Integration of Medical Services for Sporting Events with the Regional Emergency System During an Avalanche: A Case Report from the Alpine Ski World Cup

Integration of Medical Services for Sporting Events with the Regional Emergency System During an Avalanche: A Case Report from the Alpine Ski World Cup | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Integration of Medical Services for Sporting Events with the Regional Emergency System During an Avalanche: A Case Report from the Alpine Ski World Cup Simon Grosjean, Damiano Presciani, Paolo Comune, Giovanni Luca Cavoretto This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6264752/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Managing emergencies in mountain sporting competitions is complicated by difficult access and adverse environmental conditions. This case report describes a rare event in which healthcare resources from a sporting event were integrated into the rescue of a nearby avalanche, demonstrating an innovative resource management model. Case Presentation On 14th March 2025, during the Alpine Ski World Cup in La Thuile (Aosta Valley, Italy), an avalanche in the Arpy area involved nine ski mountaineers. With the primary helicopter (SA1) already engaged elsewhere, the SA2 helicopter and medical and technical personnel from the competition were diverted to the site, ensuring rapid intervention despite adverse weather. Four patients sustained injuries (one with an initial GCS of 10 and severe hypothermia); five were uninjured. Adverse weather conditions, scene hazards, and the absence of a triage system in the literature for approaching these cases complicated the intervention, but coordination between sporting resources and the Regional Emergency System optimised the overall response. Conclusions Integrating sporting healthcare resources with the Regional Emergency System offers significant added value in managing major mountain emergencies. However, as highlighted in the ICAR MedCom guidelines, triage in the mountain environment requires a compromise between healthcare needs and technical factors, such as weather conditions and accessibility of the incident site. The success of the described intervention was possible only thanks to the close collaboration between the Aosta Valley Alpine Rescue (SAV) and the 118 (local EMS) emergency physicians, ensuring a synergistic and optimal management of available resources. Avalanche Alpine rescue Emergency medicine Sporting events Major emergency Air ambulance Resource management Triage Mountain medicine Figures Figure 1 Background Sporting events in mountain environments present unique logistical challenges, related to hostile geographical conditions and the potential severity of trauma ( 1 ). Health planning for such events involves dedicated resources that often operate in synergy with the territorial emergency system. However, few studies explore how these resources can be effectively integrated to address external emergencies, such as a nearby avalanche ( 2 ). Avalanches cause approximately 150 deaths annually in Europe, with survival strongly linked to the speed of rescue: beyond 15–20 minutes of complete burial, survival probabilities decrease dramatically ( 3 , 4 ). In the Aosta Valley, the 118 Emergency System of the AUSL VdA manages sporting events with local personnel, such as AUSL VdA 118 physicians and Aosta Valley Alpine Rescue (SAV) mountain guides, ensuring familiarity with the territory and operational protocols. Avalanche emergency management should follow the international guidelines established by ICAR MedCom( 2 ), which represent the reference standard for alpine rescue worldwide. These recommendations emphasise the importance of systematic triage and standardised protocols to optimise victim survival. The Aosta Valley represents a unique context where the emergency system has developed an integrated model that provides for the use of personnel from both the healthcare (118) and technical (SAV) territorial systems for managing sporting events, facilitating the sharing of protocols, equipment, and knowledge of the territory ( 5 ). This distinctive characteristic deserves to be analysed as a potential organisational model for other alpine regions. Case Presentation On 14th March 2025, shortly after the conclusion of the women's Alpine Ski World Cup race (Super G) in La Thuile (Aosta Valley, Italy), an avalanche in the Arpy area (Morgex) involved nine ski mountaineers. Map Of Aosta Valley region and localization of rescue operations. [Figure_1.png] Activation and Initial Response At 12:36, the NUE 112 received the alert, and the 118 (EMS) dispatch centre managed the call, classifying it with code 30-B-1 (MPDS). The primary helicopter SA1 (AW139) was already engaged near Skyway in Courmayeur for a polytrauma following a paragliding fall (vehicle dispatched at 12:35). While the SAV technician at the Operations Centre was geolocating the event, Dr Cavoretto (medical officer for the event in La Thuile) was contacted to request the use of the SA2 helicopter (AW139), present for the sporting