first aid question

Yesterday:

I came upon some equipment, which I picked up, followed by large quantities of blood spatter, and a skier with what appeared to be serious open head and face injuries, barely moving. There were very few, if any skiers around. I remember seeing a couple boarders down hill, but no one coming from above. Blood was dripping fast, but not spurting. I think he got hit by a ski/binding edge during the fall.

I said - "omigod - I'm going to get ski patrol" - He moved slightly to his knees, looked at me, and said "OK". I put the equipment in front of the injured skier, and zipped as fast as I could to the nearest lift (~3 minutes away) - who radio'd the location to the patrol. I went right back up and checked on the guy; who by then was loaded on a sled - wound dressed. I imagine the total response time of ski patrol was 5-7 minutes. Two boarders were present above the scene.

As I went down - I had an immediate second thought that I might have first done something to stop the bleeding, but what? Should I have tried to stop the bleeding with a layer of his or my clothing? (or not?) Should I have waited for another skier? Is putting ice/snow on a wound appropriate? (or not). I just don't know. There wasn't anyone else around.

I'm thinking the first people on a scene are usually not the ski patrol - but I don't remember seeing a thread on what to do in this situation.

If you were able to determine that there was no arterial bleeding (spurting), you could have given him a t-shirt, rag, his hat or neck gaitor, whatever, and asked him to hold it tightly on the wound while you sprinted for the patrol. Ideally, while you were doing this, maybe another skier would have come along that you could have sent for help while you remained. Given that he could talk, there was probably not a serious airway problem.

What you want for most all types of bleeding, with the exception of a severed limb type situation, is DIRECT PRESSURE, elevation if possible (if an arm/leg injury, sitting up for a most head injuries). Presumably the patrollers, who arrived quickly (and would be expected to really crank it if you reported "head injury"), checked for neck/back injury, more serious head injury, and treated it appropriately. Our protocol here is that any head injury, except a minor laceration, is also presumed to be a potential cervical injury so dictates a backboard in most cases.

You did fine, best you could do under the circumstances.

ny patroller

In my uneducated opinion, you did the best you could do.

One of my new years resolutions this year is to take a few first aid classes. Not just for skiing injuries, but also for life in general, I'd feel a lot better knowing I'd be able to actually help anyone in need until the professionals arrive.

Brady,

To start, look into basic CPR/ First Aid / AED traing as offered by the Red Cross, American Heart Association or you local EMS.

Then go to your boss and tell him to purhcase an AED.

AED's save lives!

In this world of suing anyone and everyone, I would be apprehensive to help anyone as much as I would like to. I think you did the right thing.

Most (if not all) states have good samaritan laws that would protect you.

You could have him hold his own glove or sleeve against the would with pressure. Chances are this person already had blood on his clothing and a little more wouldn't hurt.

Thx, ny:

Direct pressure/elevation-sitting up. I'll remember that.... I did actually report it as a head injury, with alot of bleeding....and the response by patrol seemed relatively fast, altho the lift operator didn't seem particularly alert(moved slowly, forgot location-had to tell him three times, poor English). Made me wonder about whether personnel in a resort other than patrollers have minimal training on how to recognize/report these situations - I hope so.

As I think about the few seconds there, I sort of wonder if the injured skier may have been clearing blood out of his airway. Sort of on knees, bleeding out of mouth/face.

I was a bit freaked out, it looked like the injured skier was hit in the face with a meat cleaver and baseball bat, several times (probably a ski/binding during the fall), and no one else was coming down that run. I thought about stopping the bleeding right after I left, but I was already 50-100 yards downhill so I kept going. It would have bothered me more if patrol was delayed, but turns out they weren't.

Ski patrol at the scene said the injured skier will be OK.

You did the right thing.

I doubt that you carry latex gloves like patrollers. When it comes to blood, you need to take precautions not to contaminate yourself.

Exactly.

http://www.redcross.org/where/where.html

For those interested, as I am, that link will point you to your nearest red cross chapter, and from there you can take whatever training you'd like.

Unfortunately for me, the training section of my local chapter's site consists of "Thank you for your patience while we build our website." Looks like I'll be making a phone call tomorrow.


I'm rather interested in what actual patrollers have to say on this one; is it better for an untrained or mostly untrained skier to try to help someone in such a situation, or should such a bystander simply find professional or trained assistance as fast as possible?

"In such a situation" covers a lot of ground, but in this case calling the patrol, who were there in "5 - 7 minutes" was absolutely the appropriate response. It's hard to consider every hypothetical medical or trauma scenario (though chances are fair that someone here will try), but most of the ones I can think of that require help faster than a patroller can get there are either very obvious (like serious arterial bleeding) or too complex for an untrained or mostly untrained person to effectively help.

Take a witnessed cardiac arrest - what could an untrained person do about that? Same with someone with no CPR training who comes across a person who isn't breathing?

