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giving a patroller quick status

post #1 of 16
Thread Starter 
I am NOT a patroller.

Yesterday, a fellow instructor and I were freesking between lineups and came upon a distressed boarder who had fallen/hit his shoulder andor collarbone/ was pretty pale and it was COOLD out in the NE. We did the prudent thing and placed X skis while the other called patrol with a location etc from his cell phone. The other instructor had to leave but I stayed with the boarder until patrol arrived. As an EMT (my cert just ran out but I still have all the training/experience), I thought it would be good to keep the guy talking and so took a SAMPLE history (I did't initiate physical care of any sort) while patrol arrived. The patroller arrived, I gave him a status just like an EMT would to an arriving paramedic unit or an ER staff and left the care to the SP. My question is

a)do you guys get a lot of emt types doing what I did
b) If he hit the cr*p while I was waiting for him..and it seemed very likely that he was about to pass out, whats the deal with good samaritan stuff i.e. I have the skills to assist him but no jurisdiction/valid cert. but am also a mountain employee...

your .02 cents would be appreciated..
post #2 of 16
Good work. I'm sure the patient and the patrol appreciated your help. Mostly we only get reports of accidents from the public and very few are willing or able to do more. I think good samaritan laws vary by state but, in general, if you're trying to help and stay within the guidlines of your training (in your case - none officially); then they can't sue you. Probably asking his medical history might be considered wrong but if he were to crash then it would be good info to have. Certainly keeping him company, securing the scene, and talking to him can't possibly be harmful.
post #3 of 16
Nice job! You did just right! If I'd been the arriving patroller, I would have been very appreciative.

Related - Couple years ago another patroller and I responded to "some guy who hit a phone pole"; he sure as heck did...big time! We had just got the O2 on him (lots of respiratory distress), helicopter called, and were extricating him from over the trail edge when some guy shows up and just stands there out of the way watching us. I asked him politely to please move along. He told me he was an ER Doc...and was just there in case we needed him (I groaned inwardly). I asked him if he wanted to take a look and he said "No, you guys are doing just right and better than I ever could. I'll follow you down to the aid room." Perfect!
Great guy! Now he's our medical director.

The guy that hit the pole had a tension pneumothorax...all fixed up and still skiing.
post #4 of 16
I really appreciate it when qualified people like yourself do exactly as you did. Taking a history is absolutely fine, in my opinion, and if you had to intervene when the patient went downhill, morally I think you would, and you'd worry about the legalities later. To heck with the lawyers -- this is the real world and time is of the essence. No sane court would ever convict a true samaritan.

Naturally, we have to re-take the history, but that's only because we don't know you, and must be thorough ourselves, but you've really given us a leg-up on the situation. And, once you've given us the history, I appreciate it when you stand by and are available to help -- managing traffic, securing the toboggan, holding a splint while I tie it, helping with a backboard, or lifting the patient.

I've had ER docs say stuff like, "Man, I could never do what you guys do out in the field -- I'm useless without a controlled indoor environment and an assistant handing me all the tools!"

So again, thanks, and keep doing what you're doing.
post #5 of 16
While not a ski patroller, I am certified in Wilderness Advanced First Aid and consider myself fairly knowledgable in the legal and ethical issues of the good samaritan (I've done some research on it in the past.)

In most states, as long as you're acting within your personal scope of training (be it basic first-aid, EMT, or no first-aid) you're usually good, as long as you don't do anything that could potentially further harm the victim, (ie. moving before immobilizing the spine)

In your case, an off-duty (unlicensed) EMT, I'd say stick to the skill-set of the layperson. You were okay doing history and vitals as long as he consented to it.

Just be sure to stay with the basic care guidelines. After scene safety, before you even touch the guy, "Hi, my name is Jon, I've got some medical training. You look like you're banged up pretty good, would you mind if I take a look at you here?" And be sure to ask permission before anything you do.
post #6 of 16
Quote:
Originally Posted by Whitehorn2 View Post
I've had ER docs say stuff like, "Man, I could never do what you guys do out in the field -- I'm useless without a controlled indoor environment and an assistant handing me all the tools!"
.
I've seen the same. They don't know our gear, and don't often work in the snow. We once had a veternarian offer help (declined). I came on a scene where some guy was putting his girlfriends knee through all sorts of tests. I asked if he was a doctor..he was...well, research neurobiologist, but went to medical school.....15 years ago. I told him I did a few of these knees a week and he stopped wrenching her leg around and let me splint it.

BTY I think your responce was perfect, and I'm sure, appreciated.
post #7 of 16
IMO, anyone who questions things like this after the fact is probably a sensible person to begin with. Agreed that you did a great job that was surely appreciated. As to the good samaritan question, it varies by province as well. In QC, you're legally required to stop and offer what assistance you're trained to provide at any accident site.

In your case, you've got the training and no certification, so it makes sense to do what you did, but in the hypothetical case that the person needed urgent help before anyone else was available to provide it, I think you'd be morally obligated to provide (as I'm sure you would have done), and my intuition is that the courts would agree that you were justified in using your (lapsed) training to help him out. Then again, sometimes my intuition is not in line with the US court system...