event. After brief consultation with the SAV director (Paolo Comune), also present in La Thuile, it was decided to send the vehicle with personnel to the avalanche site (12:40). In other situations, if SA2 had not been available, the EMS system would still have had a B3 helicopter on standby. Medical Intervention The first physician, transported by the SA2 helicopter, was lowered by winch near the first patient found. This patient was semi-buried about 1.5 metres deep but had clear airways. The initial assessment showed a Glasgow Coma Scale (GCS) of 10, rapidly improving to 15. The evacuation of this first patient occurred within 15 minutes of the helicopter landing. The first crew that arrived at the scene, realising the presence of a total of 9 avalanche victims, of whom 4 had multiple trauma and various degrees of hypothermia, promptly requested additional medical and technical-logistical support. This support arrived within minutes thanks to the presence of medical (118) and technical personnel (SAV) already at the recently concluded sporting event. Continuing the exploration of the avalanche, three other injured persons were identified with various degrees of trauma and hypothermia, but without complete burial. Meanwhile, SA1, having completed its previous service, was sent to the emergency site at 13:18 to support evacuation operations. The medical management of the incident was coordinated by the first physician who arrived at the scene and a second physician who arrived as reinforcement from the World Cup. A third physician, also present at the competition, took care of transferring the first evacuated patient to the Parini Hospital in Aosta. Technical management was carried out by the two Helicopter Rescue Technicians (SAV mountain guides) of SA2, joined by a third HRT present at the sporting event. Triage Management and Evacuation The distribution of patients across multiple levels of the slope and the rapidly deteriorating weather significantly complicated triage. In the absence of a systematic protocol (e.g. START or Ten Second Triage), evacuation was guided primarily by position and available resources, not always by clinical severity. To illustrate: Patient 1 (with GCS returned to 15) was evacuated before Patient 2 (haemodynamically unstable). As highlighted in the ICAR MedCom document( 2 ), triage in mountain environments requires a dynamic assessment that takes into account: Adverse environmental conditions (extreme temperatures, risk of further avalanches). Accessibility and scene safety (terrain stability, helicopter availability). On-site resources available and response times for medical reinforcements. Due to the rapid deterioration of weather conditions and to receive additional medical support, it was decided to transport two patients (and 5 apparently uninjured persons) initially to the Trauma Centre (CTO) in La Thuile before the final transfer to the Parini Hospital in Aosta. The following are details of the 4 patients: [Table_1.xlsx: Clinical Data and Outcomes of Avalanche Victims] The five uninjured were transported to the CTO in La Thuile by helicopters. There they were assessed by healthcare personnel and, having confirmed the absence of significant symptoms or problems, they returned home by their own means. Operational and Coordination Difficulties Number of involved parties exceeding the initial resources present. Rapidly deteriorating weather that accelerated the need for evacuation. Limited communications (lack of ARTVA/radio helmets for some rescuers who intervened from the competition site). Non-systematic triage, with evacuation not always prioritised based on clinical severity. SA1 initially unavailable (until 13:18). A crucial element of the mission's success was the close collaboration between the technical component (SAV) and the medical component (118 physicians). The coordination between specialised rescuers and healthcare providers allowed for optimising evacuation times and methods, ensuring the most effective management possible of the major emergency in a complex context. The effective coordination between the Dispatch Center (CUS), the SAV manager, and the medical officer for the event ensured the optimal allocation of available resources and the correct sorting of patients between the CTO in La Thuile and the Parini Hospital in Aosta. Discussion and Conclusions This case effectively demonstrates how healthcare resources from a sporting event can be integrated with the Regional Emergency System to manage a major emergency in a mountain environment. The rapid intervention of the SA2 helicopter and medical personnel already on site significantly reduced response times, a crucial factor for avalanche survival( 3 ). However, the absence of systematic triage led to a suboptimal evacuation: Patient 1 (stabilised) was transported before Patient 2 (clinically more critical), reflecting a common logistical challenge in extreme and orographically complex environments( 6 ). ICAR MedCom emphasises the importance of developing dedicated triage systems that integrate both clinical criteria (e.g. trauma severity, hypothermia) and environmental and logistical factors (burial time, accessibility to the incident site, weather)( 2 ). Although the described intervention was globally effective, the absence of systematic triage according to ICAR MedCom recommendations( 2 , 7 ) resulted in non-optimal patient prioritisation. ICAR MedCom emphasises the importance of using dedicated protocols for avalanche rescue, which take into account not only traditional clinical severity but also specific factors such as burial time and the presence of an air pocket( 2 , 7 ). In the Aosta Valley, the healthcare personnel present at the sporting event, already integrated into the 118 system and supported by SAV, share operational protocols and specific skills, making this dual and complementary response possible( 5 ). Compared to events like the Galtür avalanche of 1999( 8 ) and Rigopiano in 2017( 9 ), where isolation required a predominantly external intervention with prolonged response times, in this case, the resources already present for the sporting event made the difference in terms of speed. Scientific literature has extensively documented the advantages of rapid medical intervention in avalanche accidents( 10 ), but there are few reports describing the integration between rescue systems dedicated to sporting events and the territorial emergency system. Brugger et al.( 6 ) have emphasised the importance of continuity of care between avalanche rescue and hospitalisation, while Boyd et al.( 1 ) have described the benefits of a systematic approach in managing emergencies during sporting events in mountain environments. However, none of these studies has specifically analysed the integration between the two components as occurred in our case. The integration between SAV and the 118 healthcare system was fundamental to the success of the intervention. This model of cooperation between technical and healthcare components represents an effective strategy for improving emergency management in mountain environments and should be implemented in other similar contexts. Finally, to optimise the management of future emergencies of this type, we recommend: The adoption, at least in the alpine environment, of a similar strategy of integration between assistance for major events and events and the public rescue system. Joint training between healthcare personnel and alpine rescuers to improve operational coordination. The implementation of specific triage tools for avalanche rescue, which integrate clinical needs with environmental and logistical variables. The experience described here suggests that the technical and healthcare scientific world must develop a new triage method for avalanche scenarios, accompanied by joint training between sporting event personnel and the territorial emergency system, which could further improve the effectiveness of the response. Furthermore, the development of more robust and resilient communication systems is recommended to optimise coordination in adverse environmental conditions. In conclusion, the integration of healthcare resources from sporting events into the territorial emergency system represents a promising model for managing major emergencies in mountain environments, particularly when rapid and simultaneous interventions are necessary. This approach deserves further study to verify its applicability in different geographical and organisational contexts. Abbreviations 118: Regional EMS ARTVA: Avalanche Victim Search Device CPK: Creatine Phosphokinase CTO: Orthopaedic Trauma Centre CUS: Single Rescue Centre GCS: Glasgow Coma Scale MPDS: Medical Priority Dispatch System NUE: Single Emergency Number 112 SA1/SA2: Alpine Rescue Helicopters SAV: Aosta Valley Alpine Rescue HRT: Helicopter Rescue Technician Declarations Ethics approval and consent to participate Not required for this type of study; data have been anonymised and treatment was carried out according to emergency-urgency standards. Consent for publication Informed consent obtained from all patients for the anonymised publication of clinical data. Availability of data and materials Data are available upon request from the corresponding author, with limitations related to patient privacy. Competing interests The authors declare that they have no competing interests. Funding No specific funding was received for this study. Authors' contributions SG: data analysis, manuscript drafting. GC and PC: coordination of rescue operations, collection of technical data. DP: clinical supervision, critical revision of the manuscript. All authors have read and approved the final manuscript. Acknowledgements We thank the staff of the Aosta Valley Alpine Rescue, the CUS of the Aosta Valley, the 118 personnel who intervened at various levels, and those of the Parini Hospital in Aosta and the CTO in La Thuile for the support provided during rescue operations and data collection. The EMSy Large Language Model (specifically developed for pre-hospital emergency) was used for checking and drafting the text structure, while maintaining complete supervision and revision of the content performed by the authors of the article. References Boyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: A systematic review. Resusc June. 2010;81(6):645–52. Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, et al. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol June. 2018;19(2):131–40. Haegeli P, Falk M, Brugger H, Etter HJ, Boyd J. Comparison of avalanche survival patterns in Canada and Switzerland. Can Med Assoc J 19 April. 2011;183(7):789–95. Techel F, Jarry F, Kronthaler G, Mitterer S, Nairz P, Pavšek M, et al. Avalanche fatalities in the European Alps: long-term trends and statistics. Geogr Helv 28 June. 2016;71(2):147–59. Healthcare assistance for events [Internet]. [cited 17 March 2025]. Available from: https://www.ausl.vda.it/f-a-q/come-fare-per/assistenza-sanitaria-alle-manifestazioni Brugger H, Durrer B, Adler-Kastner L, Falk M, Tschirky F. Field management of avalanche victims. Resusc Oct. 2001;51(1):7–15. Pasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K et al. On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation [Internet]. 1 marzo 2023 [citato 17 marzo 2025];184. Disponibile su: https://www.resuscitationjournal.com/article/S0300-9572(23)00021-7/fulltext Lorenzoni N, Raich M. Long-term impact of the Galtuer avalanche on the public health system. J Emerg Manag West Mass. 2021;19(2):197–208. Braun T, Frigo B, Chiaia B, Bartelt P, Famiani D, Wassermann J. Seismic signature of the deadly snow avalanche of January 18, 2017, at Rigopiano (Italy). Sci Rep 29 ottobre. 2020;10(1):18563. Procter E, Strapazzon G, Dal Cappello T, Zweifel B, Würtele A, Renner A, et al. Burial duration, depth and air pocket explain avalanche survival patterns in Austria and Switzerland. Resusc agosto. 2016;105:173–6. Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.xlsx Clinical Data and Outcomes of Avalanche Victims Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6264752","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":435950329,"identity":"624bfe63-079e-49eb-90e9-8cf2d446ad84","order_by":0,"name":"Simon Grosjean","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYNACHiBmbwASBUB8AIyI0cIDUmcA1UKEHiCQSEBowWuNfP/ahw9/yNjIm0s+fib5w4Ahse/4AcbDH/BoMbjx3NiYhyfNcOfsNDNpHqCWmWcS8DvMQOIYmzQDz2HGDbcTzKSBDjM2OEBAi/yMY2ySP3j+22+4efwbyGHGBucfEPD++TY2CR6eA4kbbvCYSQAdJmdwg5DDbrAxA/2SnLzhTE6xNY+BhJzkjYcNB87gc1j/McaHP3vsbDccP77x5o8KGx6+88mHP1TgcxgoOhh7EFwgZmzAp4GBgR/k7B/41YyCUTAKRsEIBwAIFVHYOt4r+AAAAABJRU5ErkJggg==","orcid":"","institution":"Azienda USL della Valle d’Aosta","correspondingAuthor":true,"prefix":"","firstName":"Simon","middleName":"","lastName":"Grosjean","suffix":""},{"id":435950330,"identity":"61b4a6f5-5685-4ee1-bc87-37223aaf43b1","order_by":1,"name":"Damiano Presciani","email":"","orcid":"","institution":"Azienda USL della Valle d’Aosta","correspondingAuthor":false,"prefix":"","firstName":"Damiano","middleName":"","lastName":"Presciani","suffix":""},{"id":435950333,"identity":"f510d005-04ab-494e-ab5d-f176128aef5e","order_by":2,"name":"Paolo Comune","email":"","orcid":"","institution":"Soccorso Alpino Valdostano","correspondingAuthor":false,"prefix":"","firstName":"Paolo","middleName":"","lastName":"Comune","suffix":""},{"id":435950334,"identity":"83258b8d-3a13-4d79-9444-6163b8bf90ba","order_by":3,"name":"Giovanni Luca Cavoretto","email":"","orcid":"","institution":"Azienda USL della Valle d’Aosta","correspondingAuthor":false,"prefix":"","firstName":"Giovanni","middleName":"Luca","lastName":"Cavoretto","suffix":""}],"badges":[],"createdAt":"2025-03-19 22:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6264752/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6264752/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79584460,"identity":"e5378a2e-6d65-4d14-8122-704dccf22201","added_by":"auto","created_at":"2025-03-31 12:17:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":166251,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6264752/v1/d6d7be622383b694a6f90102.png"},{"id":79693185,"identity":"826a4f94-a411-4f4a-8867-5d9d5b9a1bb1","added_by":"auto","created_at":"2025-04-01 15:01:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":610891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6264752/v1/c07e725e-78ef-4733-8972-550745ed01b2.pdf"},{"id":79584467,"identity":"edb7c43b-c9c4-4e2f-9bb0-2016932c7469","added_by":"auto","created_at":"2025-03-31 12:17:41","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":11915,"visible":true,"origin":"","legend":"\u003cp\u003eClinical Data and Outcomes of Avalanche Victims\u003c/p\u003e","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6264752/v1/79bcd7d37f696b522a310577.