WHAT TO DO (AND NOT DO) AT THE SCENE OF A SNOW SPORTS ACCIDENT
I get asked by many people, what should I do if I see a serious accident on the ski slopes? What are the "do's" and the "don'ts"?
It's an important question - although those of us on the ski patrol will be in attendance as quickly as we can, if you're first on scene there is alot that you can do whilst waiting for our arrival that can make a real difference. This is by no means a definitive guide - if you want to know more, I suggest you attend a registered first aid course run by an organisation like the Red Cross or St Johns Ambulance. The best first aid courses of all for this sort of scenario though, are those run by the ski patrols themselves. For more information in the UK, visit www.basp.org.uk
In a nutshell
If you can't be fagged reading all this page then here's a summary!
1. Summon professional help
1. Rush in without checking for safety
Stop and alert the emergency services
If you see a serious accident occur on piste, the F.I.S. code requires you to stop and assist if possible. Ensure that the emergency services are alerted. There are two main ways to do this, depending on the circumstances and location of the accident.
- Phone the ski patrol/pisteurs. There should be an emergency number on the resort piste map, or you may see it at the base station of the resort. Popping it into your mobile phone is a good idea.
- Ask someone else to ski/board down to the nearest lift station where the lift attendant can be alerted and they can contact the ski patrol
What the ski patrol will want to know
- The exact location of the incident - try and give as much information as possible. Many runs will have numbered piste markers at the side of the run which are a great help. If you have a GPS, you can obviously give the exact coordinates.
- The nature of the accident - what happened, any potential hazards
- The number of casualties and an idea of the type of injuries (if possible). Let them know if children are involved. Finally, in particular, alert the ski patrol if there is a casualty who is unconscious, not breathing or who has head or spinal injuries.
The Priorities - summarised
Once the emergency service(s) have been alerted (i.e. the ski patrol), the priorities at any accident scene can be summarised as:
- SAFETY - consider yourself, the scene and the casualty (in that order)
- AIRWAY - with cervical spine control if necessary
- BREATHING - with provision of adequate ventilation
- CIRCULATION - with control of haemorrhage
Its vitally important at the scene of any accident that you don't just rush in before considering (in order) your safety, the safety of the scene and the casualty's safety. This is very important to remember as the stress of an accident can result in common sense being thrown out of the window, especially if its a loved one or a friend who has been injured. The last thing any rescuer wants is more injured people to rescue or bodies to recover. Its not too difficult to imagine some of the hazards at the scene of a car crash, but what does this actually mean in practical terms on the ski slopes?
Quite simply, do everything you can to make sure that you're not going to be injured. Don't rush in if the scene is not safe (the most obvious examples being to venture onto an avalanche prone slope or under cliffs if there is a real risk of rocks falling onto you). If you ski with a back pack on, a wee first aid kit is not a bad idea and probably the most important thing to have in it would be a few pairs of protective gloves for your hands. That way, if the injured person has bled, you will be protected.
At the scene of a serious accident on the ski slopes, it is very important to ensure that other skiers and snowboarders do not collide with the accident scene. The best way to do this on an open slope is to position a pair of crossed skis (more if you have them) up hill from the scene - see the two photos above. This alerts others on the slope to slow down and (hopefully) avoids a collision. In some situations, you will need to do more than this if you can. At a terrain park, for example, if there is an accident at the base of a jump you will need to ensure that no other snowboarder attempts a jump and lands on the casualty. This is, of course, the idea behind always having a "spotter". If the accident is in bad weather or at a bottleneck on the slopes, you may need to get others to help you to alert oncoming skiers and boarders to the potential danger ahead so that they slow down and take care. Crossing skis and making the accident scene obvious to everyone also helps the emergency services to locate you, speeding up their response.
