma centre

INTRODUCTION: Guidelines for the treatment of patients in severe hypothermia and mainly in hypothermic cardiac arrest recommend the rewarming using the extracorporeal circulation (ECC). However,guidelines for the further in-hospital diagnostic and therapeutic approach of these patients, who often suffer from additional injuries—especially in avalanche casualties, are lacking. Lack of such algorithms may relevantly delay treatment and put patients at further risk. Together with a multidisciplinary team, the Emergency Department at the University Hospital in Bern, a level I trauma centre, created an algorithm for the in-hospital treatment of patients with hypothermic cardiac arrest. This algorithm primarily focuses on the decision-making process for the administration of ECC. THE BERNESE HYPOTHERMIA ALGORITHM: The major difference between the traditional approach, where all hypothermic patients are primarily admitted to the emergency centre, and our new algorithm is that hypothermic cardiac arrest patients without obvious signs of severe trauma are taken to the operating theatre without delay. Subsequently, the interdisciplinary team decides whether to rewarm the patient using ECC based on a standard clinical trauma assessment, serum potassium levels, core body temperature, sonographic examinations of the abdomen, pleural space, and pericardium, as well as a pelvic X-ray, if needed. During ECC, sonography is repeated and haemodynamic function as well as haemoglobin levels are regularly monitored. Standard radiological investigations according to the local multiple trauma protocol are performed only after ECC. Transfer to the intensive care unit, where mild therapeutic hypothermia is maintained for another 12 h, should not be delayed by additional X-rays for minor injuries. DISCUSSION: The presented algorithm is intended to facilitate in-hospital decision-making and shorten the door-to-reperfusion time for patients with hypothermic cardiac arrest. It was the result of intensive collaboration between different specialties and highlights the importance of high-quality teamwork for rare cases of severe accidental hypothermia. Information derived from the new International Hypothermia Registry will help to answer open questions and further optimize the algorithm.

Carbon sequestration in Himalaya's alpine meadows: Mitigating cropping encroachment on pastures in Northern Pakistan

Rangelands store about 30% of the world’s carbon and support over 120 million pastoralists globally. Adjusting the management of remote alpine pastures bears a substantial climate change mitigation potential that can provide livelihood support for marginalized pastoralists through carbon payment. Landless pastoralists in Northern Pakistan seek higher income by cropping potatoes and peas over alpine pastures. However, tilling steep slopes without terracing exposes soil to erosion. Moreover, yields decline rapidly requiring increasing fertilizer inputs. Under these conditions, carbon payment could be a feasible option to compensate pastoralists for renouncing hazardous cropping while favoring pastoral activities. The study quantifies and compares C on cropped and grazed land. The hypothesis was that cropping on alpine pastures reduces former carbon storage. The study area located in the Naran valley of the Pakistani Himalayas receives an annual average of 819 mm of rain and 764 mm of snow. Average temperatures remain below 0°C from November to March while frost may occur all year round. A total of 72 soil core samples were collected discriminating land use (cropping, pasture), aspect (North, South), elevation (low 3000, middle 3100, and high 3200 m a.s.l.), and soil depth (shallow 0-10, deep 10-30 cm). Thirty six biomass samples were collected over the same independent variables (except for soil depth) using a 10x10x20 cm steal box inserted in the ground for each sample. Aboveground biomass and coarse roots were separated from the soil aggregate and oven-dried. Soil organic carbon (SOC) and biomass carbon (BC) were estimated through a potassium dichromate oxidation treatment. The samples were collected during the second week of October 2010 at the end of the grazing and cropping season and before the first snowfall. The data was statistically analyzed by means of a one-way analysis of variance. Results show that all variables taken separately have a significant effect on mean SOC [%]: crop/pasture 1.33/1.6, North/South 1.61/1.32, low/middle/high 1.09/1.62/1.68, shallow/deep 1.4/1.53. However, for BC, only land use has a significant effect with more than twice the amount of carbon in pastures [g m-2]: crop/pasture 127/318. These preliminary findings suggest that preventing the conversion of pastures into cropping fields in the Naran valley avoids an average loss of 12.2 t C ha-1 or 44.8 t CO2eq ha-1 representing a foreseeable compensation of 672 € ha-1 for the Naran landless pastoralists who would renounce cropping. The ongoing study shall provide a complete picture for carbon payment integrating key aspects such as the rate of cropping encroachment over pastures per year, the methane leakage from the system due to livestock enteric fermentation, the expected cropping income vs. livestock income and the transaction costs of implementing the mitigation project, certifying it, and verifying carbon credits. A net present value over an infinite time horizon for the mitigation scenario shall be estimated on an iterative simulation to consider weather and price uncertainties. The study will also provide an estimate of the minimum price of carbon at which pastoralists would consider engaging in the mitigation activity.

Contamination of Alpine snow and ice at Colle Gnifetti, Swiss/Italian Alps, from nuclear weapons tests

Plutonium is present in the environment as a consequence of atmospheric nuclear tests, nuclear weapons production and industrial releases over the past 50 years. To study temporal trends, a high resolution Pu record was obtained by analyzing 52 discrete samples of an alpine firn/ice core from Colle Gnifetti (Monte Rosa, 4450 m a.s.l.), dating from 1945 to 1990. The 239Pu signal was recorded directly, without decontamination or preconcentration steps, using an Inductively Coupled Plasma - Sector Field Mass Spectrometer (ICP-SFMS) equipped with an high efficiency sample introduction system, thus requiring much less sample preparation than previously reported methods. The 239Pu profile reflects the three main periods of atmospheric nuclear weapons testing: the earliest peak lasted from 1954/55 to 1958 and was caused by the first testing period reaching a maximum in 1958. Despite a temporary halt of testing in 1959/60, the Pu concentration decreased only by half with respect to the 1958 peak due to long atmospheric residence times. In 1961/62 Pu concentrations rapidly increased reaching a maximum in 1963, which was about 40% more intense than the 1958 peak. After the signing of the "Limited Test Ban Treaty" between USA and USSR in 1964, Pu deposition decreased very sharply reaching a minimum in 1967. The third period (1967-1975) is characterized by irregular Pu concentrations with smaller peaks (about 20-30% of the 1964 peak) which might be related to the deposition of Saharan dust contaminated by the French nuclear tests of the 1960s. The data presented are in very good agreement with Pu profiles previously obtained from the Col du Dome ice core (by multi-collector ICP-MS) and Belukha ice core (by Accelerator Mass Spectrometry, AMS). Although a semi-quantitative method was employed here, the results are quantitatively comparable to previously published results.