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integration of Medical Services for Sporting Events with the Regional Emergency System During an Avalanche: A Case Report from the Alpine Ski World Cup","fulltext":[{"header":"Background","content":"\u003cp\u003eSporting events in mountain environments present unique logistical challenges, related to hostile geographical conditions and the potential severity of trauma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Health planning for such events involves dedicated resources that often operate in synergy with the territorial emergency system. However, few studies explore how these resources can be effectively integrated to address external emergencies, such as a nearby avalanche (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAvalanches cause approximately 150 deaths annually in Europe, with survival strongly linked to the speed of rescue: beyond 15\u0026ndash;20 minutes of complete burial, survival probabilities decrease dramatically (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In the Aosta Valley, the 118 Emergency System of the AUSL VdA manages sporting events with local personnel, such as AUSL VdA 118 physicians and Aosta Valley Alpine Rescue (SAV) mountain guides, ensuring familiarity with the territory and operational protocols.\u003c/p\u003e \u003cp\u003eAvalanche emergency management should follow the international guidelines established by ICAR MedCom(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), which represent the reference standard for alpine rescue worldwide. These recommendations emphasise the importance of systematic triage and standardised protocols to optimise victim survival.\u003c/p\u003e \u003cp\u003eThe Aosta Valley represents a unique context where the emergency system has developed an integrated model that provides for the use of personnel from both the healthcare (118) and technical (SAV) territorial systems for managing sporting events, facilitating the sharing of protocols, equipment, and knowledge of the territory (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This distinctive characteristic deserves to be analysed as a potential organisational model for other alpine regions.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eOn 14th March 2025, shortly after the conclusion of the women's Alpine Ski World Cup race (Super G) in La Thuile (Aosta Valley, Italy), an avalanche in the Arpy area (Morgex) involved nine ski mountaineers.\u003c/p\u003e \u003cp\u003eMap Of Aosta Valley region and localization of rescue operations.\u003c/p\u003e \u003cp\u003e[Figure_1.png]\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eActivation and Initial Response\u003c/h2\u003e \u003cp\u003eAt 12:36, the NUE 112 received the alert, and the 118 (EMS) dispatch centre managed the call, classifying it with code 30-B-1 (MPDS). The primary helicopter SA1 (AW139) was already engaged near Skyway in Courmayeur for a polytrauma following a paragliding fall (vehicle dispatched at 12:35). While the SAV technician at the Operations Centre was geolocating the event, Dr Cavoretto (medical officer for the event in La Thuile) was contacted to request the use of the SA2 helicopter (AW139), present for the sporting event. After brief consultation with the SAV director (Paolo Comune), also present in La Thuile, it was decided to send the vehicle with personnel to the avalanche site (12:40). In other situations, if SA2 had not been available, the EMS system would still have had a B3 helicopter on standby.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMedical Intervention\u003c/h3\u003e\n\u003cp\u003eThe first physician, transported by the SA2 helicopter, was lowered by winch near the first patient found. This patient was semi-buried about 1.5 metres deep but had clear airways. The initial assessment showed a Glasgow Coma Scale (GCS) of 10, rapidly improving to 15. The evacuation of this first patient occurred within 15 minutes of the helicopter landing.\u003c/p\u003e \u003cp\u003eThe first crew that arrived at the scene, realising the presence of a total of 9 avalanche victims, of whom 4 had multiple trauma and various degrees of hypothermia, promptly requested additional medical and technical-logistical support.\u003c/p\u003e \u003cp\u003eThis support arrived within minutes thanks to the presence of medical (118) and technical personnel (SAV) already at the recently concluded sporting event.\u003c/p\u003e \u003cp\u003eContinuing the exploration of the avalanche, three other injured persons were identified with various degrees of trauma and hypothermia, but without complete burial. Meanwhile, SA1, having completed its previous service, was sent to the emergency site at 13:18 to support evacuation operations.\u003c/p\u003e \u003cp\u003eThe medical management of the incident was coordinated by the first physician who arrived at the scene and a second physician who arrived as reinforcement from the World Cup. A third physician, also present at the competition, took care of transferring the first evacuated patient to the Parini Hospital in Aosta.\u003c/p\u003e \u003cp\u003eTechnical management was carried out by the two Helicopter Rescue Technicians (SAV mountain guides) of SA2, joined by a third HRT present at the sporting event.