Chapter 04: First Aid and Medical Protocols

Tahoe Backcountry Ski Patrol Manual

FIRST-AID

First-aid philosophy

Our first-aid philosophy is dictated by the terrain we patrol and the limitations of our training and equipment. The limits of our first-aid training should always be kept in mind, as should the primary rules "DON'T BECOME A VICTIM" and "DO NO HARM." Because we patrol the backcountry, we are limited in the equipment we carry and the speed with which we can evacuate the injured. Most Nordic first-aid treatment is similar to Alpine, but transportation is decidedly different. Although some of us were trained as Alpine patrollers, we must learn to think as Nordic patrollers. Consequently, our emphasis is on stabilizing injuries, controlling shock or hypothermia, and keeping patients dry and warm until appropriate transportation can be arranged. This is why we carry or have cached such items as oxygen, ensolite pads, blankets and bivouac kits. Often the most critical decision involves the method of evacuation. Patients with minor injuries can be transported by sled; more critically injured patients should be transported by helicopter, if available, or by snowmobile.

Special first-aid procedures

As noted above, our emphasis is on keeping the patient warm and dry. All patients should be placed on ensolite pads. All patients should be covered with a blanket(s) and a tarp or space blanket. Patient temperature should be monitored continuously, through use of the hypothermia thermometer if necessary. Any person suspected of being seriously hypothermic should be evacuated immediately by helicopter. Where transport by snowmobile is advisable, a bivouac should be established to provide shelter and warm liquids unless contraindicated because of specific injuries. Snowmobile transport must be arranged by the USFS through the county sheriff, and waiting time is often considerable. Your specific location must be given, so map-reading skills are essential. You must always know where you are, and be able to give appropriate map coordinates!

Consent for treatment

Adults - If the patient refuses treatment (after persuasion and informing of worst possible consequences), ask the patient to sign the Refusal of Treatment form. If they refuse to sign, have a witness sign to form to confirm the refusal. (The witness can be another patroller or a bystander).

Minors - If the injury is non-life-threatening, you must ask for guardian permission to treat. If the injury is a danger to life or limb, then treat as necessary (and guardian consent is not required). If the patient refuses treatment (after persuasion and informing of worst possible consequences), ask the patient to sign the Refusal of Treatment form. If they refuse to sign, have a witness sign to form to confirm the refusal. Unconscious (both adults and minors) - Consent is implied if the patient is unresponsive.

Decisions regarding patient transportation

As mentioned above, transportation of the injured is by sled, snowmobile or helicopter, depending upon severity of the injury. Transportation decisions also involve patient input, cost and inconvenience considerations, and availability of evacuation equipment. When a patient needs transportation, notify the Grass Valley (or Minden) dispatcher immediately of any potential need for transport, and request a helicopter in "standby" status. (The helicopter may take five minutes to takeoff and twenty minutes to arrive). After several minutes of patient evaluation, confirm with the dispatcher if helicopter or snowmobile is preferred. The helicopter can also be asked to standby over your position, without a fee until they land. Patients are usually charged for emergency transportation, a helicopter should not ordinarily be ordered for a simple fracture. However, the fact that an injured skier lacks funds or medical insurance should not dictate a slower method of transportation when an injury requires immediate advanced medical care. If asked by the patient, inform them of the cost (ranges from $7,000 to $10,000), and that most insurance plans cover the service. If they are uninsured, there are non-profits that may cover the cost. Try to convince the patient of the need for swift medical attention, and what the worst-case scenarios are without it. If the helicopter is refused, document the fact on the Incident report form, and have them sign a Release of Liability form. Patient transportation issues will be extensively discussed during training.

INFECTION CONTROL PROCEDURES

PatrolManual/Appendix_M contains information regarding the blood-borne pathogens, which produce AIDS and Hepatitis B. All patrollers and candidates must be familiar with this material and with the patrol's infection control procedures. Avoid exposure by following proper protection protocols. If you are exposed, you should: As soon as possible, wash and remove any visible fluid Ask the ambulance or helicopter what hospital they are going to, and let them know you've been exposed. Call or go to the hospital emergency room, explain the situation, and find out if the patient has tested positive. Get tested. Document the exposure on the Incident Report form, and Daily Operations Log.

Patrol Specific Outdoor Emergency Care (OEC) Protocols

Upon successful completion of the Outdoor Emergency Care (OEC) Course, patrol members are certified as OEC Technicians by the National Ski Patrol. The following information serves as a supplement to the training and instruction received by the OEC Technician during the OEC Course. It includes patrol-specific protocol regarding the treatment of patients, which may differ from the protocol as taught in OEC. It also serves to clarify other items not fully covered in the Course. For further information, please contact the TBSP OEC Advisor.