Severity and pattern of injury in survivors of alpine fall accidents

Few data are available on the medical aspects of fall accidents in mountainous terrain. Therefore, we report the severity and pattern of injury in 97 survivors of a major fall in Alpine terrain. Twenty-eight of 97 victims (29%) had severe or critical multisystem trauma, with an injury severity score >/=14, the incidence increasing to 23 out of 28 (82%) in individuals with falls exceeding 50 m. Fractures of the extremities and the sacropelvic region (n = 55) were the most common injuries. Seventeen of 21 spine fractures (81%) occurred in the thoracolumbar region. Rib fractures were found in 17 victims, in eight of them (47%) with an accompanying pneumothorax. Critical head trauma with a Glasgow Come Scale below 9 was rather uncommon (n = 6); abdominal visceral injuries were rare (n = 2). The pattern of injury observed in our study suggests a feet- or side-first body position at impact in the majority of individuals surviving Alpine fall accidents. Furthermore, it indicates a direct impact, rather than deceleration type mechanism of injury. Because of the high incidence of severe multisystem trauma, major fall in Alpine terrain should be used as triage criterion for the dispatch of an advanced trauma life support unit and direct transfer of the victim to a trauma center. Considering the high incidence of fractures, measures for adequate immobilization and analgesia will generally be necessary before the difficult evacuation from the site of the accident can be started.