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Avalanche emergency : first aid for avalanche accidents

16.07.2025

More than half of all people involved in avalanche incidents suffer no or only minor injuries. Around 32 percent of the people involved suffer serious injuries, while the fatality rate of people involved (regardless of burial depth) is around 13 percent. The prognosis for a buried person depends primarily on the degree of oxygen deprivation and/or the type of possible traumatic injury. In rare cases, hypothermia can also be fatal in the event of a long-term burial lasting more than 60 minutes.

Fortunately, many avalanche accidents have a mild outcome and no serious consequences. Survival in an avalanche depends largely on the degree of burial and the severity of the injuries sustained. Most deaths from avalanches are due to asphyxiation (around 57%) or serious injuries – trauma (around 30%). You can find out more here.

01

First aid after avalanches

The first step is always to realistically assess whether there is a further avalanche/fall hazard for first aiders in the emergency plan when assessing the hazard situation under “Self-protection“.

If a person has been swept away and is not buried, the first aid measures are carried out according to the ABCDE scheme scheme.

© snow institute

cABCDE - Scheme: Checking and clearing the airways © snow institute

cABCDE - Scheme: Breathing control ‘see - hear - feel’ © snow institute

cABCDE - Scheme: Performing a body check © snow institute

cABCDE - Scheme: Check motor skills, sensory skills, orientation © snow institute

cABCDE - Scheme: showing empathy, pain-reducing positioning, heat preservation © snow institute

Partially buried people usually have to be freed from the snow with varying degrees of effort, which can be extremely time-consuming with a snowboard on your feet, for example.

Here we look at the particularities of people who were completely buried and whose heads were under the snow, meaning that it may not have been possible to supply the brain with oxygen.

The primary objective is to clear the head or airway as quickly as possible after locating the buried person. First aiders may be confronted with three different situations.

Ultimate goal: clear airways © snow institute | argonaut.pro

Once you have digged out the head, there are three scenarios possible:

02

Scenario 1: The person is responsive, airway clear, breathing OK

The airways(A = airway) are clear and the person is awake and responsive. The body’s own protective reflexes are then present and there is no risk of suffocation. The rescuer now holds the head in a stable position. With regard to breathing(B = Breathing), it is important to check the breathing quality (depth, frequency, rhythm) as quickly as possible. The victim is also asked whether they are breathing well and whether they can inhale and exhale deeply without pain. With regard to the circulation(C = Circulation), an attempt is made to determine whether and where there is heavy bleeding. Depending on the situation, an appropriate response is made: If, for example, the thigh has already been scooped free and heavy bleeding is recognizable there, this is stopped immediately.

During further gentle shoveling, a rescue worker holds the head of the buried person and thus prevents movement in the area of the cervical spine, as injuries in this area are to be expected due to the dynamics of an avalanche. They also ensure that no snow trickles into the victim’s face as they continue to shovel.

Check the breathing by “looking/listening/feeling”© snow institute I Highland Production - Luigi Dellarole — © snow institute I Highland Production - Luigi Dellarole

Check the breathing by “looking/listening/feeling”© snow institute I Highland Production - Luigi Dellarole

Check the breathing by “looking/listening/feeling”© snow institute I Highland Production - Luigi Dellarole

Check the breathing by “looking/listening/feeling”© snow institute I Highland Production - Luigi Dellarole

The ABCDE scheme also includes a neurological status item (D = Disability). In the best case scenario, we ask the buried person their name, the day and date, the location of the accident and how it happened. If these questions are answered adequately, the buried person is considered to be fully oriented and no action is required in this regard.

However, we will react to external influences(E = environment). This can already be taken into account now by preventing further cooling of the buried person with a cap, heat pack, down jacket, etc. Once the person has been completely shovelled free, they remain immobilized at the cervical spine, a complete check from A to E is carried out and an appropriate response is made.

Ideally, there are no abnormalities, and even if the person appears “uninjured”, they are still critical for us and are taken to hospital by the emergency services for further monitoring and diagnosis.

Not only must every fully buried victim be professionally transported to a hospital – the dynamics of an avalanche also expose partially or non-buried victims to massive forces. If there is the slightest doubt, further clarification is also necessary here.

© snow institute

© snow institute I argonaut.pro

© snow institute I argonaut.pro

03

Scenario 2: The person is unresponsive, airway/respiration critical

The airways(A = airway) are clear, but the person is not awake and responsive. This also includes buried persons who only moan or only open their eyes in response to a pain stimulus. There is a risk of suffocation here, as the body’s own protective reflexes are not or only partially present. The oral cavity is checked and cleared if necessary. The rescuer now holds the head in a stable position and applies the chin lift maneuver: This involves pushing the lower jaw upwards, preventing the tongue from obstructing the airway. It is not necessary to stretch the head massively. Apart from the fact that this protects the cervical spine, less space is required. This maneuver is therefore possible for people who are already only partially cleared.

