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Odsouzen k smrti! Aktuální údaje o smrtelných úrazech v lavině.

31.January 2012

Velikost písma: A A A

Autor: Hanno Bilek a Walter Wuertl

(přeloženo a upraveno: Alpenverein Edelweiss CZ)

Že je uvolnění laviny vždy spojeno s nebezpečím života, se nemusí extra zdůrazňovat těm, kdo se zúčastňují túr, sjezdů mimo sjezdovku a zimních výstupů, protože nyní stejně jako dříve přes 50% zcela zasypaných lavinu nepřežije. Že se ale podíl zemřelých na úrazy při lavinových nehodách nyní významně zvýšil, je však překvapením.

Podklad k teoretické diskuzi o „Přežití při zasypání lavinou“, ale také v praktické výuce představuje „křivka přežití“ – vypracovaná Hermannem Bruggerem a kolegy. Tato křivka popisuje pravděpodobnost přežití zcela zasypaných osob v závislosti na době zasypání. Křivka přežití se zakládá na vyhodnocení švýcarských údajů. Pro opakování je zde ještě jednou krátce popsán průběh fází (obr.1).

Fáze přežití: Během 18 minut po zasypání zůstává křivka přežití na vysoké úrovni. 91% všech zasypaných je ještě na živu, pouze 9% zemře během této fáze, především na smrtelná zranění. Prvních 20 minut hraje při tom důležitou roli v záchraně zasypaných těmi, kteří zasypáni nejsou.

Fáze dušení: 18 – 35 minut po zasypání nastává prudký pokles křivky z 91% na 34% – „smrtelný zlom“ pravděpodobnosti přežití. Cca 60% všech zasypaných zahyne v důsledku nedostatku kyslíku, protože jejich dýchací cesty jsou ucpány sněhem. Jen ti, kteří po zastavení laviny mohou ještě dýchat díky volným dýchacím cestám, přežijí zasypání delší než 35 minut.

Latentní fáze: Mezi 35 a 90 minutami má křivka přežití plochý průběh. To znamená, že všichni ti, kteří mají tzv. „vzduchovou dutinu“, přežijí tuto dobu.

Mezi 90 a 130 minutami umírá mnoho zasypaných na kombinaci podchlazení a udušení (3-H-Syndrom). Jen asi 7% zasypaných žije v lavině déle než 2 hodiny, protože má k dispozici velkou vzduchovou dutinu nebo přívod vzduchu z venku.

Závěry z křivky přežití

Nejdůležitější poznatky z křivky přežití jsou „Kdo zůstane nahoře, vyhrává!“, protože je vyloučena hlavní příčina úmrtí udušením, a „Čas je život!“, protože při rychlé záchraně jsou šance na přežití ještě velmi vysoké.

Jinak vyjádřeno mohli bychom tvrdit, že lavinová událost se může obrátit k dobrému, když je člověk dostatečně rychle zachráněn nebo když zůstane na povrchu ( také s pomocí účinného airbagového systému). Dalším závěrem je, že udušení při lavinových nehodách je s náskokem nejvýraznější příčinou úmrtí – podíl zranění na smrti u obětí lavin leží podle různých starších průzkumů pod 10%.

Stav aktuálních rakouských údajů

Od 1. listopadu 2005 jsou nehody v Alpách v Rakousku posuzovány podle nového standardu alpské policie a jsou vyhodnocovány kuratoriem pro alpskou bezpečnost. U běžného vyhodnocení lavinových nehod rychle vynikne, že 25% ze 143 obětí laviny ( zima 2005/6 až zima 2010/11; obr. 2) vůbec nebylo zasypáno. To je hodnota, která trochu relativizuje výrok „Kdo zůstane nahoře, vyhrává!“, stejně jako názor, že udušení bývá hlavní příčinou smrti, neboť osoby ležící na povrchu nejsou se vší pravděpodobností udušeny. Nezapomeňte, že u zmíněných údajů nehod se jedná o všechny nehody a nejen o ty, které jsou zahrnuty v křivce přežití u zcela zasypaných. To by vedlo k otázce po vyhodnocení příčin smrti všech obětí laviny, aby se získala výpověď o „smrtícím účinku“ lavin – zda je člověk zcela, částečně nebo vůbec zasypán, může být sotva ovlivněno. Abychom se dostali k jádru všech příčin, bylo ještě jednou prozkoumáno všech 143 policejních zpráv o smrtelných obětech, příp. při nejasnostech byli zúčastnění úředníci znovu dotazováni.

