MOUNTAIN RESCUE IN THE MONT-BLANC MASSIF

More than 700 rescues are made each year in the mountains of the Mont-Blanc Massif by the rescuers of the "Peloton de Gendarmerie de Haute-Montagne" (PGHM). In more than 70% of these rescues a doctor is present at the scene. The rapid transmission of the alert thanks to a sophisticated radio network, the relatively compact size of the Mont-Blanc Massif and the ideal position of the Hôpital de Chamonix mean that almost all rescues are completed in less than an hour. A helicopter is used in 95% of rescues. It is still the single engine Alouette III, which was designed 40 years ago. Well adapted to the environment, very manoeuvrable, offering excellent all round vision for the search and being an acceptable size, it is equipped with a 40 meter long winch. Used at the maximum of its possibilities, it doesn't correspond with the modern standards and should be replaced within the next years by a twin engine, version which will be larger and more reliable. The normal team consists of a pilot, a winch man, one or two rescuers and a doctor.

To be effective members of the team the doctors must not only be competent in traumatology and emergency medicine but also be strong and experienced mountaineers, an essential quality that allows their integration into the team without putting either the rescuers or the victims at further risk. The most frequently used stretcher is the 'Perche Piguillem' which is well adapted to winch rescue. The victim is strapped into the stretcher and, if necessary, can be completly immobilised with neck collar, splints and vacuum stretcher. Insulation from the cold is mandatory. A first aid pouch containing syringes, cannulars and IV analgesics is carried around the doctors waist. The doctor's rucksack, developed in conjunction with Lafuma, is divided into 2 parts, one part for the climbing equipment and one part medical, which further divides into 4 pockets (respiration, circulation, medication and dressing). A standard range of medication is carried with an emphasis towards intra-venous analgesia, sedation, rehydration and coronary artery dilatation. Oxygen is systematically available, given the early onset of altitude hypoxia in trauma victims.

The population rescued are young, predominantly male and often foreign. February, March, July and August are the busiest months. 25% of rescue operations take place above 3500m. The high number of people that ski the Vallée Blanche in winter and climb Mont-Blanc in summer makes these two areas the most common sites for rescues in the massif. 40% of all victims are from ski accidents (half of them on piste) and 44% are due to climbing. However traumatic deaths are four times more common amongst climbers than amongst skiers and are mainly due to falls or stone fall. Hiking in the lower mountains of the massif accounts for 14% of rescues and involves a more standard population. Traumatic injury of the limb is common, accounting for 50% of all rescues. Because of the high kinetic energy delivered during the fall, bone fractures are often serious and compound and demand emergency surgical treatments. More worrying are the 22% of victims that present with a head injury, often due to stone or ice fall or to a fall by the climber. 10% of those rescued have a spinal injury, 12% of whom go on to have some residual impairment. 20% of victims have multiple trauma. In many of these patients, neurological signs, hypothermia and haemorrhagic shock are often mixed and it can then prove difficult to distinguish the cause. Unfortunately, 7% are dead on rescue. A follow-up study of our serious victims show that 83% go onto make either a good or complete recovery. In these patients, the outcome is all the more favourable since the delay between accident and treatment has been the shorter.

Clinical examination of a patient in the mountains is always difficult because of the amount of clothing and equipment worn by mountaineers. The initial treatment is usually based on immobilisation, sedation and analgesia. For more serious cases, advanced resuscitation techniques are possible, but this must be balanced against the risks of hypoxia, hypothermia, avalanche and rock fall and the proximity of the hospital, usually reached by a 5 min flight. The mountain and medical experience of the doctor is essential, he often has to improvise. He is the only one who can decide to perform intubation or not, perfusion or not and so on; according to the environment and the patient's condition. Veinous access is important, but must not delay the rescue. Usually, we only use the catheter to inject drugs, as it is difficult to maintain a drip in extreme condition.

Although very well suited to alpine rescue, the Alouette III faces two technical restrictions in winch rescues (45% of alpinist rescues). Firstly, the stretcher can only be brought on board if it is inclined at an angle of 50°, a manoeuver which is obviously incompatible with a patient who is haemodynamically unstable. In such a case the stretcher is winched in a horizontal position to a flat area where it is landed, and from there loaded onto the helicopter. Secondly, as only one person can be winched at a time the doctor is taken up first, followed by the patient. The cockpit of the Alouette III is cramped and it is our practice to load the stretcher in transversely with the doctor sitting above the patient. Therefore every drug that the doctor may want to use during the flight must be prepared before take off and carried in the hand.

The presence of a mountaineer emergency doctor in the rescue team is very positive. Moreover, our action is not limited to the care at the scene; in the majority of cases, the specialization of the Chamonix hospital allows us to take on the entirety of the patient's treatment, from the site of accident to his return home. Once the alert is received, the rescue almost always goes ahead in a satisfactory manner. Therefore, to reduce mortality in the Mont-Blanc massif one must concentrate on the time before the alert is received and specifically on two areas. Firstly, to encourage the more widespread and more responsible use of radios and cellular phones; and secondly and above all, to promote a higher level of safety in the mountains. For as ever, the prevention of accidents by education and training is essential.

(c) DMTM CHAMONIX 1998

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