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Risk management and Patrol Protocol

post #1 of 13
Thread Starter 
This thread has sparked some question in my mind about Ski Patrol Protocol and the impact it may have on someone to ask for Ski Patrol assistance.

With Risk Management in place at most resorts, I completely understand airing on the side of caution, and am happy to comply with their protocol if I should ever need their care.

Devils advocate scenario:
Lets say I wipe out hard but continue to ski. After taking lunch break I realize my old achy body doesn't bounce back like when I was younger, so my friends urge me to get patrol to check me out. I may not be as willing to let my friends call patrol if I know they will automatically board and collar me as a precaution because I have a stiff neck. I may really reconsider if the protocol is to call EMT. I have health insurance but even the best health insurance doesn't cover ambulance rides.


There is a lot to this topic, because it touches on emotion, physical health, Risk managment, Individual resort protocol, NSP protocol, The "doood, you really bit it" genre, and the "man up" attitude. This all without factoring in the EMT protocol. That's a whole different talk show
post #2 of 13
now we are getting somewhere.

How many here BB on mechanism of injury and how many are able to utilize WMI spinal clearing protocols to avoid an un-needed ambulance ride?
post #3 of 13
This is a tricky call. First, our area does not recognize WMA "clearing the spine", nor do we automatically just call an EMS ambulance/helicopter...that is done at the decision of the patroller(s).

I guess if I were called to the lodge and talking to this person, I'd ask them to remain as still as possible, ask lots of specific questions about what hurts, how badly, exactly where, question and check CMS at all extremities, and try to get as much MOI info as possible. Then palpate the neck and spine as usual. Assuming the patient had walked inside and had been there for awhile and there were no head injuries and all else was absolutely OK and it looked to be simply what it appears to be (a stiff neck), I'd explain the options and consequences in detail. Obviously, any sort of thing could raise a red flag (i.e., hit a tree, numbness or tingling in the legs, spinal deformity, etc.).

But...if nothing seems at all out of the ordinary, they get to make a choice: Refuse further care or take a backboard/c-collar trip to the hospital.
post #4 of 13
post #5 of 13
Quote:
Originally Posted by bunion View Post
now we are getting somewhere.

How many here BB on mechanism of injury and how many are able to utilize WMI spinal clearing protocols to avoid an un-needed ambulance ride?
The way I look at it, and the way it's worked so far, I clear the spine with palpation and cms on every call. If the MOI indicates a force sufficient to warrant a BB, then he/she gets one, whether there's signs or not. We will stress that it's precautionary. There's no sense in giving him a ride in the sled without a backboard & collar if there's a chance of a compromised spine. We normally perform spine clearing in first aid, where some of our first aiders are off-duty ALS. between getting transport back to the mountain to get the car, or not having health insurance, or who's going to watch the kid's, it can be a major hassle for the patient, so we don't transport unless we think it's necessary.
post #6 of 13
patience... in the next year or two there will be a strong move away from precautionary full immobilization without reason in EMS
post #7 of 13
Summit ---
Quote:
in the next year or two there will be a strong move away from precautionary full immobilization without reason in EMS
What makes you say this? Not that I question your opinion, I just would like the rational behind it. Will this be EMT protocol or WEC protocol or both?

I too have struggled about the seeming amount of "over care" or caution used in treatment on the hill. Our phylosophy is "treat for the worst" and let someone with more advanced skills and training make the decision that this level of treatment is not needed.

I would welcome training that would put into place a protocol that would deliniate signs and symptoms that could indicate that a BB is not called for. I think we would still error on the side of caution, but maybe not quite as much
post #8 of 13
I think it is inline with the "do no further damage" philosophy. If you backboard someone, you prevent further injury at the possible cost of inconvenience. It makes sense.

On the other hand, if my kid is backboarded, due to a suspected concussion. I am taking him off the backboard. I have had my bell rung many times and a backboard is not necessary.

I guess we can thank the plaintiffs bar for the overprotective attitude.
post #9 of 13
Quote:
Originally Posted by fischermh View Post
I think it is inline with the "do no further damage" philosophy. If you backboard someone, you prevent further injury at the possible cost of inconvenience. It makes sense.

On the other hand, if my kid is backboarded, due to a suspected concussion. I am taking him off the backboard. I have had my bell rung many times and a backboard is not necessary.

I guess we can thank the plaintiffs bar for the overprotective attitude.
This has nothing to do with Lawyers and lawsuits. You want to assume the responsibility for your own child, that is your right.

You will feel really bad if he does end up in a wheelchair, or worse.

Me thinks you may have had that bell rung one too many times.:


In the thread that inspired this one, I may not have made it clear, but my patient should have had a CT-Scan. He made a semi-informed decision.
post #10 of 13
How sad that it has come to this. Following your line of thought, we should backboard about every player on a high school football field. :
Quote:
Originally Posted by bunion View Post
This has nothing to do with Lawyers and lawsuits. You want to assume the responsibility for your own child, that is your right.

You will feel really bad if he does end up in a wheelchair, or worse.

Me thinks you may have had that bell rung one too many times.:


In the thread that inspired this one, I may not have made it clear, but my patient should have had a CT-Scan. He made a semi-informed decision.
post #11 of 13
Quote:
Originally Posted by fischermh View Post
How sad that it has come to this. Following your line of thought, we should backboard about every player on a high school football field. :
No, only the ones that take a substantial hit. We can always clear them in first aid, or BLS can clear them there. But at least if there is compromise, they don't further injure it in the transport off the hill.
post #12 of 13
I think I failed to be clear. Our protocol is to backboard when there are signs of a concussion. In the case of a mild concussion, as happens in many sports, I fail to see the necessity for a backboard. When my son falls off a chair in the kitchen and gets a nice bump on his head, I do not see the need for a backboard. When it happened, I monitor his condition. If it gets to be serious, we head to the emergency room. Otherwise, we just stay home.

I am not arguing against the use of backboards where there is a spinal injury, or a substantial head injury. In fact, regardless of how I would care for my family, I follow the protocol to the letter.

I would suggest you go back to Trekchick's initial post. Her complaint was a stiff neck. That is what I responded to, not to Bunion's thread. Totally different circumstances.
post #13 of 13
Totally fair Fisch.

There is a world of difference between a bump on the head and AOx 2 or 3 out of 4, that was my point.
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