I was just coming out into the sun to peel an orange on the Judah Patrol Shack porch when I noticed a guy getting off the chairlift frantically waving his arms at me. My interest piqued as I rushed down the stairs to hear better what he was shouting about and I learned that he had seen a skier hit a tree and remain prone in the snow afterward. I informed the hill boss I was going to respond to the report and as I clicked into my skis, I asked the RP if he knew the trail name and to follow me down and show me exactly where he had seen the accident. As we skied towards the accident site on Coldstream I told him to please remain at the scene as I dealt with the injured skier and someone else would take some information from him.
Skiing down through the crowded afternoon slopes I was scanning the forest’s edge for a prone skier and beginning a narrative in my head to prepare mentally for what was sure to come. At first I skied right past the injured party, as he was now standing at the side of the trail – not lying in it as I was expecting. The RP pointed out that this person standing on the side of the trail was indeed the guy he saw from the lift and I quickly scampered back up the trail announcing who I was and asking permission to assist.
As I clicked out of my skis and crossed them uphill, the mantra was sounding in my head, “Mechanism of injury, check scene safety, ABC – C-spine – look at the kill zone…”. The skier looked a bit dazed, but otherwise looked pretty much like all the other overheated skiers I had seen on the hill all day. I reached into my vest and slipped into BSI while asking “What’s your name? Tell me what happened”. “Please don’t move” I said as I put a gloved hand on his sweaty head to remind him to stand still. “My name is Andy” I heard him say. “Okay Andy, what happened here?” I responded, trying to calm my pounding heart. “No, not Andy, Randy, with an R” I heard him respond. Good… the patient in speaking – he has a patent airway. He was not panting, and did not seem to have difficulty breathing. Got my A and B out of the way. I reached down to grab a qualitative pulse and asked him if he felt pain anywhere. His pulse was strong and steady. I looked around and uphill. The RP pointed to the tree and said “That one, that’s the one he hit. He was just laying there a minute ago…”. So, no big pools of blood within sight, no blood on the patients clothes – just a head, wet with sweat. A beautiful arching track in the snow ended abruptly at the 10” tree trunk – where there was a sizable depression in the snow. C is good. Keep it moving….
“Do you remember what happened?” I asked. Randy tried to shake his head in reply after a brief hesitation, and I held firmly to his head and reminded him, “Please don’t move your head”. Okay, so far A&O by one. Not good. “Do you know where you are?” I asked. Again, another attempt to shake his head. Hmm. “Do you know the time of day?” I prompted. He looked at the sun and said with some hesitation “Afternoon?”. I thought this through quickly – Person, place, time, and event – sounds like A&O by one to me. Remember that and carry on.
“Does your head neck or back hurt” I asked – “Yes – my neck hurts” was the reply. “Were you unconscious at any time?” I asked. “hmmm – don’t recall” he said. “I’m just going to check you out here in a few other places – let me know if you feel any pain” I informed him and I began my urgent body survey. I covered his eyes and then removed my hand – eyes were P.E.R.L and tracked my finger when requested. No blood in the mouth, or pain when I asked him to open his mouth and then clench down. Immediately while palpating his head with my free hand I came across a rather large contusion at the base of his skull just above the C-spine. Upon closer investigation, it looked strawberry red, enlarged, and damp – not bloody. Okay – remember that – I’ll need it for the radio call. I reached around with my free hand and continued to palpate his neck and spine one vertebrae at a time. We were close now – very close as I had one hand on his head, and was reaching all the way around him. I could feel the heat rising through his ski parka in waves. “Any other pain where I push here?” I asked. “No” he said. On to the chest, abdomen, hips, and femurs. No pain anywhere, but he was complaining of shoulder pain. I quickly palpated and got a response at the end of his collar bone on the top of his shoulder. He could touch the opposite shoulder with that arm so I ruled out a dislocation. No blood – not in the kill zone – move on. Anything else? Anything else? Oh yeah – “let’s get some help down here” ran through my head. Time for the radio call. “Judah Hill Boss? This is David G.”. “I have a skier/tree collision here, middle aged male. A&O by one. I need O2, backboard and some help.”.. Anything else I was thinking. “ Oh yeah – where am I? “I’m skier’s right directly below the split between Golden Gate and Coldstream in the whoopdeedoos.” I said as I clicked the mic. Over the radio, I heard a reply, then another patroller chirped on-air with a specific location – “just below Judah tower 9”. I don’t recall if I requested an ambulance – but somehow that all seemed to happen – thanks to the hill boss.