Andy
post #8 of 16
IANAL

It varies by state.

In general (at least around here) you are protected by good samaritan laws so long as you follow your training up to the limit of your training or that of a first responder (whichever comes first). Give good and proper care.

I've done initial on several accidents on the slopes and thusly I have functioned at the level of a FR. When patrol arrives I give a report along the lines of "I'm an EMT with *agency* I can give a quick pt report."

They have always accepted. I give the report and say "this is your patient and I'm at your disposal." Usually they can use you for holding manual stabilization, moving the pt, etc.
post #9 of 16
duplicate
post #10 of 16
NJ has a good Samaritan law, I'm pretty sure you would have been covered if things went down hill. No pun intended. Nice work
post #11 of 16
You did an excellent job. I have had an EMT from another state assist me in two person CPR on the hill. I also know of an ER doctor be first on the scene to start patient care, opened airway with endoctracheal tube in the ski patrol FA room after the paramedics showed up, and work on the patient in the back of the ambulance all the way to ER.

I am a EMT-B with a local fire department rescue squad and trained in OEC from National Ski Patrol. Outside my home mountain and local rescue squad fire district, I have worked on patients in Airplanes, car accidents in other states, and on the ski hill in different states and countries. I know of a ski patroller/ medical doctor that has worked on numerous patients on ski hills in different states. I think CPR trained, first responders , ski patollers, EMTs, nurses, medical doctors help out more times than not when a medical emergency occurs.
post #12 of 16
I am a physician with plenty of experience in critical emergencies (I'm an anesthesiologist and intensivist) but I certainly echo what whitehorn and newfy said- we are often out of our element in the field. I have had to render 1st response care (including CPR once in a severe head trauma) in the field with no equipment or monitoring, and it is scary. I think that the vast majority of physicians readily admit that EMT's and patrollers are much more adept at handling these things, and that we are happy to assist within the parameters of our expertise, but let you guys take the lead.

The vet comment reminded me of an episode in our synagogue (where about half of the members are doctors). Someone had a syncopal episode during services on Yom Kippur (a fast day) and every specialty you can name was immediately at the guy's side, all ready to do whatever it was that their specialty does best. One guy, however, who is a vet held back. When someone asked why he wasn't over there helping- after all he was sort of a physician, too- he replied "give me a call when he begins to moo!"
post #13 of 16
Thanks, dp! Excellent comments (funny story, too). A great example of the patroller - paramedic - physician team occurs at World Cup downhill races (where we're all volunteers, by the way) . My experience is at Lake Louise, where we've been holding races for over 20 years, and at the Calgary 88 Olympics. An ER doc acts as chief of medical, and we have teams consisting of the three disciplines staked out at strategic points on the hill. The patroller is first in (after the race is halted), and depending on severity and the degree of intervention required by the patroller, the paramedic is next, followed by the physician. We also have a full team in the base clinic, and once the patient is in the controlled environment, the hierarchy is reversed, with the physician taking the lead. It's a great system, and we all learn from, and respect the other disciplines.

As a regular CSPS patroller on the ski hill, we sometimes have access to a physician in the base clinic. I really appreciate being able to confirm my assessment, learn more about the implications of the injury to the patient, and ask more detailed questions about anatomy and physiology.
post #14 of 16
Quote:
Originally Posted by Whitehorn2 View Post
As a regular CSPS patroller on the ski hill, we sometimes have access to a physician in the base clinic. I really appreciate being able to confirm my assessment, learn more about the implications of the injury to the patient, and ask more detailed questions about anatomy and physiology.
Great system. It's sometimes frustrating to never find out how accurate the assessment was in the field. I would love to hear back but I know the system doesn't allow that. I sure it would help us do our job better.
post #15 of 16
Whitehorn- that sounds like a really good and really well thought out system. I makes me think that we (on the hospital receiving end) should think about a feedback system to the patrol about what happened at our end once the patient arrives for definitive care. I'll bet that most patrollers involved in a case would like to know both the outcome and what the assessment of their care in the field was. If done under the rubric of trauma QA it could probably pass muster with the HIPAA regulations. This is something I will bring up with our chief of trauma the next time I see him.
post #16 of 16
Yes, it would be great if there were a more formal feedback loop to help the first-responder. In our situation, most patients go to one of two hospitals (Banff or Calgary Foothills). If we want feedback, we ask, and the patient usually gives permission for information to go back to us. There are also lots of informal networks -- some volunteer patrollers also work in health care, and will often drop into the patient's room to see how they're doing. My neighbour happens to be an orthopod, and I've fed him a few patients and gotten helpful information back.

The volunteer docs who help on the hill are terrific. They're always willing to share knowledge, with the side-benefit that the better educated we are, the more efficiently we can transfer our findings to the next level. The paramedics who pick up our patients at the hill are great, too.

It's probably fairly common at most resorts, but our management sends a letter to every patient the patrol treats, and part of that letter is an implied invitation to provide feedback on the level of care received, and offer suggestions for how their outcome could be improved, which I think is a great idea.
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