DCSki Sponsor: Massanutten Resort
The ABC’s of First Aid - Or How to Help Before Help Arrives 15
Author thumbnail By James Chen, DCSki Columnist

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 James Chen

James "Jim" Chen" is a member of the National Ski Patrol and Assistant Patrol Director at Liberty Mountain ski area in Carroll Valley, Pennsylvania. Jim has been a member of the Liberty Patrol since the 1995-1996 season. Off the slopes, Jim is an attorney in Washington, D.C. where he counsels clients on transportation, innovation, safety and environmental areas.

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Reader Comments

December 12, 2004
Avalanche danger? I think mud-slides are more common in the Mid-Atlantic.

From experience, it probably pays to ask more than one passing skier/boarder to notify ski patrol (especially on big mountains - that probably rules out the Mid-Atlantic.) Just let them know that someone else was asked to notify ski patrol and they should tell this to patrol. You never know if the first skier/boarder got side-tracked or couldn't find the patrol station. Meanwhile an injured person is waiting on a cold mountain... If people are specific about the location and details, patrol will generally know whether or not you are reporting on the same accident or a new one.
December 13, 2004
Is it best to report an accident to the lift operator or find the patrol station and report it there, assuming you don't find ski patrol on the way down?
December 13, 2004
jimmy: You can always report an accident to a lift operator -- they should be able to call it in. That can be quicker (and the lifts are easy to find.) I would stand next to the lift operator while they call it in to make sure they pass on the right details.
December 13, 2004
Excellent article, James. You obviously kept up on your OEC at refresher :).

Being on the ski patrol myself (Massanutten), I'd like to add my two cents on this.

First, reporting accidents. Yes, it is good idea to send more than one person down to report the accident.

Also, you can report accidents to any ski area employee, whether it be maintenance/snowmaking, security, lifties, etc. The maintenance, snowmaking and security usually have radios that they can communicate directly with the patrol with (at least at Massanutten, they do). Lift operators can call base on the phone (every lift shack, base and top, has one), whom, in turn will radio the patrol. And as already mentioned, lifts are easy to find, so unless you know where the patrol is at or happened to encounter a patrolman, it is best to go to the lifts or to the lodge and report an accident.

Also, before skiing, especially at an unfamilier area, it is a good idea to look at a trail map and determine where the patrol station(s) are. At Massanutten, there is a patrol station at the top of lifts 5 (Rebel Yell) and 6 (Diamond Jim/Paradice) as well as on the up-slope corner of the lodge (the side facing the base of lift 4, along Southern Comfort), on the lower level. There is always somebody posted at the stations, with a radio.

Also, if you must, you can actually call in an accident on the cell phone. (don't call 911, though - let the patrol do that, as we have certain protocols we must follow with regards to activating the emergency services). We've actually had that happen once. Somebody called down to the aid-room with a cell phone to report an accident!

And, please, as was already mentioned, be specific as you can with reporting accidents. I'd rather they gave me to much info instead of not enough. And be sure you are reporting the correct trail (again, not a bad idea to take a little time and study the trail map). There have been times when people reported an accident on Paradice, when it was actually on Diamond Jim, for example.

And lastly, it really is a good idea for everybody to take a basic CPR and First Aid course, especially if you plan on going back-country and/or into otherwise remote areas. Also, if going into remote areas, it is best to buddy-up, if at all possible, and perhaps even take one of those small radios as well as a cell phone.

Please have a happy, and safe, season. Looking forward to seeing you on the slopes!
December 13, 2004
What a great read to refresh my Eagle Scout memory. I think the best motto is that of the Boy Scouts - Be Prepared. That could mean storing ski patrol phone numbers in your cell phone, taking first aid courses or just stopping when you see a person is hurt and putting your skis in the snow in the form of an "x." Speaking of refresher courses, I need to get re-certified in CPR and plan on taking a wilderness first aid course when I return to school in the Spring.
December 14, 2004
Hey all:

Thanks for the comments. They are all appreciated. I agree that getting some basic first aid training is a good idea as is certification in CPR. Wilderness first aid courses are very similar to the Outdoor Emergency Care training that all ski patrollers in the NSP must undergo as a minimum level of training.

And, if you really like the idea of helping others on the slope, consider joining the ski patrol at your local area! While I can not speak for all areas, I know that Liberty, Whitetail and Roundtop are always looking for motivated skiers AND boarders wanting to help!
December 14, 2004
Jim said:

And, if you really like the idea of helping others on the slope, consider joining the ski patrol at your local area! While I can not speak for all areas, I know that Liberty, Whitetail and Roundtop are always looking for motivated skiers AND boarders wanting to help!

