Thoracic injuries in Snowdonia Mountain Casualties

Ruth Watson Clinical Fellow in EM/PHEM

Linda Dykes, Consultant in EMYsbyty Gwynedd

Bangor, North Wales

Background

Snowdonia attracts millions of outdoor adventure-seekers each year. We wished to ascertain the prevalence of chest injuries in mountain casualties arriving in our hospital, whose catchment area includes most of Snowdonia.

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Method

Our database of all casualties brought to Ysbyty Gwynedd following contact with Mountain Rescue Teams (MRT) and/or Search & Rescue (SAR) helicopter Jan 2004-Dec 2015 was interrogated.

Casualties with chest injuries were identified and MRT/SAR, ED, radiology and PM reports (where applicable) scrutinised. Injuries were scored using the Abbreviated Injury Score (AIS).

Cases with “significant injury” (which we defined as ≥1 rib # and/or chest injury AIS≥2) were analysed.

Results

Of 1288 casualties in the study period, 1059 (82%) were injured rather than ill.

119/1059 (11%) had chest injuries, but only 91/1059 (9%) were deemed significant.

From these 91 with significant chest injuries, 86% had fallen from height ≥2m.

Most were hill-walking (53%) or rock climbing/scrambling (29%) at time of incident. 82% were male.

40/91 (44%) of casualties with significant chest injuries died (38 of whom succumbed before help arrived) and overall, 60% of Snowdonia mountain trauma fatalities have chest injuries.

63/91 (69%) also had an associated head injury, of which 56% died.

13 casualties with significant chest injury required chest drainage. Three had suspected/confirmed tension PTx.

Conclusion

• Chest injuries occur frequently in mountain trauma casualties: 8% of those alive at scene, and 17% of fallers from height.

• Chest & head injuries are commonly found together in mountain casualties. • Our definition of “significant” includes some injuries more troublesome

than serious, but many of these cases require handling as possible major trauma on initial assessment in ED.

• Of note, however, is the rarity of tension pneumothorax, which occurred in fewer than 0.3% of mountain trauma cases. This will be around 0.5% for those with a significant mechanism of injury (half of mountain trauma cases on our database) who are still alive when help arrives at scene.

Photo courtesy of Ryan Maclean