Snowdonia mountain casualties

Mohyudin Dingle Clinical Fellow in EM/PHEM

Linda Dykes, Consultant in EMYsbyty GwyneddBangor, N Wales

Abdominal injuries

Introduction

Each year, millions of people visit Snowdonia and participate in potentially hazardous leisure activities.

We wished to ascertain the incidence of abdominal injuries in mountain casualties brought to our ED, whose catchment area includes almost all of Snowdonia.

Methods Our database of mountain casualties brought to Ysbyty Gwynedd following contact with Mountain Rescue and/or SAR helicopter January 2004-December 2015 was interrogated.

Cases with abdominal injuries were identified, and ED documentation, radiology and (where applicable) post-mortem reports scrutinised to identify those with significant intra-abdominal injury (which we defined as injuries identifiable on CT/PM).

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Results

• 1067/1282 (83%) of casualties were injured rather than ill, of which only 16/1067 (1.5%) had significant abdominal injuries (including seven fatalities). The injuries of the nine survivors are summarised in the table (right).

• Most were injured by falling from height (14/16) and most (11/16) were hill-walkers. All were male. The average age of casualties with abdominal injuries was 40.8 years (range 16-64)

• The seven casualties with abdominal injuries all died before help arrived at scene: there were no subsequent deaths.

• The liver was most commonly damaged (11/16), followed by spleen (six), kidney (four) & adrenal gland (one). Three cases had intra-abdominal free fluid noted on CT or in theatre.

• All casualties with significant abdominal injuries had injuries elsewhere, most often the chest (12/16) and head/face (12/16).

Conclusion • Significant abdominal injuries are surprisingly rare in Snowdonia mountain casualties, found in only 0.8% of those still alive by the time help

arrived. However, nearly half (44%) of casualties with significant abdominal trauma died, all of whom succumbed before rescuers arrived. • The inaccessibility of the Snowdonia mountains (we have previously shown that the mean time for help to arrive at the scene of a

Snowdonia mountain incident is about an hour) provides a brutal, but effective, triage sieve.

Abdominal injuries Other injuries23M Liver: laceration (posterior right lobe) Face, chest, wrist #

28M Liver: laceration (posterior right lobe) Chest, wrist, bilateral femur #

62M Kidney: haemorrhage from renal cyst Spinal #s, left psoas haematoma

64M Liver: transection of right lobe Right adrenal gland: haematoma

Nil significant

16M Spleen: laceration, fragmentation & encapsulated haematoma (Grade 4 injury) Liver: laceration (posterior right lobe) w/ subcapsular free fluid Left kidney: renovascular injury➔infarction

Rib #s & pneumothorax

26M Spleen: parenchymal laceration & intraparenchymal haematoma w/ contusion Left kidney: parenchymal injury & subcapsular haematoma

Head, facial #s, rib #s, spinal #s, humeral #, femoral #

47M Liver: large intrahepatic & subcapsular haematoma w/ associated free fluid

Rib #s

39M Blood in hepatorenal space (no organ injury detected)

Severe chest injuries, pelvic #

60M Liver: contusion (posterior right lobe) Severe chest injuries, spinal #s

Table: Abdominal & associated injuries in mountain casualties found alive (n=9)

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