Considerations abound: C-spine injury, Body Substance Isolation (BSI) precautions, mis-diagnosis...

One thing that anyone can do is to take action to make the scene safe - crossed skis, post someone to watch over the victim, etc. to prevent further problems.

With zero training and no others approaching/available, I think you did EXACTLY what you should/could have. With a patient that is conscious and speaking, as has been mentioned, his airway was open and he was breathing. Most know to put direct pressure on a bleed. Chances are, if he could locate it, he did just that while waiting.

If others were available, I would suggest you stay with the patient. Help him, without contact, find and pressure the bleeding. You would also be able to keep the scene safe by putting crossed upright skis in the snow above the accident. This also helps patrol locate the scene. Also, if things change with the patient, alertness, consciousness, confusion, etc. you would be able to relay these changes to patrol when they arrive.

My suggestion to EVERYONE is to get CPR certification and AED training. After that, carry gloves and a mask at all times. I have gloves, stuffed in a tube the size of a roll of lifesavers and a mask with one way valve in a pouch the size of a tic tac box. I keep them on my keychain. I'm happy to try and save your life, but less enthusiastic about risking mine in the process.

On a side note. If you have a desire to become more educated. The Outdoor Emergency Care class for ski patrol is a wealth of information. Great knowledge that you then have for life. If you camp, hike, coach, lead kids in any way on or off the beaten path, it will give you some peace of mind and possibly save a life.

The most important piece of equipment a patroller has is his/her brain. You came upon a stressful situation, stayed calm, thought it through, and made a rational decision. You did well. I don't know any patrollers that don't analyze every incident over and over in their head to think of what they could have done different/better. As in most situations, there is more than one way to handle it properly. Given the circumstances, you chose one of them.

Until I became a patroller, I didn't think they did much since I hardly ever saw any incidents. The reason is that we generally get people down to the patrol room very quickly.

I agree you did well

In situations like these it is easy to panic, you didn't

DRABC is a good simple mnemonic to remember

D - Danger (ie don't become another casualty)
R - Response (consciousness is good)
A - Airway
B - Breathing
C - Circulation (Bleeding)

so if you were SAFE to do so (D) you could minimise further danger (crossed ski's) stop the bleeding (C)

but its easy to say that in the forum harder to do it in the snow without training
That is why patrollers practice and train

Well done again

ask yourself what would have happened to the skier if you had skied past?
maybe nothing maybe he would have waited 30 minutes lost lots of blood and gone into shock ... etc

Simon

I skied a lot with a patroller friend at Sugarbush years ago, and occassionally helped him out if we were on a run and came across an accident scene. It really made an impression on me in a couple ways, the main one was to stay calm and think clearly, second was to help the injured person stay calm, and third (most important) was to do whatever I could to help but let the pros handle the serious work. From my limited standpoint, you did exactly the right thing this time around. If you had been skiing with a partner, obviously one person could have stayed with the injured skier while the other went for help. When you're by yourself, you have to make a judgement call and do what you think is right. It sounds like the guy was conscious and moving around a little, but shaken up enough to not be freaking out (yet). In that situation, I probably would have done the same exact thing you did. I tend to trust in-situ assessment in tough situations like that.

Here's a link to an article that may help folks who come up on an accident scene before trained medical personnel arrive.

http://www.dcski.com/articles/view_a...mode=headlines

Oh, and by the way, while nearly every state has a "good samaritan" law - this only provides a defense in the event of a lawsuit, it does not prevent a lawsuit from happening (very little does in the United States). Still, the likelihood of being sued for helping out is pretty low. In your case, you did the absolute right thing in getting help right away.

Hi all,

A couple of thoughts / questions from someone who isn't a ski patroller...

If I'm out skiing recreationally, and I come across a casualty, if I keep my goretex gloves on, and don't have any open wounds on my hands, is infection control really a big issue?

Lots of reference to CPR in this thread. I accept that in theory instant bystander CPR, a ski patrol paramedic with a defibrulator / appropriate drugs / intubation equipment and a rapid evacuation from the hill might save a life, but does anyone actually have experience of a patient having a VF arrest on the hill and surviving to discharge from hospital?

Gortex gloves will not protect you.

As an active EMT and ski patroller, I think its great that many of you are asking questions how to help. If you have no training and you come across an injury by yourself, someone needs to go for professional help ASAP. If help is on the way and you want to help a person that is bleeding, you must wear gloves that that will protect you from infection. If you think you may want to ever help an injured person than always carry gloves that will protect you. Sorry I don't touch bleeding patients without the proper protection. For a motor vehicle accident with blood, I take the time to put on my full turnout gear and gloves. If I don't, the rescue squad chief may suspend me.

