A Week on the Hill

I just returned from spending a few days on the slopes as a member of the doctor patrol at a downhill ski resort in the Sierra Nevada mountain range in the state of California. The patrol is a volunteer activity in which the doctor(s) assists the ski patrollers with medical issues when summoned to a scene or the first aid room. Because there hasn't been a tremendous amount of snowfall quite yet, the resort was not as crowded as usual during the holidays, which was good from an injury perspective.

However, people still get hurt, because there were falls and collisions. In discussing each days' events with the highly experienced and attentive ski patrol members, they had some interesting observations. With regard to injuries on the slopes, technology is both friend and foe. While new equipment, such as improved boots and bindings, helps prevent orthopedic injuries, the ever-improving skis and snowboards allow skiers of lesser abilities (and frequently less experience) to attempt steeper slopes and more difficult terrain. This puts them into situations where experience and judgment might combine to help avoid injuries. People who take only a few ski or snowboarding lessons leave their instructors to attempt double black diamond inclines on their own, and they are not prepared to handle them.

Peer pressure is definitely a factor, much more so for the younger crowd. In the midst of a minor blizzard and temporary "white-out," I observed three young men strip to the waist and ski, sans jackets and helmets, onto a busy slope so that they could get a picture for their friends. They weren't breaking any rules - just testing Darwin's Law.

I am completely convinced that the major contributor to injuries is speed. The faster that people ski or snowboard, the more likely that a fall or collision will result in a significant injury. Machine-groomed steep slopes are common, and high-speed lifts deliver people to the top efficiently. This puts greater numbers of individuals on these steep slopes at any given time, which contributes to falls and collisions. As one learns to drive defensively, one should ski defensively. This may take away some of the thrill, but it is the sensible thing to do.

The number one way to prevent injuries is to ski under control, and this is, unfortunately, less often the rule when people ski or board too fast. It seems as if many skiers and snowboarders have lost respect for the mountain and forces of nature, or never properly appreciate them in the first place. High winds, particularly on ridges, may make the terrain icy, and this leads to loss of control and accidents. People ski in conditions for which they are not prepared, such as white-outs and deep powder in boundary areas, which leads to lost persons and tales of survival.

In terms of equipment, the best insurance policy is a helmet. There is no question that helmets prevent or diminish head injuries. In my activities this season as a member of the doctor patrol, I have already cared for too many individuals who suffered concussions that would have been prevented had they been wearing helmets. There’s no explanation, including that of personal freedom, that I can support, to argue against helmet use. They are advised for skiers at any age and level of experience.

So, enjoy the slopes, but ski or snowboard safely and do your best to participate within your personal limits. When you take on more challenging terrain, try to do so under optimal conditions in the presence of persons who can assist you should you get in over your head, become injured, or otherwise require a rescue.

Tags: skiing,snowboarding, speed, wilderness medicine, outdoor medicine, healthline

Labels: helmet, ski, skiing, snowboard, snowboarding, speed

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Speeds Associated With Skiing and Snowboarding

Traumatic brain injury (TBI) is a serious event that usually follows a direct blow to the head. It is a dreaded situation that is of concern to skiers, snowboarders, climbers, mountain bikers, and others in outdoor sports situations. There are numerous injury prevention strategies, but none more important than minimizing the situation of risk and wearing a helmet.

Ski season is upon us. In Volume 18, Number 2 (2007) of the journal Wilderness & Environmental Medicine appeared an article entitled "Speeds Associated With Skiing and Snowboarding," authored by Robert Williams, MD and coauthors. In the article, the authors note that current helmet use among skiers and snowboarders remains low, particularly among adults. While it is currently accepted that the benefits of wearing a helmet include increased warmth and protection from face and scalp bruising, scrapes and cuts due to collisions with skis, boards, skiers, boarders, and other objects (e.g., dwellings, trees, and lift poles), there is some controversy about how useful are helmets during high speed collisions. It is felt that as the velocity of impact increases, the utility of a helmet diminishes, which makes sense. In terms of a number, 15 miles per hour has been mentioned as the speed above which a person cannot expect much benefit from wearing a helmet.

However, as the authors note, skiers and snowboarders have many reasons to be moving more slowly - while negotiating turns, choppy terrain, terrain parks, traveling through the woods or in backcountry areas, etc. Therefore, a helmet might be expected to be useful in these situations. With this thought in mind, they looked at determinations of skiers' and snowboarders' speeds using radar guns. Because of limitations involving the use of the radar guns, any speed less than 11 miles per hour (mph) was recorded as zero, and any speed of 11 mph or greater was recorded accurately. Their findings were that in the majority of instances, both skiers and snowboarders traversed "nontraditional terrain" (e.g., turns, out of bounds, in the trees, etc.) at relatively slow velocities. In 87.6% of observations, the measured speed was below 15 mph. So, one would expect a helmet to be of benefit for these skiers and snowboarders should they suffer a fall or collision.

The authors further noted that a helmet might provide protection to a skier or snowboarder in the backcountry caught in an avalanche. Although most deaths in an avalanche situation are due to asphyxiation, there are associated head injuries that might be lessened or prevented.

There doesn't seem to be any significant safety argument against wearing a helmet while skiing or snowboarding. That is, there is no evidence that wearing a helmet encourages risky behavior or increases the incidence of an associated neck injury. The authors comment that the medical community has been slow to endorse the use of helmets for skiing. Not this doctor! As an emergency physician, wilderness medicine expert, and member of the national medical committee for the National Ski Patrol System, I strongly encourage all skiers and snowboarders, including NSPS and volunteer patrollers, to wear helmets when they are skiing and boarding.

photo courtesy of www.skileb.com

Tags: injury,injury prevention,skiing,snowboarding, helmet,speed, wilderness medicine, outdoor medicine, healthline

Labels: accident, helmet, ski, skiing, snowboard, snowboarding, speed

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