Deep breath. What’s next? “Randy, remember to stand still. Help is on the way”. He asked me to wipe some sweat from his eyes and I complied. “Randy, you allergic to anything? On any medications? When did you eat last?” The questions fired out of my mouth automatically, and as he answered negatively to each one I moved on. Nothing exceptional to note or remember. “Ever injure this shoulder before?” I asked. Another “No” came as a reply. With my free hand, I palpated his right shoulder, upper arm, forearms, wrists, and hands. “Any pain here” I asked. Another “No”. Moving on to the other side – remembering about his injured shoulder just in time not to poke him right at the sore spot. Again – no other pain. Help starting arriving on scene. Time to take a step back mentally and decide what comes next. As I directed the helpers to get oxygen going at 15 LPM I instructed them we were going to do a standing backboard. The C-collar was out, sized, and applied. Oxygen mask was applied. “You okay Randy” I asked. A muffled yes came through the mask.
Someone else took Randy’s head, I moved to the back of the board, took over the head, counted to three, helpers hands under his arms clasping the backboard, we lowered him to the ground in one smooth motion. Red coats with white crosses all around me now. Faces concentrating on straps, and tape and keeping the backboard level. I looked up and saw someone taking a statement from the witness. Pen and paper in hand I was relieved to see. No need to ask someone to follow-up with that now.
Everyone knew their job and I just watched Randy and reassured him we were strapping him to a board to help get him down the hill safely. He responded he was taking an EMT class and it was very bizarre to be experiencing this from the patient’s perspective. I thought – “Good - this guy is talking, making sense, remembers things about his situation – probably just a head clunk”.
So many helpers around. I’m not alone. Very relieved. The hard part is over. As I was clicking into my skis, I looked back at Randy and saw others were finishing the packaging tasks. Then, looking forward I was trying to imagine how I was going to get this loaded sled UP over the trail’s berm. Hmm. Never really practiced that in all our drills. I looked over back to the response squad and asked Andrew to help me pull the sled up to the edge of the trail. Locomotive attached, we motored ahead and I herringboned in the horns staying slightly ahead. Then all at once, we were moving smoothly downhill. I was leading the sled – no tail roper – no problem. “Think of the patient, go slow, pick a smooth route, stay loose in the handles…” and on and on voices in my head sounded. The voices managed the sled and I picked a route as smooth as possible to the Judah FAR.
We don’t really get a chance to ski over here very often as candidates, and I had never brought a sled down the terrain park before so I was not on autopilot. Looking ahead through the snowboard features I was glad that there were groomed pathways to each side allowing me to move down the hill without too much jive. “Randy, you okay back there?” I asked. Muffled “yes” came back as we glided down.
Swooping down right to the upraised loading door, I stepped out of my skis, rotated the sled and pushed it onto the white waiting gurney. Hmm. “Had anyone alerted the clinic staff?” I wondered silently. Magically, a red coat appeared next to the gurney, and staff poured out of the clinic door. “Hi everyone..” I said. “This is Randy, A&O by 1, back of head injury, sore shoulder..” I barely blurted out and then the nurse took over. All the same questions, a quick check of the pulse, a rapid body survey and a decision. “We’re going to keep you on this backboard and transport you down to Tahoe Forest hospital” she said. “Matter of fact there is already an ambulance here and he’ll take you down right away”. Then, the EMT took over, repeated the questions, the urgent body survey, and we transferred Randy to his gurney and we wheeled him down the ramp. I barely had time to say goodbye to Randy and to grab a replacement backboard from the back of the ambulance before it roared off down the hill.