Obviously Airway is very important. If your not trained you may do more harm than good trying to open an airway. Trying to stop bleeding may also do more harm if its not a major bleed and you cause addition infection. Head scalp injuries tend to bleed a lot but in many cases its not enough blood to be a problem. Head injuries usually mean a possible cervical spine injury. Any movement of the head could cause permanent paralysis or immediate death. If your not trained on how to open an airway without moving the head than you may do more harm than good.

Always remember that the injury may have been caused by a previous medical problem or even a head spine injury that occurred an hour before the accident.

You did well

Great job!

The accurate location on the mountain should be the first priority once you have determined that you must leave the injured and seek help. Take a good look and formulate the location description BEFORE you depart the scene. Consult a trail map if you need to. Speedy response by the patrol is a good thing! Nothing worse than sending people and equipment to the wrong place.

Don't hesitate to have the lift-op or whoever you contact, dial the number for rescue or base dispatch, then you can describe the location. No sense to play "telegraph" Don't worry about trying to describe your evaluation of the injury on the phone, "Head injury with bleeding" will get a lot of response in a hurry!

Suggesting that the injured apply pressure to his own injury is a very good idea. Your clear head and eyes, the injured's own "yuck".

In perspective, Take a one liter beverage bottle filled with water or better yet tomato sauce and squirt it in the snow all around you while standing in one place. That's a lot of red! A normal adult can tolerate the loss of a liter without much difficulty.

Stay calm! Don't worry about lawyers! Move quickly


CalG

The first time I came across someone laid out on a trail, the first thing I did was ask him where he felt pain. I thought he might pass out and not be able to tell anyone where he was hurt.
He had lost one ski but the other one was still attached. I stayed with him and sent someone for help, and waved off the Jersey Drunks who came racing down on us. This was night skiing, in the Garden State.
The guy was conscious when help arrived, and I got out of their way.

Patrollers throw away our gloves after treating a person. If the bleeding is bad, we go may go through a three of four pair of gloves. It is important not to contaminant gear. So lets say that I put on a pair of gloves and apply a bandage. Then I need something else in my pack. I remove the gloves without touching the outside with my bare hands and put on another pair. The used gloves are disposed of in a biobag along with bloody snow and bandages.

Do you want to throw out your Goretex gloves?

Good point on the CPR. We are all trained to give CPR and O2 and an AED is in the trauma bag. However, a paramedic told me that very infrequently does it save a life. That being said, if performing CPR has the chance of saving a life, it is important to do it.

I looked at statistics on people who'd been defibrillated in ERs and ICUs. The life spans of most of these people were measured in hours, not days.
CPR stats were more elusive.
In medicine the treatment is considered a success if the patient lives long enough to sign papers agreeing to pay his bill; it's considered a failure if he lives long enough to exhaust his insurance coverage.

Gore-tex is porous. It will in no way protect you from blood-borne pathogens.

I don't agree with you on this. Ski wear Goretex is used to make surgeon's gowns which are sold as being impervious to blood. I do accept that old Goretex gloves will be less effective due to delamination and holes.

The argument that the gloves will get covered in blood and need throwing away is more persuasive. Do you throw your patrol jacket away if it gets contaminated with blood?

ever try to launder a glove??:

I use shell gloves. You can launder them just the same way that you launder a shell jacket. You do launder your clothes don't you?

Having thought about it a bit more though, I think the dexterity issue might make me wish I had disposable gloves.

Those Gore-tex gowns are meant as a replacement for reusable gowns, which are not water- or pathogen-proof at all.

I hadn't thought that through. good point I retract the :

My jacket was close to 300 bucks (don't ask---it was a sore subject when purchased and has not gotten less irratating since), and washes quite well.

I buy about 2 pairs of 10 dollar gloves a year (at costco) --- I would not be inclined to wash them, I'd just toss them and break out a new pair---since they do not wash terribly well---then again, they are not real high quality either..

reusable Gore-Tex barrier surgical gown, which it expects to become the biggest product in the company's history.
The liquidproof and breathable gown is being marketed to surgeons

Full article here

http://findarticles.com/p/articles/m...54/ai_11593625

Having said all that, and having thought about it a bit, I do think that the lack of dexterity involved with trying to do anything in Goretex gloves does make carrying disposable medical gloves a good idea for me, as a recreational skiier with first aid knowledge.

I'm starting to find this forum to be a bit of a concern though. In amongst the good stuff there seems to be a lot of ski patrollers with limited medical knowledge offering opinions about things that they don't really understand.

How do you come to a conclusion as to who might be a patroller here and who is not?

What 'limited medical knowledge' might that be? Not an all inclusive list---just a representative sample will do.

Thats a problem with ALL of the forums, you have to sift thru the chaff to find pearls---why should this one be any different?? There is no (to my knowledge) restriction on posting here---please don't make an assumption that every one posting is a patroller.

And please be sure you know what the patrollers required level of "limited medical knowledge' really is before casting aspersions.