SLED INCIDENT RESPONSE: BURIAL, MACHINE TRAUMA AND EXTRACTION

The Technique

1. Work DRSABCD, but understand that on a sled scene the D is plural. Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation is the spine of everything below, and it does not change because there is a machine involved. What changes is the danger step. Before you go to a downed rider you are checking for the slope above you, riders still moving on the hill, machines still running, spilled fuel, hot exhaust, and terrain traps below the casualty. Stop at the edge of the scene and say the hazards out loud so the group hears them. Put one person on watching the slope and approaching traffic while the rest work. A group that walks straight into a scene without doing this is the most common way one injury becomes three.
2. In a slide involving a rider and a machine, treat it as an avalanche burial with a trauma problem bolted on. Run your transceiver search and companion rescue exactly as trained, and see the avalanche transceiver search and companion rescue lessons in this library for the search itself. The sled specific parts are these. Carry your transceiver on your body, under your outer layer, never mounted on the machine, because rider and machine almost always separate in moving snow. During a search, keep running machines and phones well away from searchers, since the electronics and metal degrade a transceiver signal. A machine spotted on the surface is a clue to where to search, not a marker of where the rider is. And do not stop searching when you find the sled. Machines are big, hard and heavy, so a rider caught with one is far more likely to have serious injury on top of asphyxia. Once you have an airway, do a proper look for bleeding, chest injury and limb damage before you think about moving anyone.
3. Treat fuel and hot exhaust as live hazards for as long as you are on scene. A crashed machine can be leaking petrol into the snow where you cannot smell it well in cold air, and a hot exhaust or turbo will sit at burn temperature long after the engine stops. Kill every machine on scene that does not need to be running, and stand the running ones away from the crash and pointing away from people. If fuel has soaked a rider's clothing, get that clothing off them as soon as you have somewhere dry and sheltered to do it, because petrol on skin strips heat fast and accelerates cold injury as well as burning the skin chemically. Never let anyone light a stove, flare or lighter near a fuel smell. A hot exhaust buried in snow also melts a void under the machine, so the sled can settle or roll without warning. Assume any machine sitting in deep snow is unstable.
4. Take carbon monoxide seriously, because in snow country it kills quietly. Carbon monoxide has no colour and no smell, and it builds up wherever an engine runs in a confined or snow packed space. The classic sled scenarios are an engine left running while the machine is buried nose down in a tree well or a creek bank, a machine idling near the entrance of a snow shelter or tent, and someone running an engine for warmth in a dug out hole. The early signs look like altitude, dehydration or a bad day out: headache, feeling sick, dizziness, a rider who seems slow to answer or oddly clumsy. If several people in one spot feel that way at once, that is your alarm. Get everyone into open moving air immediately, shut the engine down, and do not let an affected person walk back in to fetch gear. Anyone who lost consciousness, is confused, or does not clear up quickly in fresh air needs emergency services and hospital assessment, because carbon monoxide can look better while the person is still in trouble.
5. Know what machines do to bodies so you look in the right places. The heavy pattern is crush, where a machine has rolled or landed on a rider: expect chest and pelvic injury, breathing that gets worse over minutes, and internal bleeding you cannot see. The chest pattern is a rider folded over the bars, which loads the ribs, lungs and upper abdomen. Watch for a rider who is short of breath and getting worse, holding one side of the chest, or whose belly is rigid and painful, and treat that as an urgent evacuation rather than a walk it off. The hand pattern is the one riders shrug at and should not: thumbs caught in the bars or a strap take ligament damage that ends up needing surgery, and hands caught between bar and tree get crushed, cut or degloved. Splint or tape a bad thumb in the position you found it, keep the hand warm because a cold injured hand is easy to freeze, and get imaging rather than guessing. Also check the lower legs and knees, which take hits from the tunnel, running boards and A arms.
6. Free a rider from under a machine promptly and with enough hands. If a sled is lying on a person, do not lever it with one person and hope. Get everyone available on it, agree who calls the lift, agree where it is going, and clear that path first so nobody has to shuffle mid lift. Lift, do not roll, so you never roll the machine across the casualty. If snow is holding the machine up it will move when you load it, so brace or block before you commit. Once the weight is off, expect the casualty to feel worse rather than better for a while, keep them still, keep them warm, and get help moving. If you genuinely cannot free them with the people you have, do not exhaust the group trying: protect their airway, insulate them from the snow, and put your energy into calling for help early, as covered in the emergency comms and evacuation lesson.
7. Build a working platform before you try to move anyone in deep snow. Trying to lift, roll or package a casualty while you are chest deep in powder is how backs get hurt and how airways get buried. Stamp or shovel a firm, flat platform beside and under the casualty that is longer than they are and wide enough for people to kneel on both sides. Put insulation down first, because the snow will pull heat out of them the entire time you work: a sled cover, foam pads, packs, spare jackets, anything that is not snow. Move the casualty as one piece with enough hands and one person calling it, keeping the head and body in line, and never drag anyone by an arm or leg. If the ground above is steep or the casualty is in a terrain trap, get them to a defendable spot before you start detailed care.
8. Understand what improvised sled transport can and cannot do, and keep them warm the whole way. A purpose built rescue toboggan towed behind a machine is a real option if someone in the group carries one and has practised rigging it. Improvised transport is not free. A casualty lashed to a machine or a makeshift sled has no spinal protection, cannot brace, cannot tell you they are getting cold, and will be dropped if the driver falls. Never carry an unconscious rider across a lap or wedged between two riders. If you do move someone, secure them properly, insulate them from below with a full barrier, wrap them windproof from head to feet, keep the face clear and visible, and put a second machine behind so the casualty is never out of sight. Wind chill on a moving machine is savage and an injured, still person makes almost no heat of their own, so travel slowly, stop often, check their face and hands for frostbite, and check they are still talking. Keep them away from the exhaust, because a person who cannot feel or move will not pull away from a hot pipe. If they are cold, handle them gently and see the hypothermia and cold injuries lesson before you rewarm anything.

Common Mistakes

Leaving the transceiver mounted on the machine instead of on your body. Fix: wear it under your outer layer, on your torso, every ride, and check it at the trailhead with the group.

• Calling the search off when the sled is found. Fix: treat the machine as one clue only and keep searching for the rider until the rider is found.
• Leaving an engine running near a shelter, a snow hole or a buried nose to keep warm. Fix: shut engines down whenever you are digging in, sheltering or working a scene, and keep exhaust in open moving air.
• Dismissing a thumb or hand injury as minor and riding on with a cold, wet glove. Fix: splint or tape it in the position it sits, get the hand dry and warm, and have it imaged rather than guessed at.
• Packaging a casualty straight onto the snow surface. Fix: platform first, insulation under them before anything else, then assess and package.
• Riding a loaded improvised sled at normal pace to save time. Fix: slow to the speed at which a fall is unlikely, run a second machine behind, and stop regularly to check the casualty.

The Drill

Pick a slope with deep snow and no avalanche exposure, lay a machine on its side, and put a volunteer under the edge of it in a jacket. The group has to arrive, call the hazards out loud, shut down and stage machines, free the volunteer with a coordinated lift on one count, build a stamped platform with insulation down, and get the volunteer packaged windproof and off the snow. Standard: hazards called before anyone touches the machine, insulation under the casualty within five minutes of arrival, and packaged ready to move within fifteen, with the group able to state where the nearest vehicle access point is without looking it up.

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