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The ABC’s of First Aid - Or How to Help Before Help Arrives
By James Chen, DCSki Columnist

December 12, 2004 — There’s nothing like the feeling of riding down a snow covered mountain, whether it’s on skis, a snowboard, twin tips, or even a tube. The rush from this activity is why the skiing and snowboarding industry reported over 57 million skier/boarder visits last season, according to statistics from the National Ski Areas Association. It’s also why USA Today reports that skiing and snowboarding are two of the top three winter sports activities in the United States with snowboarding as one of the fastest growing. Unfortunately, like every sport, skiing and boarding also come with the risk of injury.

In a previous article, I wrote about some of the more common injuries that occur to skiers and boarders and ways to avoid them. This article focuses on some of the steps you can take if someone you are with gets hurt or you come upon an injured skier/boarder. Although this article cannot provide you with enough information to completely treat injuries (nor does it even pretend to do so!), there are some basic life-saving steps that you can take until trained medical personnel arrive.

CALL FOR HELP – seems rather silly, but before doing anything for an injured person, the first thing to do is make sure that help is on the way. You want to make sure that trained medical care is en route as soon as possible – especially in the case of more serious accidents. Typically, in the resort setting, this initial medical care is in the form of the area’s ski patrol. Make sure that someone is notifying ski patrol. Do not guess. If you are not sure that someone was sent, send another person. Better too many reports, than none at all.

When the accident is reported, make sure the reporting person has and knows to pass along vital information such as the specific location of the incident, the number of injured parties, and a general description of what the incident involves. For example, the ski patrol will have a much easier time finding an accident if it’s reported as “an injured skier, sitting by himself, on the left side of the ‘Blue Streak’ run, halfway down the trail” versus “an injured skier somewhere on the backside of the mountain.” Believe it or not, reports do come in sounding like the latter example. More specificity and information about the location of an accident is generally better than less. If the accident took place on a trail with a lift, you can describe which lift tower is nearby. Most lift towers have a unique number on them.

SCENE SAFE – After you know help is on the way, turn to the situation at hand. The first rule of assisting an injured person (or anyone else for that matter) is to ensure that you can do so safely. The last thing you want to do is to rush into an environment where you may become hurt yourself. This leaves two patients for the rescuers on the way, as opposed to one, and means that you are no longer in a position to help. Therefore, check first to see if you can get to the injured person safely. Are there snow guns in the way? Electrical lines? High pressure hoses? Steep cliffs? Avalanche dangers (admittedly rare in the Mid-Atlantic!)? If there are unavoidable dangers that are in the way, best to wait until the ski patrol arrives.

DO NO HARM. Once you have determined that you can reached an injured skier or boarder safely, you should approach them with caution. You do not want to do anything to further harm the injured person or jeopardize their safety (or yours). Keeping this in mind, assisting an injured skier is a matter of A-B-C.

A=Airway. The most fundamental element necessary for human survival is oxygen. Without oxygen, a person will die within a matter of minutes. Food and water needs pale by comparison as human beings can live for several days without either. Therefore, the first step in assisting an injured skier is to ensure they have an open airway. If an injured person is conscious, you can check to see if their airway is open just by whether the person is talking. If they can talk, chances are their airway is fine. If an injured person is unconscious, make sure the area around their nose and mouth is clear of snow, clothing or anything else external that could block their airway. Avoid moving the injured person unless absolutely necessary (i.e., there is a clear and imminent danger). Moving them otherwise could aggravate any injuries or make their condition worse.

B=Breathing. The next step is to check if a person is breathing. Easy to do for a conscious person - chances are if a person is conscious, they are breathing. If the person is unconscious, look, listen and feel for signs of breathing. LOOK by seeing if you can see the chest area expand and contract. LISTEN by placing your ear near the nose and mouth to determine if you can hear breathing. FEEL by placing your cheek near the person’s nose and mouth to determine if you can feel exhaling breath.

If the person is not breathing, check to see if their airway is clear. If the person is lying on their back, you can open their airway by using the head tilt, chin lift method. This is accomplished by placing one hand on the person’s forehead and the three fingers of the other hand under the person’s chin. GENTLY push on the forehead and lift the chin simultaneously. Be careful not to otherwise move, twist or shift the person’s head, neck or spine. If you suspect there may be a neck or spine injury, try using the jaw-thrust method instead. To accomplish this, place one hand on each side of the head, and facing the injured person’s feet, put your index and third fingers in front of the earlobes and push the jaw forward and up. If that method does not work, go back to the head tilt, chin left method. The point is to get the person breathing. Once the airway is open, the person may begin breathing on their own.

