A Word About Prevention

Preventing an injury is just as important as knowing how to handle one. Two important ingredients are proper gear and adequate conditioning. Make sure that you have the right gear to stay warm and dry through the day. High-quality eyewear goes a long way towards keeping you out of trouble, so pay careful attention to conditions and choose the right goggles, sunglasses or eye protection. Because the altitude intensifies the effects of the sun it's actually easier to get a sunburn. Use, and reapply sunscreen and lip protection throughout the day to prevent sun and windburn.

If it's your first day on the slopes for the season, listen to your body. Even you've been rigorously conditioning, your body will need to use unique muscles and lots of energy to keep moving and keep warm. Eat a good breakfast to make sure you have enough stamina to last the day out on the slopes. Stop often to warm up and drink non-caffeinated fluids to keep well hydrated.

Have your skis or board serviced regularly and make sure to check that boots and bindings are functioning correctly and adjusted comfortably before hopping on the first lift. You'll be glad you did. Also, make sure all loose scarves, hats, gloves, ski leashes, and zipper pulls are tucked away to avoid snagging on tree branches or chairlifts and causing a fall. Charge up your mobile phone and keep it handy, just in case.

Get to Know the Mountain

Ski Patrol, resort guides and staff work vigorously to maintain trails, and post conditions at the base continuously. It just takes a second to read the comments as you board the lift chair; pay attention to all posted hazards and warnings. Carry a trail map with you and get familiar with the area, making sure to always plan an easy route down, in case problems arise. You don't want to be stuck on the top of a steep mogul field with a busted binding, or desperately needing a bathroom break. Be aware of potential hazards that develop as temperature dips, the sun changes position, or the weather suddenly changes.

When an accident occurs, it's important to stay calm, so you can think about the best way to handle things. The US Ski Patrol recommends crossing your skis in the snow above you to alert other skiers to avoid hitting you and let the patrol know help is needed.

ABCs of First Aid

Coming across a badly injured skier, or your finding your buddy after a big spill can be pretty stressful. Fortunately, all you need to remember is your alphabet.

Airway ' Make sure there is no visible obstruction in the mouth or throat. Do not push anything into the throat by putting your fingers deep into the mouth. Use a shallow sweeping motion to clear out any debris or vomit.

 Breathing: Check to see if the victim is breathing by listening and feeling for breaths or chest movement. If not, that is the first thing that must be attended to. If you've been trained in CPR, now is the time to put it to use. If the victim is unconscious, clear the mouth, and turn the head to side, to avoid potential aspiration of vomit

Circulation - Does the victim have a pulse? To check, place you finger under the corner of the jawbone near the ear. If there is bleeding, stop the flow with pressure to the wound or just above it. Bleeding that can't be stopped by direct pressure will require a tourniquet. A limb can survive for over 2 hours with a tourniquet, so don't be afraid to apply one if necessary.

D and E' - On the mountain, 'D' and 'E' stand for Disability and Environment. When deciding how to handle an accident, these are two important factors. Carefully assess the degree of injury and how able, or disabled the person is. Consider the environment, degree of difficulty of the trail, and weather conditions. If you have any doubt that you or your injured buddy can safely make it to the bottom of the slopes, don't try it. When I tore my ACL a few years ago, a Ski Patrol arrived before I could even get my gear off. As embarrassing as it was to ride down in the telltale BIG RED sled, I would have only injured myself more severely if I'd tried to make it down on my own. And it was toasty warm too!

Bumps, Spills and Broken Bones

Falls, or being injured by an out-of-control skier are a significant cause of injuries on the slopes. When head trauma occurs, never move the victim unless they are in danger of further injury. Protect the neck until it is clear that there is no spinal injury. Remove your buddy's or your own skis, but keep your boots on. Injured areas can swell instantly and you will not be able to get the boot on again. The boot will also stabilize the injured area.

If possible, splint the injured extremity until help arrives. If you are part of a large party, have someone stay with the victim and send another person to get help. Otherwise, do not leave the victim alone to get help.