I say:

Massanutten could really use a few more patrol, both on the hill (red jackets) and auxiliary (blue jackets).
December 15, 2004
Auxiliary is a great program - If I'm not mistaken, they ski for free and help people find their way and such?
December 16, 2004
Great information Jim.

One thing to add to the scene safe: If you are on a slope, take your skis off and cross them above the scene. This gives other skiers warning that something is going on and to at least avoid that area.

Maybe there are some other tips you can give in this area since, unfortunately, most of us are not versed in First Aid but there are some easy things to do to prevent further harm.
December 16, 2004
You're right, I should have added that to the article. I guess I'm too used to setting up the the X pattern myself when I come up on an accident scene! Not only does the X help other skiers, it sure makes it easier for patrol to find the accident (as opposed to folks just resting on the side of the trail!). Another tip that may help is if there are enough people, post a person above and to the side of the accident to wave away fast oncoming skiers and boarders - especially in our high density mid-Atlantic ski areas!
December 19, 2004
Nice article. At first, it may seem a bit advanced, but all first aiders are civilians who learned the basics and the Airway, Breathing, and Circulation basics are three things all of us can and should learn, for the slopes, our homes, on the road, and in emergencies we can't anticipate. Remember 9/11 and remember that we live in our Nation's capitol city. Good online first aid course, thanks.
December 21, 2004
Jarrett said:

Auxiliary is a great program - If I'm not mistaken, they ski for free and help people find their way and such?

I say:

Yes, they do get to ski free and often help people find thier way and such. At least at Massanutten, the auxiliary is in everyway the same as the on-hill patrol, with one major difference. The auxiliary do not run sleds, either due to not being as proficient in skiing, or just simply rather not participate in that aspect of patrolling (the idea of taking, say a 250-pound man down in a taboggan on an icy slope, through the bumps, in foul weather, can be intimidating to even some proficient skiiers). At Massanutten, the auxiliary are the ones that usually man the aid-room, and all patrol help with guests finding thier way around the ski slope and lodge.

I've spent a season as an auxiliary (injured my knee during on-hill training), and I found it to be an enjoyable time. The next season, with a recovered knee, I completed the on-hill ski and taboggan training and earned my red jacket, as I much prefered being out on the hill (and the challenge of taking that 250 pound guy down the icy bumps in crap weather) instead of down in the aid-room all day. I guess like the cop rather be out on the street instead of stuck behind a desk.

But anyway, if anybody reading this is at all the least bit interested in the challenges and rewards of being on the ski patrol, then I highly, highly recommend talking to the patrol at your local area.

Don't be shy to ski/board/walk up to any patrolman you happen to see out there and ask them, "hey, what do I need to do to join?". I guess to crib the Marine's slogan, at least at Massantten, we are always looking for a "Few good Men (and Women)".

Do you think you have what it takes to wear this uniform? If you do, please see your local patrol about joining!
December 22, 2004
Last year, my husband & I watched a Boarder launch himself off the trail & into a tree. We quickly crossed our skis and ran down to him. He was unconscious and in/out of breathing. I started jumping and hollaring at passing skiers to report it, husband trying to untangle everything to start CPR. Fortunately, Wintergreen had very fast response before he started CPR so they could do it, backboard him, transport and then airlift him to Charlottesville. Fortunately, kid is OK now. Our question, in hindsight, to move &/or CPR if Patrol not there pronto?
December 26, 2004
In those types of situations, the A-B-C's are vital. If the boarder had a clear airway, was breathing and circulation was present, in an area like Wintergreen where help is literally minutes away, it may have been best to avoid moving the injured boarder. If, however, the A-B-C's are compromised, minutes DO count.

In your case, the boarder's breathing was "in-and-out" indicating a problem. In that case, you and your husband were probably right in intervening. The tips in the article above are intended to address the type of situation you found yourself in. I hope you find them helpful should you find yourselves in this situation again. In hindsight, your husband's and your instincts were likely correct in supporting the boarder's vitals.
January 20, 2005
Great thoughts for all of us to think about. As a Red Cross First Aid instructor I always stop when someone falls in front of me. I believe that I have a morale obligation to do so and make sure that they are not injured. It only takes a couple of seconds to ensure they are OK, and it gives me a rest break as well!!

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