If the person is not lying on their back, you may have to move them in this position. Because of the risk of significant further injury to the neck or spine, it’s typically best to wait until trained medical assistance arrives. However, if you are in the back country or in a remote area of a ski resort where help is a long time coming, you may have no choice but to try to move an unconscious person. In that case, try to “log roll” the person onto their back while minimizing any twisting or shifting of the spine from an in-line position. If there is more than one person available to assist, this can make the job much easier with one person stabilizing the head, another at the shoulders and another at the hips and legs.

After opening the airway, if the person is still not breathing, you may have to begin rescue breathing. Pinch the nose and give two long, slow breaths, making sure to maintain a good seal over the person’s mouth. Because of the risk of disease transmission, it’s always a good idea to use latex gloves and a breathing mask. As you give the rescue breaths, watch for the chest to rise and fall. If this does not happen, or the breaths are not going in, retilt the head and try again. You may need to look into the person’s mouth and clear out any debris, food, or other matter. After giving the two slow breathes, move onto the next step.

C=Circulation (and bleeding). After checking the airway and breathing, check the injured person’s circulation. This step is actually two parts – first, you want to check for overall circulation. You can do this by checking the person’s pulse. Pulse points can be found at the wrist, upper arm, neck, thigh and foot areas. Typically, the easiest and fastest point to check the pulse is at the neck or wrist. Assess the rate, rhythm and strength. Ideally, there should be a slow, steady pulse of approximately 70 beats per minute plus or minus 10 beats per minute. If there is no pulse, you need to begin cardiopulmonary resuscitation or CPR. Both the Red Cross and the American Heart Association offer courses in CPR and it’s a good skill set for anyone to have.

The second part of circulation is to check for bleeding. Any open bleeding must be addressed immediately – particularly arterial bleeding, where blood spouts out in an intermittent fountain. This type of bleeding is a true medical emergency. Other types of bleeding may include venous bleeding, where large amounts of blood ooze out of a wound, or subcutaneous bleeding from a cut or scrape on the skin. The best approach for addressing bleeding is direct pressure. Using a clean (preferably sterile) cloth, apply direct pressure on the site of the bleeding. If nothing else is available, a glove, hat, scarf or other material will do. If the bleeding soaks through the cloth, do not remove it. Instead, place another cloth or dressing over the first and continue to apply direct pressure. Elevate the wound if possible. Elevating the wound assists in decreasing blood pressure at the site of the wound and can help in slowing bleeding. In addition, you can use pressure points to help slow or cut off the flow of bleeding. Pressure points correspond to pulse points in the upper arm and thigh area. Placing pressure on these points can help staunch bleeding. Tourniquets, strips of cloth or a belt to tie off blood supply above a wound, are extreme measures that can result in the need for medical amputation of the affected limb and therefore should be avoided at all costs.

Once you have addressed airway, breathing and circulation, stay with the injured skier or boarder until more advanced medical care can arrive. If additional rescue breathing and/or CPR is required, continue providing these potentially life saving measures. If the person is conscious, try to keep the injured person still. Remember that unnecessary movements can aggravate any unseen injuries. Also try to keep the person warm. For example, make sure their coat, hat and gloves are still on. If not, assist them in putting them back on or covering them up, being careful of any injuries in those areas. Also, try to find out what happened and how the person came to be injured. This may help the ski patrol provide additional medical care. Above all, try to keep both you and your patient calm. After all, help is on the way. Finally, make sure not to leave the scene of the accident or injury until you have spoken with the ski patrol. You want to make sure that the person you helped is taken care of before you leave and your information is vital for the ski patrol to proceed with the next level of medical care. Hopefully, you will never have to use the information in this article, but if you do, just remember the A-B-C’s.

About the Author

James “Jim” Chen has been a member of the National Ski Patrol since 1995 and patrols with the Ski Liberty Ski Patrol at Liberty Mountain in Carroll Valley, Pennsylvania.  The views, opinions or experiences Jim expresses on DCSki are entirely his own and do not represent those of the National Ski Patrol, Liberty Mountain or any of their affiliates.  Off the slopes, Jim is a partner with the Washington, D.C. law firm of Crowell & Moring, L.L.P. where he practices environmental, transportation, safety, and product regulatory law. To read other articles by Jim, click here.

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