Obr.2 Rozdělení příčin úmrtí při lavinových nehodách mezi roky 2006 – 2011. Celkový počet obětí 143. Zdroj: Alpinpolizei Oesterreich, Kuratorium fuer Alpine Sicherheit. *Traumata jsou v lékařství: poškození, zranění nebo rány způsobené silou.

32% zemřelých na traumatická zranění v Rakousku

Velmi překvapujícím výsledkem bylo, že nejméně 46 obětí laviny (32%) zemřelo následkem traumatického zranění. 58% (83 obětí) bylo podle údajů místních lékařů, příp. lékařů farností nebo patologů udušeno a 2% (2 oběti) podlehly 3-H-syndromu. U 12 osob (8%) nemohla být zpětně jednoznačně stanovena příčina smrti. V detailu to vypadá tak, že všech 13 nezasypaných smrtelných obětí zemřelo na trauma, u 13 částečně zasypaných lavinových obětí bylo ze 77% trauma příčinou smrti. Z 10 viditelně zcela zasypaných ( „Hlava ve sněhu, ale jedna část těla je viditelná“) zemřeli 4 na trauma a 5 se udusilo. Dokonce u zcela zasypaných, z nichž nebylo nic vidět, byl podíl trauma ještě 18%.

Vliv terénu na traumatická zranění

Málo překvapujícím byla při vyhodnocení okolnost, že přes 95% případů úmrtí na trauma vykazovalo jeden nebo více „nebezpečných“ parametrů terénu. Jako „nebezpečné“ parametry terénu byly ohodnoceny spádnicová dráha pádu („lavina se spouští v úžlabině“), spuštění laviny na příkrém stupňi nebo lavina v lese. Obzvláště ten poslední bod se nejeví v představě turisty a freeridového jezdce jako nebezpečí, protože se mu uvolnění laviny v lese zdá méně pravděpodobným – ale, jestliže k tomu přece dojde, tak je člověk vržen proti stromům a tak může být těžce zraněný. Zřetelný rozdíl mezi zemřelými na traumatická zranění a obětmi udušenými lavinou byl také v délce laviny. U první skupiny byla průměrně 403 m, zatím co u druhé skupiny činila délka jen okolo poloviny (209 m).

Důsledky

#1 Vyhnout se uvolnění laviny!

Když u 32% zabitých lavinou je rozsudek smrti jistý už při jejím pádu, musíme se ještě důsledněji vyhýbat uvolňovaní lavin!

#2 Vyhýbat se nebezpečného terénu!

Volbě správného terénu přináleží nesmírný význam při vyvarování se lavin. V nebezpečném terénu představují smrtelné nebezpečí už malé laviny!

#3 Helma a ochrany mohou chránit před traumatickými zraněními!

Obzvláště použitím helmy se dá zabránit těžkým traumatickým zraněním při pádu laviny příp. je zmírnit.

Závěr

Výrok „čas je život!“ stále ještě platí a má právě u traumatických zranění velký význam. Také výrok „ zůstat nahoře znamená přežít“ se může jenom podtrhnout . Doporučuje se používání systému airbagů. Skutečnost, že přežít pád laviny, je ještě menší než často předpokládáme, nás musí nutit přemýšlet a mít vliv na naše chování venku v terénu.

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