Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

OBJECTIVE

Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines.

METHODS

Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20-73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar. After each scenario, a lateral radiograph was taken of the cervical spine to observe for changes in alignment.

RESULTS

Compared with the control group (helmet on, no collar), we observed 9 degrees of increased overall (occiput-C7) cervical extension in the helmet on, with collar group (P < .001), and 17 degrees in the helmet off, with collar group (P < .001). There was increased extension at the occiput-C2 intersegment in the helmet on, with collar group (9 degrees, P < .001) and at both the occiput-C2 (9 degrees, P < .001) and C2-C7 (8 degrees, P < .001) intersegments in the helmet off, with collar group.

CONCLUSION

Ski helmet removal and c-collar application each leads to increased extension of the cervical spine. In the absence of other clinical factors, our recommendation is that helmets should be left in place and c-collars not routinely applied during ski patrol rescue.

Utah ski patrol: assessing training types and resources

BACKGROUND

Skiers and snowboarders incur a variety of injuries and medical emergencies each year at ski resorts. The ski patrol is primarily responsible for initial triage, assessment and stabilization of these problems.

OBJECTIVE

The purpose of this study was to subjectively evaluate the type of training, resources, and equipment available to local ski patrols within Utah.

METHODS

Ski patrol directors at ski resorts in Utah were asked to complete a voluntary computerized survey.

RESULTS

Of the 14 ski areas in Utah, ski patrol directors representing 8 resorts responded. The majority of patrols in Utah use Outdoor Emergency Care (OEC) as their primary education and certification source. Most programs also include site-specific training in addition to basic certification. All responding resorts had basic first responder equipment, including splinting devices, basic airway management, and hemorrhage control. Six of 8 responding resorts had affiliated clinics, and all had access to aeromedical transport. All of the responding ski patrol directors believed the current training level was adequate.

CONCLUSIONS

Utah area ski patrollers frequently see trauma-related injuries and have the resources to assess and provide initial immobilization techniques. Many resorts have affiliated clinics with advanced providers, and all have access to aeromedical support to rapidly transfer patients to trauma centers. Medical directors may be of use for training as well as developing extended scope of practice protocols for advanced airway use or medication administration. Patrols may benefit from additional resort-specific training that addresses other frequently seen injuries or illnesses.