Risk management in Norwegian avalanche rescue operations Managing uncertainty, complexity, over-commitment and the long-term monitoring of accident risk. by Albert Lunde Thesis submitted in fulfilment of the requirements for the degree of PHILOSOPHIAE DOCTOR (PhD) Faculty of Science and Technology Department of Safety, Economics and Planning 2019 University of Stavanger NO-4036 Stavanger NORWAY www.uis.no ©2019 Albert Lunde ISBN: 978-82-7644-884-9 ISSN: 1890-1387 PhD: Thesis UiS No. 486 Acknowledgements This thesis represents a culmination of forty years in volunteer rescue organizations. It would not have come to this if it was not for the patience of my family and the contributions made by fellow rescuers. Being a volunteer rescuer is not a paid job. It is a mild form of mental disorder – and it is chronic. I am wholeheartedly grateful to my wife Elisabeth, who has always been supportive and caring. Even in my late blooming as an academic, she keeps on cheering. Perhaps it is because of her background as volunteer rescuer in the Red Cross? Our children, Kirsti, Sondre and Ingvild, who in their early years did service as “bodies” for avalanche dog training, have later become our trusted advisors in many aspects of life, also rescue and research. All over the country, I could point at rescuers who have made a difference by sharing their knowledge and experience. They have created the curiosity I needed to embark on the lane of research. Great inspirers in the rescue service are medical doctor Tore Dahlberg and rescue paramedics Haakon Nordseth and Christen Tellefsen from the Norwegian Air Ambulance. In a humble manner, they merge their commitment to volunteer rescue with years of experience from airborne rescue missions. Krister Kristensen from the Norwegian Geotechnical Institute has for many years made a quiet and massive impact on safety in mountain travel as well as in alpine rescue operations. For nearly twenty years, fellow members of the Avalanche resource group in the Norwegian Red Cross Rescue Corps (NRCRC), Tor Andrè Skjelbakken, Jan Peder Hoggen, Mats Hjelle, Egil Torpe, Kristian Bryn and Kim Sviland, created many joyful and educational moments. Their zealous work to improve rescue procedures eventually yielded a standard, later approved as the National Guidelines for Avalanche Rescue. iii The NRCRC was for many years the sole Norwegian member of the International Commission for Alpine Rescue (ICAR), taking on the financial burden and the responsibility of sharing worldwide rescue experience to colleagues in Norway. I am grateful to Jens Gløersen, a former consultant at the NRCRC, who forwarded my name as delegate to the ICAR Avalanche commission in 1996. This honorary post marked the start of my career as a researcher, bringing a commitment to prepare and present statistics on Norwegian avalanche accidents. The Avalanche commission in ICAR brought the international perspective and a deeper understanding of the differences and similarities that arise between countries, organizations and mountain ranges. It also brought a worldwide network of enthusiasts, who all share the common goal of providing a safe and efficient rescue service. To access data, I was totally reliant on trust and assistance from supportive employees at the Joint Rescue Coordination Centres in South- and North-Norway. Ola Vaage, Stein Solberg, Jarle Øversveen and Tore Wangsfjord, along with many of their colleagues, have all shared in generating knowledge about Norwegian avalanche rescue operations. Ole Hafnor from the Ministry of justice and public security has for many years been an important facilitator of cross-organizational cooperation. By inviting me to meetings and seminars, they have created arenas for sharing and discussing results. This has served as inspiration and validation. In my hometown, Lom, the late local police chief Steinar Angard was a dedicated supporter of volunteer mountain rescue organizations. He facilitated a close cooperation with local rescue resources and encouraged my commitment to rescue work. Nils Lund, a former colleague at the local police office and longstanding instructor in the Norwegian Rescue Dog Association, is the one who invited us to Lom in the first place. For our family, his initiative led to a good life in the mountains, and two avalanche rescue dogs. iv In my academic career at the University of Stavanger (UiS), I have enjoyed the superb supervision of professor Ove Njå. His great insight into societal safety research, and a keen interest in avalanche rescue, created this opportunity. Through his enthusiastic and relentless feedback, I have been guided along a track of learning experiences. As a co-supervisor, professor Geir Sverre Braut has kept my spirits high and my worries low. With