Medical Care
Ski Patrol follows the current OEC textbook (6th Edition) for medical care and direction. RLM provides patrollers with medical equipment and an aid room in base patrol. Patient assessment consists of five parts: Scene size-up, Primary patient assessment, History taking, Secondary patient assessment, and Reassessment, which is typically performed in the Aid Room at base.
On Scene Care. Patrollers wear vests or carry packs with essential medical supplies to provide immediate medical care.
Scene Size Up. Ensure scene safety, determine number of patients, apply standard precautions, assess the mechanism of injury or nature of illness, consider additional help and resources. Request EMS as soon as possible for “sick” patients (trauma or medical) to give the ambulance time to transit to the mountain.
Primary Assessment. Assess and fix threats to life and limb (ABCDE).
How to perform patient assessment-trauma
How to perform patient assessment-medical
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AVPU. When approaching the patient and they have their eyes open and look at you, they are alert. Talk to the guest to evaluate mental status and whether the airway is open and they are breathing sufficiently. If not alert, ask them to open their eyes and look at you to assess if they respond to verbal stimulus. If they don’t respond to verbal stimulus, touch the patient and give a squeeze on the shoulder to determine if they respond to pain stimulus. If the patient does not respond to pain, they are unresponsive. Check breathing and pulse for all unconscious patients and begin cardiopulmonary resuscitation (CPR) and apply an AED, if absent.
Major bleeding. Scan for major bleeding requiring immediate intervention. Apply direct pressure and sterile gauze to stop bleeding. Secure with bandaging. If major bleeding does not stop with direct pressure, consider hemostatic dressing (e.g., Quik Clot) and tourniquet application.
How to apply direct pressure for major bleeding
How to apply hemostatic dressing
Airway. Patients suffering airway swelling (edema), traumatic injury, or foreign body obstruction require immediate intervention. Manually position the head to open their airway, perform abdominal thrusts (Heimlich manuever) if choking, or insert an airway adjunct (e.g. OPA, NPA). Suction patients or turn them on their side if unable to proctor their airway and they have visible vomit or blood in their mouth.
How to perform head-tilt, chin-lift technique
How to perform jaw-thrust technique
How to suction the oral airway
How to perform abdominal thrusts
Breathing. Patients unable to speak in complete sentences and having difficulty breathing, shortness of breath (dyspnea), breathing too slowly (bradypnea), or too fast (tachypnea) may be suffering anxiety, asthma attack, COPD exacerbation, traumatic thoracic injury, open or closed pneumothorax. Keep patients sitting up if alert, provide supplemental oxygen, and ventilate with a BVM if not breathing sufficiently. Apply an occlusive dressing to penetrating traumatic wounds to the chest, upper back, or neck.
How to use a Bag-Valve Mask (BVM)
How to set up supplemental oxygen
How to assist a patient's metered dose inhaler (MDI)
How to manage Allergic Reaction
How to apply an occlusive dressing
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Circulation. Patients with poor circulation may have pale complexion, blue lips (cyanosis) and altered mental status. Measure the patient’s radial or carotid pulse and assess capillary refill. Patients with abnormal skin presentation with a slow heart rate (bradycardia) or fast heart rate (tachycardia) may be a sign of shock (insufficient tissue perfusion).
How to measure oxygen saturation
Disability. Alert patients should be able to state their name (person), where they are (place), the day or date (time), and what happened (event). They should have good CMS in all four extremities. Any exceptions to A&O x4 and good CMS x4 is a sign of possible injury/illness. Patients who are not A&O x4 may have a TBI and should be sent to the Emergency Room. Provide a copy of the Head Injury Information sheet found on the desk in the aid room.
Exposure. “Skin to wind” is required for all injuries to ensure there is no serious bleeding, wounds, or deformity. If the environment prohibits exposure on the mountain, expose in the aid room.
Spinal Motion Restriction. Patients who fall or strike another guest or object may have a head, neck, or back injury and require spinal motion restriction (SMR) to prevent further injury. Refer to the Spinal Motion Restriction Algorithm.
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Consider holding the patient's head in anatomical alignment and applying a cervical collar and securing on a long spine board or vacuum mattress.
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Palpate cervical spine and back for pt complaint of pain and new deformity
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Check CMS in all four extremities to assess for deficit
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Consider mechanisms of injury to include speed, ejection, height of fall, etc. as well as distracting injury, altered mental status to include intoxication, and neuro deficit.
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Consider the benefits of KED v. LSB v. vacuum mattress for extrication
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Position the foot of the LSB between knees and feet prior to rolling and once rolled onto the board, make one fluid movement to center the patient on the board using axial drag.