Frostbite

According to the British Mountaineering Council, frostbite means that skin and underlying tissue actually freeze. This condition rarely occurs in still air above -10'C. The main cause of frostbite, they suggest, is carelessness. Know the symptoms of this common, cold weather hazard: numbness, and burning of fingers or toes with prolonged cold exposure. Numbness early on, especially in your toes, might be the result of overly tight ski boots or multiple layers of sock. Frostbite severity is graded in a similar way to burns; 1st degree thru 4th degree, with increasing worsening prognoses. Within the first hour you might notice whitish or grey discoloration of the skin. Later, blisters may develop.

Treatment means re-warming the area. If you are not sure how long it will take, don't attempt to re-warm frost bitten extremities; re-freezing dramatically worsens the outcome. Warming might also make it impossible for the victim to bear weight, making rescue more complicated. While frostbite numbs the exposed areas, re-warming can be intensely painful, and may require narcotic pain medication.

Mild frostbite can be treated with supportive care, making sure you feel comfortable. Ibuprofen or aspirin will help you heal faster and feel better. It usually takes 20-60 minutes for frostbitten skin to thaw. Avoid massaging or rubbing the affected area, which may be numb, because it can worsen the injury. If necessary, split the area, to avoid further injury. When the skin becomes pink and flushed, it's an indication of adequate blood flow. It's crucial to keep any area of the body that's had a cold injury protected from re-exposure, even years later.

More severe frostbite will cause the skin to slough off after a day or so, exposing deeper layers. It's important to keep these areas clean and dry to prevent infection. Clear blisters should be opened to avoid infection, but blood blisters should be left alone. Tetanus prophylaxis should be given if your status is unknown, or not up to date. Although the skin can appear very damaged, the body has a remarkable ability to repair itself. It can take up to 4-6 weeks to know what the final tissue loss will be.

While 1st degree FB usually heals completely, 2nd and 3rd degree injuries will require some form of amputation. 4th degree FB will necessitate both large-scale amputation and effect major body organs and systems.

To help prevent frostbite, make sure skin is not directly exposed to cold air. The face and neck are especially vulnerable because the wind can multiply the effect of the cold. Make sure gear is not too tight since that will decrease blood flow to the skin and actually increase the risk of frostbite. Mittens will keep fingers warmer than gloves. Direct skin contact with metal or fluids is extremely dangerous in frigid temperatures. Drink enough fluids to help your circulatory system keep you warm, and eat enough to offset the extra energy expenditure your body uses to keep warm.

Hypothermia

Prolonged exposure to the cold can quickly develop into a life-threatening drop in your body's temperature. Wind and damp clothes rapidly accelerate the effects of the cold. Symptoms of severe cold exposure include shivering, lethargy and confusion, and later, muscle stiffness. People suffering from moderate hypothermia often look like they're drunk.

If the symptoms are minimal, exercise will stimulate the circulation and warm the body. It may seem counter-intuitive, but the severely hypothermic skier should remain as calm and still as possible. Activity only pushes the cooled external blood from the skin into the internal organs making the situation worse. The first step in treating severe cold exposure is preventing further heat loss. Removing wet gear and shielding them from wind are the best strategies to keep them warm. Warmed, humidified oxygen has been shown to be the most effective way to raise the core temperature quickly, although it won't be available on the slopes. Use external warming devices like hot packs as long as the person is not in cardiac arrest. Place at the neck, armpits, and groin.

Finally, skiers suffering from hypothermia may appear lifeless because their breathing and heart rate are so depressed they can't be observed. Continue to provide care until the victim is warm and still shows no signs of life, and should not be considered dead until 'warm and dead' according to the medical specialists at www.hypothermia.org and the Journal of the American Medical Association.

Prevent hypothermia by dressing in layers, having an extra pair of dry socks in your gear, and paying attention to your body. Be aware of the potential dangers and warm up inside the lodge frequently if the temperatures are especially low.

About the Author

Peta Minerof is a successful healthcare writer, longtime skiing enthusiast, as well as a board certified clinician with over a decade of private practice experience. Her most recent features include safety contributions to 'Snow Blowers n' Plows