\u003c/p\u003e\n\u003ch3\u003eTriage Management and Evacuation\u003c/h3\u003e\n\u003cp\u003eThe distribution of patients across multiple levels of the slope and the rapidly deteriorating weather significantly complicated triage. In the absence of a systematic protocol (e.g. START or Ten Second Triage), evacuation was guided primarily by position and available resources, not always by clinical severity. To illustrate: Patient 1 (with GCS returned to 15) was evacuated before Patient 2 (haemodynamically unstable).\u003c/p\u003e \u003cp\u003eAs highlighted in the ICAR MedCom document(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), triage in mountain environments requires a dynamic assessment that takes into account:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAdverse environmental conditions (extreme temperatures, risk of further avalanches).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAccessibility and scene safety (terrain stability, helicopter availability).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOn-site resources available and response times for medical reinforcements.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDue to the rapid deterioration of weather conditions and to receive additional medical support, it was decided to transport two patients (and 5 apparently uninjured persons) initially to the Trauma Centre (CTO) in La Thuile before the final transfer to the Parini Hospital in Aosta.\u003c/p\u003e \u003cp\u003eThe following are details of the 4 patients:\u003c/p\u003e \u003cp\u003e[Table_1.xlsx: Clinical Data and Outcomes of Avalanche Victims]\u003c/p\u003e \u003cp\u003eThe five uninjured were transported to the CTO in La Thuile by helicopters. There they were assessed by healthcare personnel and, having confirmed the absence of significant symptoms or problems, they returned home by their own means.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOperational and Coordination Difficulties\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNumber of involved parties exceeding the initial resources present.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRapidly deteriorating weather that accelerated the need for evacuation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLimited communications (lack of ARTVA/radio helmets for some rescuers who intervened from the competition site).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNon-systematic triage, with evacuation not always prioritised based on clinical severity.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSA1 initially unavailable (until 13:18).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eA crucial element of the mission's success was the close collaboration between the technical component (SAV) and the medical component (118 physicians). The coordination between specialised rescuers and healthcare providers allowed for optimising evacuation times and methods, ensuring the most effective management possible of the major emergency in a complex context.\u003c/p\u003e \u003cp\u003eThe effective coordination between the Dispatch Center (CUS), the SAV manager, and the medical officer for the event ensured the optimal allocation of available resources and the correct sorting of patients between the CTO in La Thuile and the Parini Hospital in Aosta.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThis case effectively demonstrates how healthcare resources from a sporting event can be integrated with the Regional Emergency System to manage a major emergency in a mountain environment. The rapid intervention of the SA2 helicopter and medical personnel already on site significantly reduced response times, a crucial factor for avalanche survival(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, the absence of systematic triage led to a suboptimal evacuation: Patient 1 (stabilised) was transported before Patient 2 (clinically more critical), reflecting a common logistical challenge in extreme and orographically complex environments(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). ICAR MedCom emphasises the importance of developing dedicated triage systems that integrate both clinical criteria (e.g. trauma severity, hypothermia) and environmental and logistical factors (burial time, accessibility to the incident site, weather)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the described intervention was globally effective, the absence of systematic triage according to ICAR MedCom recommendations(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) resulted in non-optimal patient prioritisation. ICAR MedCom emphasises the importance of using dedicated protocols for avalanche rescue, which take into account not only traditional clinical severity but also specific factors such as burial time and the presence of an air pocket(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the Aosta Valley, the healthcare personnel present at the sporting event, already integrated into the 118 system and supported by SAV, share operational protocols and specific skills, making this dual and complementary response possible(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Compared to events like the Galt\u0026uuml;r avalanche of 1999(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and Rigopiano in 2017(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), where isolation required a predominantly external intervention with prolonged response times, in this case, the resources already present for the sporting event made the difference in terms of speed.