The safety of the casualty
Ensure the casualty is out of danger if you can without exposing yourself to danger. In general, the golden rule is don't move the casualty unless you have to. Unless you have first aid training and know what you are doing, perhaps the only reason to move them would be if they were in imminent danger of further injury (from, for example, falling rocks).
2. Airway (and cervical spine control)
- Check if your casualty is conscious or not - ask them in a loud voice something along the lines of "Hello, can you hear me?". Remember of course, that English may not be their first language but nevertheless they will probably respond to "HALLO" if you shout loudly enough!
- DO NOT SHAKE THE CASUALTY VIGOROUSLY! If the casualty is unconscious, the accident occured at high speed, involved a jump or somersaults or there is any other possibility of damage to the neck or the spine (the casualty may indicate pain in their neck or back) - then hold their head still by placing one hand on either side of their head and keep their head still. If possible, get another bystander to do this whilst you assess their airway. FROM THIS MOMENT ON, DO NOT REMOVE THE HANDS FROM EITHER SIDE OF THE CASUALTY'S HEAD UNTIL THE SKI PATROL ARRIVE AND ASSESS THE SITUATION
- Look, listen and feel for any obvious obstructions to the casualty's airway. If you need to open the airway, you are safest to use the jaw thrust technique so as not to move the casualty's neck
3. Breathing (with provision of adequate ventilation)
In this sort of situation the most you can really do until professional help arrives is:
- Perform mouth to mouth ventilation (if possible) if the casualty is not breathing
- Look/ask for any obvious signs of damage to the chest - sites of impact, wounds, bleeding, pain, difficulty breathing etc.
- Count the number of breaths the casualty takes in 30 seconds. Multiply this by 2. This is known as the "respiratory rate". Tell the ski patrol what this value is (and has been) when they arrive. In healthy adults it should be between 10-30 breaths per minute.
4. Circulation (with control of haemorrhage)
Casualties who are bleeding heavily need to be transported to medical care as soon as possible. Reduce the risks of haemorrhage by applying pressure to obvious bleeding points and elevating the affected area if at all possible. DO NOT APPLY TOURNIQUETS.
If you do nothing more than continually check "Safety-ABC" as above, you will be doing alot for your casualty. Remember that things can change with time - that airway that was once open might close, which is why constant reassessment is so important. Try and remember everything that has happened since you got to the scene so that you can pass this on to the ski patrol.
- WHAT IF THE CASUALTY VOMITS?
Don't panic. Try not to move them if you can help it. If you have to move them, then use other bystanders and roll the casualty over without twisting their body so that the vomit can safely dribble out. This technique is called a "log or spinal roll". Once the vomiting has stopped, roll them gently back over onto their back. At all times, someone should be holding either side of their head to keep their neck still and everyone should try and move at the same pace so that the spine doesn't twist.
- SHOULD I TAKE THEIR SKI BOOT OFF?
No. Leave this to the ski patrol to decide. In general we leave ski boots on at the slope side most of the time.
- SHOULD I TAKE THEIR HELMET OFF?
Again, as a general rule - NO. The only reason to remove a helmet (and it would have to be a full face racing helmet) would be if the person was obviously dying from a blocked airway and the presence of the helmet is stopping you clearing the obstruction. In this case, try and get others to help you and minimise the amount of neck movement that takes place when the helmet is removed. A 'possible' neck injury is not as important as a 'definite' airway problem.
- WHAT DO I DO ABOUT RENTAL EQUIPMENT?
This is the least of your concerns! Speak to the ski patrol who should help to repatriate the equipment with the ski shop.
OTHER POINTS TO NOTE
- Even if you don't know them and don't know if they understand you, TALK TO AND REASSURE YOUR CASUALTY. They are scared and in pain and at this point in time you are the one of the most important people in the world to them. Hold their hand(s) and reassure them. Believe me - it can make a world of difference.
- Try and locate family/friends if at all possible, but don't let this distract you from caring for your casualty. Rescue services the world over are used to having to sort things like contacting relatives out.