October 10, 2025 • 17 mins
In this episode of Wilderness Medicine Updates, host Patrick Fink delves into groundbreaking technology designed to improve safety during avalanche events. The focus is on SafeBack SBX, a Norwegian-developed device that supplies air to users buried in avalanches, potentially extending survival time. Patrick reviews new research published in the Journal of the American Medical Association, which demonstrates significant efficacy in delaying hypoxia during simulated avalanche burials. The episode provides an in-depth analysis of SafeBack SBX, its mechanisms, study results, and its comparative and complementary role alongside existing safety technologies like airbags. Concluding with potential applications and limitations, Patrick aids listeners in deciding whether SafeBack SBX is a worthy addition to their avalanche safety gear.
Links
Eisendle F, Roveri G, Rauch S, et al. Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial. JAMA. Published online October 08, 2025. doi:10.1001/jama.2025.16837
Articles I've written about Safeback:
Suffocation or Survival: A Crucial Factor in Avalanche Burials
Avalanche Safety: Assessing the Safeback SBX System
First Look: Safeback SBX Avalanche Safety System
Chapters
00:31 Overview of SafeBack SBX Technology
02:55 Importance of SafeBack in Avalanche Safety
05:40 Details of the SafeBack Study
07:53 Study Results and Analysis
11:07 Implications and Future Directions
15:50 Conclusion and Final Thoughts
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.
Connect with us by email at wildernessmedicineupdates@gmail.com.
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Connect with us on social!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:15):
Hello and welcome back toWilderness Medicine Updates the
show for providers at the Edges.
I'm your host, Patrick Fink.
Today I'm doing a fast push.
This format is my opportunity toget some fresh research out to
you guys that I think isinteresting.
I'm gonna go a little bit deepertoday.
We're gonna dive into a newtechnology to mitigate risk when
traveling an avalanche reducingthe risk of avalanche burial.
(00:39):
It's called the safe back SBX,and there's new research out
October 8th, the day before Irecord this in the journal of.
The American MedicalAssociation, also known as jama,
one of the top journals inmedicine.
And so I think this is reallyworthy of note, and I think it's
potentially game changing interms of technologies that can
(00:59):
reduce risk in avalancheterrain.
So we're gonna dive in firsttalk about what is the safe back
SBX system, and then review thisnew independent research from
the URAC group that waspublished in JAMA.
Cover, how it works, the sciencebehind it, what the research
found.
And where it fits into ouravalanche safety gear.
So to start with, what is safeback?
(01:20):
SBX Safe Back is a technologythat was developed by an
independent Norwegian company.
If you're familiar with theAvalon device, the Black Diamond
Avalon, it is analogous to anAvalon.
It's a fan-based system thatgoes into a backpack or vest and
draws air from within thebackpack around the sides of the
(01:40):
backpack from the snow pack.
And uses a fan to drive it outthrough the shoulder straps of
the backpack and deliver up to150 liters per minute of flow of
air to the user's face.
So if this user is buried in anavalanche, they get a supply of
air delivered to buy their face.
Unlike the.
Black Diamond Avalon.
(02:01):
There is no need to sticksomething in your mouth.
Use a mouthpiece.
There's lower potential forhazard, and it's triggered by
pulling a handle on the shoulderstrap, much like an avalanche
airbag pack.
So that can either be deployedbefore entering into avalanche
drain, or at the time that anavalanche, occurs.
(02:22):
The device has a stated runtimeof about 90 minutes.
It runs on disposable lithium AAbatteries, and it weighs about
500 grams, which is lighter thanmost airbag systems, and comes
in at a comparable pricecurrently with a backpack cost
in 752$900 in current form,available currently through RAID
(02:47):
research in the United States.
With more backpack companies tocome Heli Hansen announcing that
they're going to bring this tothe US as well next year.
Okay, so why does thistechnology matter?
This matters because inavalanche accidents, asphyxia,
or lack of oxygen is the causeof death in somewhere around 75%
(03:07):
of avalanche deaths.
And when a victim is buried inthe snow by an avalanche.
Their survival is very timedependent, so your survival at
10 minutes is pretty good.
If you haven't died of traumaduring the initial event, your
survival at 10 minutes is about90%, but at 35 minutes.
(03:31):
It drops to 31%, it startsdropping pretty precipitously,
beginning at around 10 minutes,and then really drops off after
35.