\u003c/p\u003e \u003cp\u003eScientific literature has extensively documented the advantages of rapid medical intervention in avalanche accidents(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), but there are few reports describing the integration between rescue systems dedicated to sporting events and the territorial emergency system. Brugger et al.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) have emphasised the importance of continuity of care between avalanche rescue and hospitalisation, while Boyd et al.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) have described the benefits of a systematic approach in managing emergencies during sporting events in mountain environments. However, none of these studies has specifically analysed the integration between the two components as occurred in our case.\u003c/p\u003e \u003cp\u003eThe integration between SAV and the 118 healthcare system was fundamental to the success of the intervention. This model of cooperation between technical and healthcare components represents an effective strategy for improving emergency management in mountain environments and should be implemented in other similar contexts.\u003c/p\u003e \u003cp\u003eFinally, to optimise the management of future emergencies of this type, we recommend:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe adoption, at least in the alpine environment, of a similar strategy of integration between assistance for major events and events and the public rescue system.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eJoint training between healthcare personnel and alpine rescuers to improve operational coordination.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe implementation of specific triage tools for avalanche rescue, which integrate clinical needs with environmental and logistical variables.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe experience described here suggests that the technical and healthcare scientific world must develop a new triage method for avalanche scenarios, accompanied by joint training between sporting event personnel and the territorial emergency system, which could further improve the effectiveness of the response. Furthermore, the development of more robust and resilient communication systems is recommended to optimise coordination in adverse environmental conditions.\u003c/p\u003e \u003cp\u003eIn conclusion, the integration of healthcare resources from sporting events into the territorial emergency system represents a promising model for managing major emergencies in mountain environments, particularly when rapid and simultaneous interventions are necessary. This approach deserves further study to verify its applicability in different geographical and organisational contexts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e118: Regional EMS\u003c/p\u003e\n\u003cp\u003eARTVA: Avalanche Victim Search Device\u003c/p\u003e\n\u003cp\u003eCPK: Creatine Phosphokinase\u003c/p\u003e\n\u003cp\u003eCTO: Orthopaedic Trauma Centre\u003c/p\u003e\n\u003cp\u003eCUS: Single Rescue Centre\u003c/p\u003e\n\u003cp\u003eGCS: Glasgow Coma Scale\u003c/p\u003e\n\u003cp\u003eMPDS: Medical Priority Dispatch System\u003c/p\u003e\n\u003cp\u003eNUE: Single Emergency Number 112\u003c/p\u003e\n\u003cp\u003eSA1/SA2: Alpine Rescue Helicopters\u003c/p\u003e\n\u003cp\u003eSAV: Aosta Valley Alpine Rescue\u003c/p\u003e\n\u003cp\u003eHRT: Helicopter Rescue Technician\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot required for this type of study; data have been anonymised and treatment was carried out according to emergency-urgency standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent obtained from all patients for the anonymised publication of clinical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available upon request from the corresponding author, with limitations related to patient privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSG: data analysis, manuscript drafting. GC and PC: coordination of rescue operations, collection of technical data. DP: clinical supervision, critical revision of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the staff of the Aosta Valley Alpine Rescue, the CUS of the Aosta Valley, the 118 personnel who intervened at various levels, and those of the Parini Hospital in Aosta and the CTO in La Thuile for the support provided during rescue operations and data collection.\u003c/p\u003e\n\u003cp\u003eThe EMSy Large Language Model (specifically developed for pre-hospital emergency) was used for checking and drafting the text structure, while maintaining complete supervision and revision of the content performed by the authors of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: A systematic review. Resusc June. 2010;81(6):645\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlancher M, Albasini F, Elsensohn F, Zafren K, H\u0026ouml;lzl N, McLaughlin K, et al. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol June. 2018;19(2):131\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaegeli P, Falk M, Brugger H, Etter HJ, Boyd J. Comparison of avalanche survival patterns in Canada and Switzerland. Can Med Assoc J 19 April. 2011;183(7):789\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTechel F, Jarry F, Kronthaler G, Mitterer S, Nairz P, Pavšek M, et al. Avalanche fatalities in the European Alps: long-term trends and statistics. Geogr Helv 28 June. 2016;71(2):147\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealthcare assistance for events [Internet]. [cited 17 March 2025]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ausl.vda.it/f-a-q/come-fare-per/assistenza-sanitaria-alle-manifestazioni\u003c/span\u003e\u003cspan address=\"https://www.ausl.vda.it/f-a-q/come-fare-per/assistenza-sanitaria-alle-manifestazioni\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrugger H, Durrer B, Adler-Kastner L, Falk M, Tschirky F. Field management of avalanche victims. Resusc Oct. 2001;51(1):7\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K et al. On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation [Internet]. 1 marzo 2023 [citato 17 marzo 2025];184. Disponibile su: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.resuscitationjournal.com/article/S0300-9572(23)00021-7/fulltext\u003c/span\u003e\u003cspan address=\"https://www.resuscitationjournal.com/article/S0300-9572(23)00021-7/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorenzoni N, Raich M. Long-term impact of the Galtuer avalanche on the public health system. J Emerg Manag West Mass. 2021;19(2):197\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun T, Frigo B, Chiaia B, Bartelt P, Famiani D, Wassermann J. Seismic signature of the deadly snow avalanche of January 18, 2017, at Rigopiano (Italy). Sci Rep 29 ottobre. 2020;10(1):18563.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProcter E, Strapazzon G, Dal Cappello T, Zweifel B, W\u0026uuml;rtele A, Renner A, et al. Burial duration, depth and air pocket explain avalanche survival patterns in Austria and Switzerland. Resusc agosto. 2016;105:173\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Avalanche, Alpine rescue, Emergency medicine, Sporting events, Major emergency, Air ambulance, Resource management, Triage, Mountain medicine","lastPublishedDoi":"10.21203/rs.3.rs-6264752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6264752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eManaging emergencies in mountain sporting competitions is complicated by difficult access and adverse environmental conditions. This case report describes a rare event in which healthcare resources from a sporting event were integrated into the rescue of a nearby avalanche, demonstrating an innovative resource management model.\u003c/p\u003e\u003ch2\u003eCase Presentation\u003c/h2\u003e \u003cp\u003eOn 14th March 2025, during the Alpine Ski World Cup in La Thuile (Aosta Valley, Italy), an avalanche in the Arpy area involved nine ski mountaineers. With the primary helicopter (SA1) already engaged elsewhere, the SA2 helicopter and medical and technical personnel from the competition were diverted to the site, ensuring rapid intervention despite adverse weather. Four patients sustained injuries (one with an initial GCS of 10 and severe hypothermia); five were uninjured. Adverse weather conditions, scene hazards, and the absence of a triage system in the literature for approaching these cases complicated the intervention, but coordination between sporting resources and the Regional Emergency System optimised the overall response.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIntegrating sporting healthcare resources with the Regional Emergency System offers significant added value in managing major mountain emergencies. However, as highlighted in the ICAR MedCom guidelines, triage in the mountain environment requires a compromise between healthcare needs and technical factors, such as weather conditions and accessibility of the incident site. The success of the described intervention was possible only thanks to the close collaboration between the Aosta Valley Alpine Rescue (SAV) and the 118 (local EMS) emergency physicians, ensuring a synergistic and optimal management of available resources.\u003c/p\u003e","manuscriptTitle":"Integration of Medical Services for Sporting Events with the Regional Emergency System During an Avalanche: A Case Report from the Alpine Ski World Cup","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 12:17:36","doi":"10.21203/rs.3.rs-6264752/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a160345f-d082-478e-9bf8-bfd5ae14dd4d","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-01T14:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 12:17:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6264752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6264752","identity":"rs-6264752","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}