A flipped perspective on patient care on the hill
By Chris Huskinson
On closing day of the ski season, I broke my leg. It happened from a missed edge on a run I’ve cruised many times, not just from doing something dumb or trying to show off. I ended my season with surgery and months of recovery. Go figure.
I started skiing at the age of five on wooden skis when Levi’s® worked as snow pants. Over time, I picked up snowboarding and have done both for the last 40-something years. I even have a monoski! Skiing and snowboarding is what I look forward to every winter. I joined the ski patrol at Kelly Canyon, the local hill about 20 miles east of Idaho Falls, Idaho, just over six years ago to give back to the community, play, and forge new friendships.
As a retired paramedic, I chose to take the Outdoor Emergency Care class to refresh my skills and become part of the group when I was invited to join. Since then, I have earned my OEC instructor’s certification and was named the “OEC guy” for Kelly Canyon. I was instructor of record for the last four OEC classes sponsored by my ski patrol. Hence, I do have a pretty good background in emergency medicine and how things work.
On this closing day, I was with a group of friends at Grand Targhee Resort near Driggs, Idaho. It was April 15, and the conditions were near perfect: just above freezing, perfect snow with a couple of inches from a storm the night before, bright and sunny skies, and great company. Anyone familiar with Grand Targhee knows the hill provides wonderful powder and challenging terrain.
All morning, we smashed the fading mogul fields, played in the trees, chased the last of the fluff, and cruised the occasional groomer. As the only snowboarder in the group, I was the butt of more than a few jokes, but it was all in good fun. We planned to meet in the parking lot for a little barbecue in the afternoon sun. As it happened, I never made it for my brat.
A couple of guys took off through the trees, while a friend and I decided to go easy and take the Ridge Run down. It’s an intermediate run I have done hundreds of times, wide open with a few tree “islands” dispersed around the slope. The snow was a perfect blend of groomed with a little buttery powder starting to soften under the rising temperatures. The south edge of the run was smooth on the edge where the soft wind had blown the snow over the groomer marks, creating a wonderful 20-foot-wide ribbon of awesomeness. It was my second time down that run that day, and I was making fairly tight turns to stay in the “good stuff.”
Pushing into the turns, I could feel just a hint of groomer crust under the fluff. I remember thinking I better ease up or I’d crash. Well, I crashed. My toe-side turn washed out from under me, and all of a sudden I was sliding down the hill on my stomach with my board leading the way. As I tried to dig the edge of my board into the snow to stop, I clearly remember thinking “How did I miss that turn?”
The run has a lip that drops off to another run below it and is interspersed with those previously mentioned “tree islands,” which consist of four or five six-inch diameter trees in each grouping. I hit one of those trees with the bottom of my snowboard directly in line with my left leg. I came to a complete and very sudden stop, forcefully. Think transfer of kinetic energy theory: boom!
I didn’t hear my leg snap, but I immediately felt a severe pain shooting up my leg all the way to my pelvis. It took me a few seconds to understand what had happened as I tried to roll over to see what I hit and what was going on with my leg. As I moved, the pain intensified, and nausea set in. As I tried to keep the bile down, a guy in a black coat stopped and asked if I was okay. I wasn’t sure what I said, but the look on his face was enough for me. He simply told me he would ski down and alert the ski patrol. I was alone; my friend, Robert, was ahead of me and had no idea of my disaster.
I attempted to unbuckle my board with little success. I could not turn over without the pain and nausea jabbing me. I tried to assess myself mentally by pushing through a self-directed SAMPLE survey. I remember thinking that at least I had done this before lunch, so I wouldn’t get to see lunch come back up. AVPU was silly; it hurt, and it hurt badly. So much for assigning the pain a number. The worst pain you have ever felt short of childbirth was what I was thinking, but of course, I’m not a woman, so I don’t know how accurate that is.
I lay there waiting, and my mind started to clear a bit. I was below the Ridge Run, and no one could see me below the edge. The run below me was situated such that everyone was skiing away from me. What if Black Coat Guy forgot to tell anyone? With a little panic setting in, I decided to do the slow-motion crawl back up to the run I had started on. That AVPU number of “10” screamed at me every time I moved anything below my waist. I managed to get my head and shoulders on the run and started waving. As luck would have it, a patroller from nearby Jackson Hole Mountain Resort was closing out his season at Targhee. He skied up to me and asked a few questions before pulling out his phone. He knew the direct number to the ski patrol top shack and gave this report:
I’m on Ridge Run midway down on the south side with a male snowboarder conscious and alert times four complaining of severe pain in his left leg. Request additional patrollers and toboggan.
As he waited with me for the ski patrol to arrive, I was grateful for his compassion and professionalism. As a caregiver most of my life, I have never been the patient except in scenarios; I have always been on the other side of the table relying on my training and instinct to help people. I was about to learn more about my chosen career than I could possibly imagine.
As we talked, he found out I was also a patroller, and we both had to laugh at the irony of the situation. I am not sure how long we visited, but he made the time and pain more tolerable by being compassionate.
When the first patroller arrived, he did everything right out of the OEC textbook. The off-duty Jackson Hole patroller gave him a quick report and bid me farewell. I can’t even recall his name.