his expertise in public health care, risk regulations, audits, and as a master of words, he has provided the right input at the right time. I am very grateful to the rescue experts and the air ambulance crew members who participated in these studies. Their honest answers and comments were priceless input in trying to understand the systems and mechanisms that act on rescue performance. I have also enjoyed kind and knowledgeable assistance from colleagues, academic and administrative staff at the UiS Faculty of Science and Technology. Not to forget, my sister Mia Lunde Husebø and my niece Veslemøy Guise, both post doctors at the Stavanger University Hospital and UiS Department of Health studies, respectively, have offered invaluable tips and tricks on how to cope as a PhD student. My brother Knud Lunde and his wife Barbara have used their experience as PhD scholars in Cambridge, UK, to encourage my academic writing skills. Lastly, local rescuers from the Red Cross, the Norwegian alpine rescue team and the Norwegian rescue dog association, along with crew members from the Norwegian air ambulance base at Dombås, provide a safe arena for rescue practice and evaluation of rescue performance. Thanks to everyone! v Summary Introduction: Avalanche incidents commonly take place in adverse environmental conditions, and the expected survival time of avalanche victims is short. These situations require an immediate rescue response, which may pose a serious challenge to the safety of both rescuers and avalanche victims. Historically, the Norwegian rescue service has experienced few serious accidents, but undesirable incidents where rescuers are dangerously exposed in avalanche runout zones seem more frequent. Risk management in the avalanche rescue service is multifaceted, influenced by its multi-organizational structure. Individuals acting in this socio-technical rescue system are easily caught between two imperatives: saving lives and staying alive. The aim of risk management is to maintain equilibrium in rescue commitment. This project analysed whether the Norwegian avalanche rescue system is correctly balanced to withstand the extra load of common risk influencing factors in rescue operations. Aim: The fundamental aim of this thesis was to contribute to new knowledge on factors that are important for risk management and performance in the Norwegian avalanche rescue service. Methods: Mixed methods research was applied to answer the specific research questions. This implied multiple research activities in a combination of quantitative and qualitative methodologies. Study number 1 was a retrospective study to characterize Norwegian avalanche incidents and rescue response (Paper I). A comprehensive study comprising avalanche rescue statistics, cross-case analysis, factor analysis and risk modelling was conducted to gain insight into avalanche rescue performance (Paper II). In a phenomenological study to explore the concept of overcommitment, nine air ambulance crews from five bases took part in focus group interviews (Papers III and IV). Lastly, a systemic safety analysis was conducted in two separate seminars, vi supported by the insight of six experts in Norwegian avalanche rescue operations (Paper V). The thesis itself is a cross-paper synthesis of results. Results: The studies returned results which contribute to justified beliefs about patient and rescuer safety in Norwegian avalanche rescue operations. Paper I: Norwegian avalanche rescue statistics from the periods 1996- 2017 and 2010-2017 showed that 75% of avalanche victims were already located and recovered by the time organized rescue units arrived at the accident site. Of the remaining 25% not recovered by companion rescuers, organized rescuers located 62% due to visible parts and transceivers. Of the avalanche victims, 55% were characterized as patients, and many of these suffered serious injuries. These statistics indicate that avalanche incidents are first and foremost medical emergencies, leading to the conclusion that medical personnel should be dispatched directly to the accident site without waiting or detouring for specialized resources for search operations. Paper II: Descriptive statistics confirmed that the number of road related avalanche rescue incidents increased markedly in the study period. In the period 1996-2014, avalanches reaching public roads caused six fatal accidents, four personal injury accidents and fifteen close calls. Eleven out of 34 avalanche victims died (32.4%). Out of 135 incidents, 110 had no victims involved in the avalanches. From 1996 to 2014, no vehicles were completely covered by avalanche debris, and all onshore victims were located due to visible parts. In 62% of 45 analysed cases, in the period 2010-2014, the regional