We think that that's becausepeople are asphyxiating.
They do not have enough air tocontinue to survive.
There are some prior studiesthat give some validity to the
idea that giving airflow tosomeone who's buried would help
them survive.
(03:52):
A 2022 randomized controlledtrial showed that supplemental
air increased tolerance insimulated avalanche burial from
13 to 22 minutes, and ananalysis by the same research
group that performed the samestudy that we're gonna review
today.
I found that at least 41% ofvictims buried in an avalanche
(04:12):
didn't have their airway packedwith snow.
This is an area where there's alot of incomplete data, so that
number could be much larger, butat least 40% of people could
potentially benefit from thistechnology.
And then Safe Back has done someinternal testing.
I've communicated with themabout this, showing that in all
different kinds of.
(04:32):
Snow packs, they can stilldeliver adequate flow through
the snow.
And it's actually the snow youwould not think that makes it
difficult to deliver air.
It's light powdery snow.
Low density snow is actuallyharder to deliver air through
because it has fewer airchannels.
It's the.
Dense snow with large grains,which is typically what results
(04:54):
after an avalanche because ofall of the tumbling involved
that can deliver even higherrates of airflow.
So there's plausibility to thistechnology to determine whether
this is actually effective.
I have to applaud safe backbecause they backed some
research that could have sunkthem.
(05:15):
The URAC Research Group is anindependent research group in
Europe that tackles big publichealth questions, and they've
done some research in this spacebefore, but Safe Back gave them
a bunch of packs and said, Hey,study whether this is effective.
And URAC came back and said,great.
If it's not effective, we'restill gonna publish the results.
We good?
(05:35):
Safe back.
Said, yeah, we're good.
we really actually wanna knowwhether this works.
So let's talk about this studyagain.
This was published October 8thin the Journal of the American
Medical Association by I SendalEtal.
The title is Respiratory GasShifts to Delay Asphyxiation in
Critical Avalanche Burial, ARandomized Clinical Trial.
(05:57):
This was a prettystraightforward trial, but they
have some study design that'spretty interesting that really
improves the quality of theirdata.
They screened a bunch of adultsto participate in this study.
18 to 60 years old ended upgetting a slightly narrower age
range in the people who actuallyparticipated, but ultimately
ended up doing 12 people in theintervention group and 12 people
(06:21):
in the control group.
And what they did in this studywas they buried people face
down.
With at least 50 centimeters ofsnow over their head and torso,
simulating a critical avalancheburial, and they were wearing
equipment that allowed them tomeasure their respiratory
parameters, their inspiredoxygen, their expired CO2.
(06:42):
They had probes in the snowmeasuring gas content around
them.
The intervention group had thesafe back fan device present,
and the control group had adevice that was similar in all
respects, including the noisethat it made, except it didn't
actually deliver error to buythe face.
The participants didn't knowwhich one they had, and indeed
(07:04):
only the person responsible foractivating the pac who was the
lead investigator.
Knew which device was which.
So everyone else conducting thestudy was blinded to who
actually had which pack.
they buried people into the snowand they said, Hey, we're gonna
let you go for at least 35minutes unless your oxygen
saturation dips below 80%.
(07:26):
Or you ring this danger bell andsay, I want to be done In the
group that had the actual safeback device, if they reached 35
minutes, they then turned offthe safe back.
And simultaneously activated asham device to make sure that if
that group, did better, itwasn't just because of their
burial conditions.
(07:47):
they gave them the sameconditions as the control group
after 35 minutes.
So what actually happened?
In the device group who had thereal safe back, 11 participants
completed the entire 35 minutes.
One of the participantsrequested early termination
because they had tingling in anextremity.
(08:09):
They didn't stop for anyrespiratory reasons of the
people who had the sham device,the not real device.
Seven were stopped early for anoxygen saturation, less than
80%, and four of them werestopped because of participant
requests, three of which werefor shortness of breath and one
of which was for a panic attack.
So that means that only one ofthe sham group managed to go to
(08:32):
the full 35 minutes.
so there was a reallystatistically significant
difference in the time thatcould be tolerated under the
snow while wearing the safe backdevice.
In comparison to the sham.
Also notable within the Shamgroup, the median time to reach
an oxygen saturation of 80% was6.4 minutes.
(08:55):
And in the safe back group,everyone who completed the full
length of the study, except forthat one person who got the
tingles, none of themexperienced oxygen desaturation
to 80%.