Breathing (B = Breathing) is checked with all the senses in terms of breathing quality. In this scenario 2, the buried person is clearly breathing adequately.

The upper body is now scooped free as quickly as possible so that a log roll can be performed in the event of vomiting. This maneuver requires a second rescuer (shoveler) and replaces the recovery position if the buried person has not yet been completely shoveled free. It also has the additional advantage that the spine is manipulated less.

Only now do we deal with the circulation(C = Circulation), i.e. we try to determine whether and where there is heavy bleeding and react accordingly. During the further gentle scooping out, the rescuer continues the chin lift and constantly checks A and B in order to be able to react if necessary (Logroll).

The neurological status(D = Disability) is subordinated because A and B are relevant. The item External influences(E = Environment) is taken into account according to the situation.

Scenario 3: The person is not breathing.

If the airway is not clear, breathing is not possible. For this reason, the mouth and throat of the buried person is cleared with the fingers and the head is extended or the chinlift maneuver is performed. Clearing the airways can, under certain circumstances, lead to breathing resuming. However, if breathing(B = Breathing) is still not adequate or there are doubts about the quality of breathing, initial ventilation (5 breaths) is performed. Resuscitation must then be started – which is a challenge if the person is not fully resuscitated. Therefore, the top priority is to free the buried person as quickly as possible so that chest compressions (cardiac massage) are possible.

This presupposes that,

04

Szenario 3: Die Person hat keine Atmung.

Sind die Atemwege (A = Airway) nicht frei, ist keine Atmung möglich. Deswegen wird der Mund- und Rachenraum der verschütteten Person mit den Fingern freigeräumt und der Kopf überstreckt bzw. das Chinlift-Manöver durchgeführt. Das Freiräumen der Atemwege kann unter Umständen dazu führen, dass die Atmung wieder einsetzt. Stellt man bei Atmung (B = Breathing) allerdings trotzdem keine adäquate Atemtätigkeit fest bzw. hat Zweifel bezüglich der Atemqualität, führt man eine Initialbeatmung (5x beatmen) durch. Anschließend muss mit der Reanimation begonnen werden – was bei einer nicht gänzlich freigeschaufelten Person eine Herausforderung darstellt. Deswegen ist es oberste Priorität, die verschüttete Person so schnell wie möglich so weit freizulegen, dass eine Thoraxkompression (Herzdruckmassage) möglich ist.

Das setzt voraus, dass,

the buried person is in the supine position.
the surface is hard enough and does not give way.
the rescuer reaches a position in relation to the buried person from which they can carry out the compression.

If the buried person has to be shoveled out further, emergency resuscitation is started during this time:

Head is hyperextended
Mouth-to-mouth (better: mouth-to-mask)
10 times per minute (every 6 seconds)
a “normal” exhalation in terms of volume and strength

This emergency ventilation serves as a bridge and must be replaced as quickly as possible by combined resuscitation with a ratio of 30 chest compressions to 2 ventilations. This must be continued until the rescuers are relieved. If several rescuers are available, it is important that they communicate well with each other and take turns during resuscitation. This ensures that the quality of the compressions does not deteriorate.

NO FEAR: You cannot start resuscitation too early. Not much happens even if the patient is circulating and breathing.

© snow institute

© snow institute I Highland Production - Luigi Dellarole

With the point Circulation (C = Circulation) are carried out by independent assistants. This means that any heavy bleeding during resuscitation is stopped as best as possible. The neurological status ( D = Disability) and also to the external influences (E = Environment) are not considered because further cooling can be advantageous in this scenario.

Depending on the situation and resources, this scenario is complex and a good leader will be instrumental in maintaining an overview, optimally allocating the emergency services and recognizing which measures have priority.

Thermal management

Once all injuries have been treated or there are no wounds to treat, the patient must be protected from further cooling. The status is constantly monitored in order to be able to intervene immediately if necessary.

Use hats, scarves and hoods so that no heat is lost through the head.
Ideally, the rescue blanket should cover as much of the body as possible over the bottom layer of clothing.
Pack the injured person in a down jacket, bivouac sack or similar.
If possible from a safety point of view, place the person on rucksacks or other protection to keep out the cold from below.
Try to place the person as sheltered as possible from the wind. For example, all the helpers can sit in front of them to protect them.

© snow institute

Rescue blanket © snow institute

Bivouac bag © snow institute I argonaut.pro

© snow institute I argonaut.pro

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Cover picture: © snow institute | LWD Tirol

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