Avalanche Survival Chances
Markus Falk 1
Hermann Brugger 2
Liselotte Adler-Kastner 3
SIR - The risk of triggering an avalanche makes ski touring the most dangerous winter
sport, claiming about 150 lives annually in the Alps alone1.
Using data2 on all avalanche disasters in Switzerland from
1981 to 1991, we have calculated survival probability in relation to the length of time
buried under the snow. At 15 min the survival probability (92%) is markedly higher than
previously assumed, but the survival function then drops precipitously to only 30% at 35
min, representing deaths through acute asphyxiation. Thereafter, survival is impossible
without an air pocket. After 90 min, victims gradually succumb to hypoxia and hypothermia
unless the air pocket is open to the outside. This reassessment of survival probability
has far-reaching implications for recommended rescue strategies, emphasizing the
importance of rapid and efficient help by uninjured companions and explaining the low
success rate achieved by organized rescue parties.
We have analysed precise, minuted rescue data2. Of 422 buried
skiers, 241 (57%) were dead on extrication. The mean depth of burial under the snow (head)
was 105+/-85 cm (s.d.). An analysis of the relationship between rescue outcome, depth of
burial and time of extrication (data not shown) indicates that there is no direct
influence of depth of burial on survival, and so the poor results on extrication of
deeply-buried skiers merely reflect the generally prolonged rescue time involved.
All rescue directives to date are based on the survival function proposed by Schild3. But Brugger and Falk's4
computer-assisted procedure5 applied to the avalanche rescue
data2 allows estimation of survival probability with far
greater accuracy. The fundamental difference in survival function (a
in the figure) lies in the steep drop of the present curve at 15 min until 35 min,
with a further dip commencing at about 90 min, as compared with the gradual exponential
decrease in survival probability assumed by Schild.
The only finding giving grounds for optimism is that the initial survival probability is
much higher than previously assumed. Indeed, of the 123 skiers extricated within 15 min,
only 8 were dead and, moreover, only 2 had died of asphyxia (extrication times 10 and 15
min), whereas the remaining 6 skiers had all sustained fatal injuries during descent of
the avalanche. The survival probability then plummets from 92% at 15 min to only 30% at 35
min, in contrast to the hitherto-accepted gentle decrease from 67 to 55% (ref. 3) over the
same period. The corresponding pronounced increase in cumulative hazard function (b in the figure) is comparable
with the well-known observation of rapid decline in probability of successfully
resuscitating acutely asphyxiated patients. This fatal drop in survival function probably
results from acute asphyxiation of all victims without an air pocket.
The virtually constant survival (a in the figure) and cumulative hazard (b)
functions between 35 and 90 min indicate that for skiers still alive in a fortuitous or
self-created air pocket at the beginning of this phase, the risk of dying is minimal for
the next 55 min. It is known that the snow cover prevents rapid hypothermia (maximally 3
degrees C per hour)6 and that oxygen consumption decreases
significantly with lowering of the body temperature and loss of consciousness 7.
The survival probability then falls from 27% at 90 min to only 3% at 130 min (a
in the figure), mirrored by the increase in hazard function (b). Hence, victims
with a'closed' air pocket eventually succumb between 90 and 130 min after descent of the
avalanche. Death is due to a combination of "slow asphyxia" and hypothermia.
(The decrease in body core temperature appears to be greatly slowed down if oxygenation is
adequate, especially with an 'open' air pocket.) Thus, in the absence of fatal injuries,
speed of extrication from the avalanche and existence of an air pocket are the decisive
factors determining survival. The fact that there was no decline in the annual mortality
rate between 1981 and 1991, despite increasing standards of professional rescue techniques
and medical emergency back-up services, is largely explained by the difficulties in
mobilizing mountain rescue teams within the brief optimum survival time.
Reduction of the present high mortality rate depends on increasing the proportion of
skiers freed within 15 min, which, realistically, means by uninjured companions.
Professional help should be sought immediately after, but not during, this critical phase.
We believe that mountaineering organizations should teach skiers mandatory safety
precautions, as well as the basic techniques of finding, extracting and resuscitating
avalanche victims. At present, many skiers carrying search appliances (transceivers) are
insufficiently familiar with their use, with fatal consequences. Another essential step
would be to develop self-help techniques to facilitate creation of a life-saving air
pocket, which would give the skier a relatively safe haven for about 90 min which is the
new time goal set for professional rescue. However, optimal equipment and experience
provide no life guarantee, and may induce a false sense of security. Prophylaxis remains
the only reliable safeguard for the individual.
a, Survival function and b, cumulative hazard function, of totally buried
avalanche victims, 1981-91. The survival function (solid line) is shown in comparison with
the hithertoaccepted function proposed in ref. 3 (dashed line). Both show the cumulative
probability of survival under the snow in relation to time since burial. Our assessment of
the survival function was based on a non-parametric estimation procedure in ref. 5,
whereby the extrication times are entered as doublecensored data (dead: left censored;
alive: right censored). b, The cumulative hazard function, - log(survival function), shows
the force of mortality in relation to duration of burial. The two phases of increase in
cumulative hazard function are indicated by arrows and represent the prognosis for groups
without (lower arrow) and with an air pocket (upper arrow).
Markus Falk
Department of Biostatistics,
University of Innsbruck,
A-6020 Innsbruck, Austria
Hermann Brugger*
Bergrettungsdienst im Alpenverein
Sudtirol,
Europastrasse 17,
1-39031 Bruneck, Italy
Liselotte Adler-Kastner
Pharmacology Institute,
University of Vienna,
Vienna A-1090, Austria
* Author for correspondence.
1. Valla, F. Bull. Int. Comm. Alpine Rescue. (ad. Schon.
M.)(Birchwil. Switzerland, in the press)
2. Etter, H. J. at al. Durch Lawinen verursachte
Unfalle und Schaden im Gebiet der Schweizer Alpen, Winterberichte des SLF 46-55
(1981-1991) (Eidgenossisches Institut fur Schnee und Lawinenforschung Davos).
3. Schild, M. Lawinen, Ortung- Prophylaxe-Rettung
56-84 (Fond. Int. Vanni Eigenmann, Milano, 1975).
4. Brugger. H. & Falk. M. Wien. klin. Wschr. 104,
167-173(1992).
5. Turnbull. B. W. J. R. statist.
Soc. Ser. B38, 290-295(1976).
6. Locher. Th., Walpoth, B., Pfluger. D. & Althaus, U. Schweiz. med. Wschr. 121.
1020-1028 (1991).
7. Hossli, G. Lawinen 77-87 (Juris, Zurich, 1976).