Then when they flipped off theirsafe back.
They started seeing the samekind of results in that group as
they did in the Sham group.
There was no difference betweenthe two.
So that difference that wasobserved between the sham and
(09:17):
the safe back group was entirelydue to the technology and not
because of some other issue.
So what do I take away from thisstudy?
I think this is a really greatstudy.
I think they did a really goodjob.
It's an independent study.
They have their own funding.
They just got devices from safeback.
I think there's a low risk ofbias and I think that there was
high quality blinding.
(09:39):
It was a well controlledenvironment with uniform burials
and they had an internal controlthat like turn off the safe back
turn on a sham that ensured thatthe burial condition was uniform
between the two groups.
So the observed differences canbe attributed to the technology.
The results are impressive inthat hypoxia was delayed for at
(10:01):
least 35 minutes, and we reallydon't know the endpoint on that
because they didn't try to gofurther.
When I asked one of the studyorganizers why they did that, it
was because they feel the bestwindow where they've seen a lot
of deterioration is up to that35 minute mark.
That's not to say that youcouldn't stay under the snow
longer with the safe back.
(10:23):
The primary limitation of thestudy is the uniform burial
condition, so we don't know ifit would work as well if people
were in different positions,different snow densities at
different altitudes.
In positions that resulted inwhat are called positional
asphyxia, which is where.
Snow packed around the torsoprevents one from actually
(10:45):
expanding the chest.
A recent simulation study oftree well burials, which I think
we've discussed on here before,showed that just putting people
in a different position can leadto hypoxia a lot sooner.
Still, the results areimpressive and I think that it
suggests a strong likelihood ofbenefit under real world
(11:06):
conditions.
Should we all just start usingsafe back all the time when
we're in avalanche terrain?
Should it replace airbags?
I don't think that there'senough information to make that
decision yet.
It's important to recognize thatthis is a fundamentally
different technology fromairbags.
Airbags reduce the likelihood ofbecoming buried by doing so.
(11:29):
They prevent critical burial.
They cut critical burial riskfrom 47% down to 20%.
That reduces mortality from 22%down to 11%.
So if you wanna make that soundreally good, it cuts mortality
in half.
It's a 50% reduction.
(11:49):
Beacons have an absolutemortality reduction of about
15%, surprisingly.
The technology also has some ofthe same limitations as other
technologies.
Namely, the user has to triggerthe device.
You have to pull it.
Airbags also don't work if youdon't deploy them.
Safe back has the potential tobe deployed before entering into
(12:10):
the avalanche zone.
So you could start it beforeentering into a ski run.
However, so far my personalexperience using the device I
have in my possession is thatit's a little too hard to turn
off.
And so, because it's hard toturn off, you're not gonna turn
it on before a run.
And then at the end of the run,go digging around in your pack
to turn it off.
(12:30):
I've given the company feedbackon that they're aware that
there's room for improvementthere.
Also, this is only a usefultechnology if you're skiing or
traveling with a partner, andthat partner can in turn locate
you and excavate you stillreasonably quickly.
It's not at all useful really tosomeone who is traveling solo
(12:55):
that that person needs to focuson not getting buried in the
first place.
Otherwise, a device like this isonly going to prolong the
horrific time under the snowwhere they're not being rescued
and there's no hope of rescue.
And then finally, like allavalanche safety technology, it,
you know, there's always thepotential that using a new
safety technology couldinfluence our behavior.
(13:17):
If you don't think that that's areal thing, and that's somewhat
debated whether this effectcalled risk homeostasis is.
Real or significant?
Consider whether you change yourbackcountry behavior.
If I took your beacon away,That's my mental argument.
For the existence of riskhomeostasis, I think you would
behave differently.
(13:37):
Skiing with no beacon.
On the other hand, I thinkthere's some interesting use
cases, two use cases that safeback addresses, which are not
addressed by other technologiescurrently.
The first one is the potentialfor addressing snow immersion
suffocation or tree well burial.
This, as we've discussed on theshow before, has a really high
fatality rate.
It's like 80 to 90% fatal anddeath is often within five
(14:02):
minutes, and that's because of acombination of airway plugging,
positional asphyxia.
And, inability to gas exchangesafe back could potentially help
with this.
If it was deployed prior tofalling in a tree, well, maybe
they develop a commercialproduct for use in a ski resort,
a vest that can be easily turnedon and off.