How to perform Supine Log Roll
How to perform Spinal Immobilization for a Supine Patient
Spinal Immobilization for Supine Patient
How to perform Spinal Immobilization for a Seated Patient
How to use Kendrick's Extrication Device (KED)
How to use a Full Body Vacuum Splint
Traumatic Brain Injury. A concussion is a traumatic brain injury (TBI) that changes the way the brain normally functions. Concussions are caused by a blow or jolt which violently shakes the delicate brain tissue inside the skull. Most concussions do not involve loss of consciousness. CT and MRI images are necessary to evaluate brain injury. The injury begins with impact and continues for 2-3 days. Concussion can cause physical, mental, emotional, and sleep symptoms. Trauma patients suffering head injury who are altered should be treated according to the Excellence in Prehospital Injury Care (EPIC) treatment guidelines.
Prehospital TBI treatment with EPIC (3 minutes)
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Field Triage Guidelines. The 2021 National Guidelines for the Field Triage of Injured Patients or “Guidelines” support decision making to ensure that seriously injured patients are transported to the most clinically appropriate trauma centers. Become familiar with these Guidelines for patients suffering traumatic injury in order to activate EMS and Beartooth Billings Clinic ED.
Multiple Casualty Incident (MCI). When there is an incident involving multiple injured persons an MCI may be declared in order to activate the Incident Command System to quickly and effectively respond with appropriate personnel and resources. Simple Triage and Rapid Treatment (START) is a triage method used by first responders to quickly classify victims during a mass casualty incident based on the severity of their injury.
Trauma Assessment. First and foremost in trauma assessment is to check for major bleeding, then ABCs. Expose the injury site and assess if an open or closed fracture, penetrating wounds, etc. Always check CMS before and after splinting long bone fractures/dislocations. If CMS is compromised, make one attempt to anatomically realign the long bone to restore blood flow and sensation to the extremity. Assess wounds, tenderness and deformity as well as shortening and rotation. Consider applying an ice pack to the injury site for pain management. When confronted with an open fracture which is grossly contaminated, consider withholding attempts to align the bone and cleaning the area with sterile water to reduce risk of infection. Not all equipment or devices may be immediately available, however become knowledgeable of as many devices as possible.
-Upper extremity. Consider splinting with a sling and swathe and SAM splint using a sugar tong technique or C-curve and secure with a cravat or bandaging (Kerlix).
How to apply a Sling and Swathe
-Lower extremity. Use padded rigid splints, pillows, and SAM splints using sugar tong technique or a wrap, secured with a cravat, Coban, or Kerlix gauze wrap.
How to splint a lower leg fracture
-Pelvic fracture. A life-threatening injury if the large iliac artery is injured. A large amount of blood loss can occur which may not be identified before the patient experiences signs and symptoms of shock. When properly applied it, the SAM Pelvic Sling will reduce and stabilize open-book pelvic ring fractures and occlude internal bleeding.
How to lift a patient using the BEAN-Bridge lift technique
-Femur and Hip fracture. While usually not life threatening, these injuries are very painful and applying a traction splint can provide immediate relief until EMS arrives. The Slishman can also be used when the SAM Pelvic Sling is applied.
How to apply an STS Slishman Traction Splint
How to apply a Sager Traction Splint
How to apply a Kendrick Splint
-Knee and patella. Lateral patella dislocation is common, especially in young people participating in athletics or manual labor. The patella may be reduced if the patient straightens the leg, otherwise splint in place for EMS care. Knee dislocations are more serious and should be splinted in place with rigid splints, padding, and pillows.
How to splint a traumatic knee injury using ri
History Taking. Use SAMPLE and OPQRST to determine Chief Complaint and relevant information. Question family and bystanders. Question patient and family members if the patient is taking anticoagulant or antiplatelet medications if the patient suffers a traumatic injury or possibly suffering a stroke. Common anticoagulant medications: apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), enoxaparin (Lovenox), and warfarin (Coumadin). Common antiplatelet medications: aspirin and clopidogrel (Plavix)
How medications affect the blood's normal clotting process
Secondary Assessment. Use DCAP-BTLS to perform a head-to-toe assessment (look, listen, feel) of the patient’s head, ears, eyes, nose, throat (HEENT), chest, abdomen, pelvis, groin, back, legs and arms. Assess the patient's eyes using a penlight assessing PERRL. Look at ears for clear or blood-tinged fluid. Look at the throat for JVD or tracheal deviation. Assess chest for crepitus, flail chest, punctures. Assess abdomen for tenderness, rigidity, and punctures. Assess pelvis for crepitus. Assess extremities for wounds, tenderness, and deformity.
