[New perspectives of avalanche disasters. Phase classification using pathophysiologic considerations]

This study comprises an analysis of the data on 332 persons totally buried by avalanches in Switzerland between 1981 and 1989. The survival rate was calculated with the aid of a computer-assisted estimation procedure according to Turnbull. The curve pattern was interpreted according to pathophysiological considerations, on the basis of which the time course of the battle for survival was divided into 4 phases: 1) Survival phase: until 15 minutes after burial under the snow masses. The survival probability amounts to 93% and is, thus, higher than so far assumed. Almost all those buried survived this period of the time provided they were not fatally injured and received first aid. 2) Asphyxia phase: duration of burial under the avalanche from 15 to 45 minutes. The probability of survival sank dramatically during this period from 93% to about 25% (fatal kink of the survival probability curve). Those buried under the snow without an air pocket die of acute asphyxia (the point of no return) and the mortality rate reaches its maximum in this phase. 3) Latent phase: the period as from 45 minutes following the avalanche until the time of rescue. This phase is survived only in the presence of an air pocket. With sufficient oxygen reserves and freedom of thoracic movement a "phase of relative safety" occurs, whereby the survival probability diminishes further only slowly. The first deaths due to hypothermia arise after 90 minutes. 4) Rescue phase: from the time of extrication from the snow until arrival in hospital. There is an increased risk of a fatal outcome during the rescue procedure and immediately afterwards through augmented hypothermia.(ABSTRACT TRUNCATED AT 250 WORDS)