(14:22):
It would be really the onlytechnology that would aim to
address this problem.
We don't really know if it wouldwork it would require a
completely different studydesign and those things that I
talked about.
Airway plugging, positionalasphyxia.
Would potentially reduce theeffectiveness of safe back under
those conditions.
Still, for a space that has notechnologies currently, there's
(14:45):
a lot of room to grow there andSafe back looks like the most
promising option so far.
The other case where Safe Backcould potentially be quite
useful is for rescuers or skipatrollers who are.
Working in the tail of anavalanche slope in the runout
zone down at the bottom wherethere's still existing hang fire
or approaching from below.
(15:07):
In that setting, I would expectsafe back to be more useful than
an avalanche airbag.
Why?
How do airbags work?
They work through reversesegregation.
This is best described as theBrazil nut principle.
If you have trail mix and youshake it, the big nuts come to
the top.
An airbag turns you from apeanut into a Brazil nut.
(15:27):
It makes you a bigger particlethat's more likely to end up on
the top of the mixture.
After all of the shaking, ifyou're at the bottom of the
slope, there's no time to shakeand tumble.
You're just getting hit by snowfrom above.
In that setting, safe back couldreduce the risk of exposure and
prolong time available forrescue to people who are working
(15:48):
in those avalanche paths.
So in conclusion.
Safe Back is a new technologythat shows real promise for
extending survival time duringavalanche burial.
So far, it does not appear to bea replacement for airbags or
other safety technologies, andit's certainly not a replacement
(16:10):
for a well-trained partner, butit may be complimentary.
Our real world data on this isstill limited to none, so field
validation really needs tohappen.
We need some field experiencewith this.
And where I think the big futuredirection is here is if safe
back is combined with an airbag.
If you have a fan powered airbagthat also powers a safe back
(16:33):
fan, that is kind of aGoldilocks technology that will
both reduce the risk of burialand mitigate the effects of
burial.
And that's the first goodargument I've heard so far for
using a fan-based airbag.
But that combination technologyis still a few years away at
(16:54):
best.
So that's it for this fast push.
I hope that you enjoyed thisdiscussion of this paper.
I'm gonna put the citation downin the show notes.
You can read the abstract onjama unfortunately.
Unless you have institutionalaccess or a subscription to
jama, you won't be able to readthe whole thing.
It is stuck behind an expensivepaywall.
(17:16):
That said, I think you know whatyou need to know after listening
to this quick podcast.
And you can start making adecision about whether safe back
is a technology that you want tocarry.
Protect you against the risk oftree well burial or out in the
back country for recreation orfor rescue.
If you have questions, comments,send them to Wilderness Medicine
(17:39):
updates@gmail.com.
If you have ideas for othershows or just wanna send some
feedback, reach out to me.
Share this episode with yourbackcountry partners, your ski
patrol fellows.
Until next time, I'm your host,Patrick Fink.
Stay fit, stay focused, and havefun.
Hello and welcome back toWilderness Medicine Updates the
show for providers at the Edges.
I'm your host, Patrick Fink.
Today I'm doing a fast push.
This format is my opportunity toget some fresh research out to
you guys that I think isinteresting.
I'm gonna go a little bit deepertoday.
We're gonna dive into a newtechnology to mitigate risk when
traveling an avalanche reducingthe risk of avalanche burial.
(00:39):
It's called the safe back SBX,and there's new research out
October 8th, the day before Irecord this in the journal of.
The American MedicalAssociation, also known as jama,
one of the top journals inmedicine.
And so I think this is reallyworthy of note, and I think it's
potentially game changing interms of technologies that can
(00:59):
reduce risk in avalancheterrain.
So we're gonna dive in firsttalk about what is the safe back
SBX system, and then review thisnew independent research from
the URAC group that waspublished in JAMA.
Cover, how it works, the sciencebehind it, what the research
found.
And where it fits into ouravalanche safety gear.
So to start with, what is safeback?
(01:20):
SBX Safe Back is a technologythat was developed by an
independent Norwegian company.
If you're familiar with theAvalon device, the Black Diamond
Avalon, it is analogous to anAvalon.
It's a fan-based system thatgoes into a backpack or vest and
draws air from within thebackpack around the sides of the
(01:40):
backpack from the snow pack.
And uses a fan to drive it outthrough the shoulder straps of
the backpack and deliver up to150 liters per minute of flow of
air to the user's face.
