Brokeback Mountain: Spinal Injuries in Mountain Casualties in Snowdonia

Abstract

Our emergency department (ED) receives casualties from Snowdonia National Park and surrounding areas. Suspected spinal injuries are common in mountain casualties and pose handling challenges for rescue personnel. The pattern and severity of spinal injuries occurring among UK mountain casualties has not been well studied. Therefore, we wished to establish the incidence and pattern of spinal injuries in mountain casualties presenting to our hospital. Cases with spinal fractures were identified from our database of mountain casualties brought to our ED January 2004 to December 2011 after contact with mountain rescue teams or Royal Air Force Search and Rescue helicopter, or both. Radiological reports and images were reviewed to establish vertebral level and type of injury. Of 789 mountain casualties during the study period, 636 (80%) were injured rather than ill, although 196 had only isolated lower leg injuries. Fifty-one cases had confirmed spinal fractures, including 8 fatalities (17.4% of the 46 trauma fatalities). Most of the spinal fractures (44 of 51) had fallen from a height greater than standing; 20 were direct and 24 were tumbling falls. Most were rock climbing or hill walking at the time of incident. Forty-three of 394 nonisolated ankle trauma casualties (11%) had spinal fractures, but only 7 of 43 were unstable: the unstable fracture rate in casualties found alive was 1.8%. Only 1 survivor sustained spinal cord damage, compared with 5 of 8 fatalities (56%); T12 and L1 together accounted for 43% of spinal fractures. Spinal fractures are quite common in mountain casualties in North Wales. However, only 1.8% of casualties still alive when help arrived had unstable spinal fractures, and only 1 casualty sustained spinal cord injury. Direct falls (eg, rock climbing) produce a similar injury pattern as for urban fallers, but falls of a tumbling nature were associated with a higher rate of cervical and thoracic injury and a greater mortality among fallers with spinal injuries.