Head to toe assessment
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Adventitious Lung Sounds
1. Crackles/Rales. Crackling, popping sound during inspiration not cleared by cough
- common with pneumonia, CHF, chronic bronchitis, asthma, restrictive diseases
2. Wheezes. High-pitched musical sound during expiration
- common with COPD exacerbation, asthma
3. Rhonchi. Course, loud, low snoring, rattling during expiration may be cleared by cough
- common with bronchitis
4. Stridor. harsh, high-pitched squeaking on expiration caused by upper airway obstruction
- common in airway obstruction, vocal cord paralysis in adults, and croup in children
Aid Room. Once the patient is transported to base patrol, they are moved into the aid room where they are reassessed and treated while awaiting EMS transport or transport by privately owned vehicle (POV). Reassess every 5 min for critical, and 15 min for stable patients. Weather conditions may prohibit exposing a patient’s injuries until they are moved to the aid room where the temperature is controlled. Measure blood pressure, heart rate, and pulse oximetry. Measure blood glucose if the patient is altered and there was no traumatic injury. The following resources and equipment are available in the aid room.
1. Wheelchair. Once patients arrive at base patrol, patrollers can use a wheelchair to move the patient from the toboggan to the stretcher bed. The wheelchair is also used to move patients from the aid room to their POV.
2. Long spine board (LSB). Patients in the base area unable to walk or walk safely, can be moved to the aid room using the long spine board (LSB) with or without spinal motion restriction. If SMR is not required, move them off the LSB as soon as possible to avoid posterior injury.
3. Stretcher bed. Patients can sit upright, lay supine, or in the Fowler’s position on three hospital beds. The first bed has infrared (IR) heat lamps and is intended for trauma or hypothermic patients for rapid warming
4. AED. Automatic External Defibrillators are used for patients who do not have a pulse and require cardiopulmonary resuscitation (CPR). The AED device assesses the patient’s heart rhythm and advises whether they should be defibrillated (shocked). Verify device operability by pushing the power button and verifying “Adult Pads” are connected. Ensure adult and pediatric pads are not expired.
Cardiac Arrest Management
RLM AED Program. The RLM AED Program is managed by the Ski Patrol manager and supervised by William "Billy" Oley, MD, of Beartooth Billings Clinic. There are three AED units; located at Ski Patrol Dispatch, Grizzly Peak Summit, and Base Patrol. Contact 9-1-1 on the Red Dispatch cell phone and request an ALS ambulance anytime an AED is connected to a patient in cardiac arrest. Attempt to contact the responding ambulance on the Kenwood radio using the Rural Repeater channel. Contact Dr Oley for online medical control anytime the AED is connected to a patient. Reference the AED Program Written Plan in the Dispatch Binder for detailed requirements.
5. Vitals monitor. A Phillips cardiac monitor is used to measure patient blood pressure, pulse oximetry, and pulse rate. Verify operation by powering on the monitor with a toggle button on the side. NIBP cuff and pulse oximeter are connected.
6. Oxygen and suction. Supplemental oxygen and Laerdal Compact Suction Unit (LCSU) are available bedside. Verify oxygen tank pressure level by opening valve then closing and releasing pressure. Oxygen delivery (NC, NRB, and BVM) are stored in the wall.
7. Cardboard splints and padding. If patients are departing the aid room by POV, use padding and cardboard splints secured with tape to splint upper and lower extremities.
8. Glucometer. Patients suffering from weakness, altered mental status should have their blood glucose measured using a blood glucometer. If their blood glucose is low (<60) administer oral glucose if they are able to follow commands.
9. Aspirin. Patients suffering from acute, non-traumatic, chest pain/pressure should be given aspirin 324 mg chew and swallow while awaiting EMS as long as they have no contraindications (active bleeding ulcers, sensitivity to NSAID).
10. Supplies. Blankets, hot packs, nitrile gloves, gauze, bandages, oxygen delivery devices, aspirin, oral glucose, and splinting materials are available in the drawers and cabinets.
11. Dispatch, Flight, EMS Radios. Radios are located on the counter and used to contact Carbon County Dispatch, Help Flight, First Flight, Carbon County SAR, and RLFR.
12. Telephone. Landline phone on the desk is used to call Beartooth Billings Clinic with radio report and Dispatch to provide patient disposition and times for Incident Report.
13. Fax machine. Fax Cover Sheet to BBC after making a voice report. Place Cover Sheet face down on the glass, press the START button, follow prompts to select YES/NO, press speed dial #1.
The Mountain Shop. Guests may purchase over-the-counter medication at the Mountain Shop (e.g., Tylenol, ibuprofen).