So if this user is buried in anavalanche, they get a supply of
air delivered to buy their face.
Unlike the.
Black Diamond Avalon.
(02:01):
There is no need to sticksomething in your mouth.
Use a mouthpiece.
There's lower potential forhazard, and it's triggered by
pulling a handle on the shoulderstrap, much like an avalanche
airbag pack.
So that can either be deployedbefore entering into avalanche
drain, or at the time that anavalanche, occurs.
(02:22):
The device has a stated runtimeof about 90 minutes.
It runs on disposable lithium AAbatteries, and it weighs about
500 grams, which is lighter thanmost airbag systems, and comes
in at a comparable pricecurrently with a backpack cost
in 752$900 in current form,available currently through RAID
(02:47):
research in the United States.
With more backpack companies tocome Heli Hansen announcing that
they're going to bring this tothe US as well next year.
Okay, so why does thistechnology matter?
This matters because inavalanche accidents, asphyxia,
or lack of oxygen is the causeof death in somewhere around 75%
(03:07):
of avalanche deaths.
And when a victim is buried inthe snow by an avalanche.
Their survival is very timedependent, so your survival at
10 minutes is pretty good.
If you haven't died of traumaduring the initial event, your
survival at 10 minutes is about90%, but at 35 minutes.
(03:31):
It drops to 31%, it startsdropping pretty precipitously,
beginning at around 10 minutes,and then really drops off after
35.
We think that that's becausepeople are asphyxiating.
They do not have enough air tocontinue to survive.
There are some prior studiesthat give some validity to the
idea that giving airflow tosomeone who's buried would help
them survive.
(03:52):
A 2022 randomized controlledtrial showed that supplemental
air increased tolerance insimulated avalanche burial from
13 to 22 minutes, and ananalysis by the same research
group that performed the samestudy that we're gonna review
today.
I found that at least 41% ofvictims buried in an avalanche
(04:12):
didn't have their airway packedwith snow.
This is an area where there's alot of incomplete data, so that
number could be much larger, butat least 40% of people could
potentially benefit from thistechnology.
And then Safe Back has done someinternal testing.
I've communicated with themabout this, showing that in all
different kinds of.
(04:32):
Snow packs, they can stilldeliver adequate flow through
the snow.
And it's actually the snow youwould not think that makes it
difficult to deliver air.
It's light powdery snow.
Low density snow is actuallyharder to deliver air through
because it has fewer airchannels.
It's the.
Dense snow with large grains,which is typically what results
(04:54):
after an avalanche because ofall of the tumbling involved
that can deliver even higherrates of airflow.
So there's plausibility to thistechnology to determine whether
this is actually effective.
I have to applaud safe backbecause they backed some
research that could have sunkthem.
(05:15):
The URAC Research Group is anindependent research group in
Europe that tackles big publichealth questions, and they've
done some research in this spacebefore, but Safe Back gave them
a bunch of packs and said, Hey,study whether this is effective.
And URAC came back and said,great.
If it's not effective, we'restill gonna publish the results.
We good?
(05:35):
Safe back.
Said, yeah, we're good.
we really actually wanna knowwhether this works.
So let's talk about this studyagain.
This was published October 8thin the Journal of the American
Medical Association by I SendalEtal.
The title is Respiratory GasShifts to Delay Asphyxiation in
Critical Avalanche Burial, ARandomized Clinical Trial.
(05:57):
This was a prettystraightforward trial, but they
have some study design that'spretty interesting that really
improves the quality of theirdata.
They screened a bunch of adultsto participate in this study.
18 to 60 years old ended upgetting a slightly narrower age
range in the people who actuallyparticipated, but ultimately
ended up doing 12 people in theintervention group and 12 people
(06:21):
in the control group.
And what they did in this studywas they buried people face
down.
With at least 50 centimeters ofsnow over their head and torso,
simulating a critical avalancheburial, and they were wearing
equipment that allowed them tomeasure their respiratory
parameters, their inspiredoxygen, their expired CO2.
(06:42):
They had probes in the snowmeasuring gas content around
them.
The intervention group had thesafe back fan device present,
and the control group had adevice that was similar in all
respects, including the noisethat it made, except it didn't
actually deliver error to buythe face.
The participants didn't knowwhich one they had, and indeed
(07:04):
only the person responsible foractivating the pac who was the
lead investigator.
Knew which device was which.
