Mountain Multi-Casualty Incidents in Sweden: Frequencies and Perceived Rescue Capacity

Introduction: More than one billion people live in mountain areas worldwide. Increasing mountain tourism and decreasing visitor preparedness may increase the risk for major incidents, and climate instability may affect incident mechanisms, frequencies, magnitudes, as well as conditions for medical evacuation. In its guidelines for mountain multi-casualty incidents (MCIs), the International Commission for Alpine Rescue (ICAR) notes that, compared with an urban environment, a lower number of casualties may be considered an MCI because resources are more limited. In Sweden, previous research on mountain rescue medical capacity is lacking. Aim: To describe the incidence of mountain MCIs in Sweden and assess the corresponding perceived capacity of Swedish mountain rescue personnel. Methods: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018– 2022 (n = 1543) was performed to describe frequencies of incidents with ≥2 casualties. 21 participants from the Swedish police governed and volunteer-based organization, Swedish mountain rescuers, from 4 different mountain counties were interviewed to describe self-assessed capacity concerning MCIs. The collected data were analyzed using qualitative content analysis. Results: 216 (14%) of all incidents 2018–2022 involved ≥2 casualties. Of these, 39 involved 3 casualties, 21 involved 4 casualties, and 15 involved 5 casualties. Interviewees indicated the context-dependent number of casualties above which mountain rescue resources may become insufficient as 2-4. Impending factors indicated were organizational (e.g., inter-organizational communication, dependency on other organizations, mobilization time), legislative (trained medical professionals prohibited from administering drugs), and human (e.g., rescuer fatigue). Conclusion: A notable proportion of mountain incidents in Sweden exceeds the self-assessed maximum capacity of Swedish mountain rescue. The dependency on other organizations for medical evacuation motivates further study into possible international joint rescue ventures, exercises, and information exchange. Current legislation regarding the administration of medication by trained medical professionals warrants further discussion.