So everyone else conducting thestudy was blinded to who
actually had which pack.
they buried people into the snowand they said, Hey, we're gonna
let you go for at least 35minutes unless your oxygen
saturation dips below 80%.
(07:26):
Or you ring this danger bell andsay, I want to be done In the
group that had the actual safeback device, if they reached 35
minutes, they then turned offthe safe back.
And simultaneously activated asham device to make sure that if
that group, did better, itwasn't just because of their
burial conditions.
(07:47):
they gave them the sameconditions as the control group
after 35 minutes.
So what actually happened?
In the device group who had thereal safe back, 11 participants
completed the entire 35 minutes.
One of the participantsrequested early termination
because they had tingling in anextremity.
(08:09):
They didn't stop for anyrespiratory reasons of the
people who had the sham device,the not real device.
Seven were stopped early for anoxygen saturation, less than
80%, and four of them werestopped because of participant
requests, three of which werefor shortness of breath and one
of which was for a panic attack.
So that means that only one ofthe sham group managed to go to
(08:32):
the full 35 minutes.
so there was a reallystatistically significant
difference in the time thatcould be tolerated under the
snow while wearing the safe backdevice.
In comparison to the sham.
Also notable within the Shamgroup, the median time to reach
an oxygen saturation of 80% was6.4 minutes.
(08:55):
And in the safe back group,everyone who completed the full
length of the study, except forthat one person who got the
tingles, none of themexperienced oxygen desaturation
to 80%.
Then when they flipped off theirsafe back.
They started seeing the samekind of results in that group as
they did in the Sham group.
There was no difference betweenthe two.
So that difference that wasobserved between the sham and
(09:17):
the safe back group was entirelydue to the technology and not
because of some other issue.
So what do I take away from thisstudy?
I think this is a really greatstudy.
I think they did a really goodjob.
It's an independent study.
They have their own funding.
They just got devices from safeback.
I think there's a low risk ofbias and I think that there was
high quality blinding.
(09:39):
It was a well controlledenvironment with uniform burials
and they had an internal controlthat like turn off the safe back
turn on a sham that ensured thatthe burial condition was uniform
between the two groups.
So the observed differences canbe attributed to the technology.
The results are impressive inthat hypoxia was delayed for at
(10:01):
least 35 minutes, and we reallydon't know the endpoint on that
because they didn't try to gofurther.
When I asked one of the studyorganizers why they did that, it
was because they feel the bestwindow where they've seen a lot
of deterioration is up to that35 minute mark.
That's not to say that youcouldn't stay under the snow
longer with the safe back.
(10:23):
The primary limitation of thestudy is the uniform burial
condition, so we don't know ifit would work as well if people
were in different positions,different snow densities at
different altitudes.
In positions that resulted inwhat are called positional
asphyxia, which is where.
Snow packed around the torsoprevents one from actually
(10:45):
expanding the chest.
A recent simulation study oftree well burials, which I think
we've discussed on here before,showed that just putting people
in a different position can leadto hypoxia a lot sooner.
Still, the results areimpressive and I think that it
suggests a strong likelihood ofbenefit under real world
(11:06):
conditions.
Should we all just start usingsafe back all the time when
we're in avalanche terrain?
Should it replace airbags?
I don't think that there'senough information to make that
decision yet.
It's important to recognize thatthis is a fundamentally
different technology fromairbags.
Airbags reduce the likelihood ofbecoming buried by doing so.
(11:29):
They prevent critical burial.
They cut critical burial riskfrom 47% down to 20%.
That reduces mortality from 22%down to 11%.
So if you wanna make that soundreally good, it cuts mortality
in half.
It's a 50% reduction.
(11:49):
Beacons have an absolutemortality reduction of about
15%, surprisingly.
The technology also has some ofthe same limitations as other
technologies.
Namely, the user has to triggerthe device.
You have to pull it.
Airbags also don't work if youdon't deploy them.
Safe back has the potential tobe deployed before entering into
(12:10):
the avalanche zone.
So you could start it beforeentering into a ski run.
However, so far my personalexperience using the device I
have in my possession is thatit's a little too hard to turn
off.
And so, because it's hard toturn off, you're not gonna turn
it on before a run.
And then at the end of the run,go digging around in your pack
to turn it off.
(12:30):
I've given the company feedbackon that they're aware that
there's room for improvementthere.
Also, this is only a usefultechnology if you're skiing or
traveling with a partner, andthat partner can in turn locate
you and excavate you stillreasonably quickly.
It's not at all useful really tosomeone who is traveling solo
(12:55):
that that person needs to focuson not getting buried in the
first place.
Otherwise, a device like this isonly going to prolong the
horrific time under the snowwhere they're not being rescued
and there's no hope of rescue.
And then finally, like allavalanche safety technology, it,
you know, there's always thepotential that using a new
safety technology couldinfluence our behavior.
(13:17):
If you don't think that that's areal thing, and that's somewhat
debated whether this effectcalled risk homeostasis is.
Real or significant?
Consider whether you change yourbackcountry behavior.
If I took your beacon away,That's my mental argument.
For the existence of riskhomeostasis, I think you would
behave differently.
(13:37):
Skiing with no beacon.
On the other hand, I thinkthere's some interesting use
cases, two use cases that safeback addresses, which are not
addressed by other technologiescurrently.
The first one is the potentialfor addressing snow immersion
suffocation or tree well burial.
This, as we've discussed on theshow before, has a really high
fatality rate.
It's like 80 to 90% fatal anddeath is often within five
(14:02):
minutes, and that's because of acombination of airway plugging,
positional asphyxia.
And, inability to gas exchangesafe back could potentially help
with this.
If it was deployed prior tofalling in a tree, well, maybe
they develop a commercialproduct for use in a ski resort,
a vest that can be easily turnedon and off.
(14:22):
It would be really the onlytechnology that would aim to
address this problem.
We don't really know if it wouldwork it would require a
completely different studydesign and those things that I
talked about.
Airway plugging, positionalasphyxia.
Would potentially reduce theeffectiveness of safe back under
those conditions.
Still, for a space that has notechnologies currently, there's
(14:45):
a lot of room to grow there andSafe back looks like the most
promising option so far.
The other case where Safe Backcould potentially be quite
useful is for rescuers or skipatrollers who are.
Working in the tail of anavalanche slope in the runout
zone down at the bottom wherethere's still existing hang fire
or approaching from below.
(15:07):
In that setting, I would expectsafe back to be more useful than
an avalanche airbag.
Why?
How do airbags work?
They work through reversesegregation.
This is best described as theBrazil nut principle.
If you have trail mix and youshake it, the big nuts come to
the top.
An airbag turns you from apeanut into a Brazil nut.
(15:27):
It makes you a bigger particlethat's more likely to end up on
the top of the mixture.
After all of the shaking, ifyou're at the bottom of the
slope, there's no time to shakeand tumble.
You're just getting hit by snowfrom above.
In that setting, safe back couldreduce the risk of exposure and
prolong time available forrescue to people who are working
(15:48):
in those avalanche paths.
So in conclusion.
Safe Back is a new technologythat shows real promise for
extending survival time duringavalanche burial.
So far, it does not appear to bea replacement for airbags or
other safety technologies, andit's certainly not a replacement
(16:10):
for a well-trained partner, butit may be complimentary.
Our real world data on this isstill limited to none, so field
validation really needs tohappen.
We need some field experiencewith this.
And where I think the big futuredirection is here is if safe
back is combined with an airbag.
If you have a fan powered airbagthat also powers a safe back
(16:33):
fan, that is kind of aGoldilocks technology that will
both reduce the risk of burialand mitigate the effects of
burial.
And that's the first goodargument I've heard so far for
using a fan-based airbag.
But that combination technologyis still a few years away at
(16:54):
best.
So that's it for this fast push.
I hope that you enjoyed thisdiscussion of this paper.
I'm gonna put the citation downin the show notes.
You can read the abstract onjama unfortunately.
Unless you have institutionalaccess or a subscription to
jama, you won't be able to readthe whole thing.
It is stuck behind an expensivepaywall.
(17:16):
That said, I think you know whatyou need to know after listening
to this quick podcast.
And you can start making adecision about whether safe back
is a technology that you want tocarry.
Protect you against the risk oftree well burial or out in the
back country for recreation orfor rescue.
If you have questions, comments,send them to Wilderness Medicine
(17:39):
updates@gmail.com.
If you have ideas for othershows or just wanna send some
feedback, reach out to me.
Share this episode with yourbackcountry partners, your ski
patrol fellows.
Until next time, I'm your host,Patrick Fink.
Stay fit, stay focused, and havefun.
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