As the patroller blocked off the area with his skis, he asked all the right questions and did good assessments. Then he looked at me and told me he was going to remove my board, and I had to smile, as I have told that exact thing to numerous patients over the years, not actually realizing the amount of pain they could be experiencing. I have always had scrapes, bruises, and bumps that hurt, but those were pretty minor compared to the pain shooting up my leg. He worked smoothly and carefully, unbuckling the board and digging the snow away from it so he could get it out of the way.
As he focused on my leg, he told me he could feel a step-off right at boot height under my pants. He loosened my boot and got his fingers deeper toward my ankle, then told me he felt another, bigger, step-off. He was as impressed as I was. At least two different breaks, but at least they were a closed injury.
A second and third patroller arrived with the toboggan. I watched them get the sled properly positioned in the snow and thought about how I had done that on many occasions, but this time, I was the patient, a real live “I need your help” patient. A splint was applied, vitals assessed, oxygen applied, and then the fun began.
Being somewhat proud or somewhat stupid, I volunteered to help move myself into the sled. That lasted until I sat up to move, and then the pain and nausea come back like a proverbial runaway freight train. Those three patrollers picked me up and placed me in the toboggan with kid gloves. Granted it hurt, and I may or may not have said a few choice words, but thinking back it was a very smooth transition from the cold snow. They had experience and good training.
It seems silly now, but I remember the toboggan ride as being one of the best I have ever experienced as a patient. I was wrapped in blankets, O2 was put in place, and I was strapped in. The patroller in the horns was good, and the ride smooth. I didn’t get any snow kicked up in my face, and he talked to me the entire way down the hill. His calm demeanor and knowledge of the best route to run a toboggan down the slope was great. I actually started to relax a little bit and had confidence in him.
Arriving at the aid room, they picked me up again and put me in a wheelchair to go inside. More assessments, more questions, paperwork, and more pain and nausea. Removing my boot was horrible; I’m sure childbirth had nothing on what that felt like. Down to bare skin, we could all see the jagged edges of my tibia and fibula wanting to poke through the skin. Grotesque, yet cool to see. I wished it was someone else’s leg though.
They had dispatched the local ambulance service to the mountain, and they arrived shortly after I was brought to the base area. Of course, they offered me something to take the “edge” off, as the brash young man stated. Though it hurt badly, I started to really think about my options. If I accepted pain medicine from the ambulance, I would be required to be transported by them to the closest hospital. I knew I would probably require surgery and lots of follow-up care and really wanted to be closer to home. My other option, the one I chose, was to have some friends drive me the approximately 90 minutes to Idaho Falls in a private vehicle and put up with the pain for the duration of the drive. After all, I wasn’t dying, right?
Of course, I had to convince the medics I wasn’t crazy, or any crazier than the last patient who had denied transport. As per protocol for the ambulance service, I had to sign the refusal forms and accept the risks of refusing their care. Their guidelines allowed the senior paramedic to make a judgment call on my soundness of mind, which I apparently passed without any further direction from the on-call doctor.
Once the details were worked out, the patrollers wheeled me to the parking lot, picked me up, and placed me in my vehicle. They all wished me luck. One of my friends had volunteered to drive me back home with his wife following in another car. Numerous times during that drive, I second-guessed my choice. My leg was hurting, and I was hungry and cranky. I knew I shouldn’t eat anything in the event surgery was needed immediately.
Once at the hospital, I got enough pain medicine in the form of morphine and Versed to make things seem OK. I was in the operating room within two hours of arrival. X-rays showed I had broken my fibula in two separate places, while my tibia had suffered a spiral comminuted fracture, earning me a nifty titanium plate and 13 screws in my leg. The surgery lasted almost three hours. When I woke up, I was looking at the recovery room nurse, who told me I had done great. I think my comment was something along the lines of, “Duh. …”
I spent the next few weeks trying to figure out how to do simple things, such as showering while balancing on one leg, vacuuming, grocery shopping, etc. I did like the little motorized carts some stores provide!
Over the next three months, I learned to balance on crutches while under strict orders to be non-weight bearing on my surgically repaired leg. The start of the fourth month, I was told I could walk as tolerated. At that time, I was also told not to ski or snowboard for at least a year, and that the swelling in my leg might never go away. The only good news was I got rid of those blasted crutches.
After seven months, I still have the swelling, a limp, an aching leg, and an itch to go snowboarding.
I think a lot about that day and the people that helped me. I must give credit to Minnie Dole for his foresight in creating a ski patrol to help others. Credit also goes to all those who have fine-tuned the OEC book and skills over the years, as well as to the ski patrollers that do the job every day, either as paid patrollers or volunteers. They, we, are the face of the National Ski Patrol that the public sees every time they go to the ski hill. The public relies on us to aid and help when needed.
As a patroller and a patient, I knew how things were going to happen and in what sequence. I knew what and how was coming in terms of my care. For example, I knew the basics of how they were going to package me and transport me down the hill. I knew that getting the splint on my leg was going to hurt, yet it had to be done to prevent further injury. The patrollers did a good job of telling me what they were doing, how they were going to do it, and when to hold on tight. A person without that background in the same situation would have no idea what to expect, and that person would be hurting, scared, and needing a friend to help them. A good patroller needs to understand those basic needs for their patient and care for them as they would a family member.
As a patroller, one must constantly work on communication skills to help with patient care and understanding. Although each call for help on the mountain is different, the principals of good communication are the same: inform, educate, and gain your patient’s trust. It is a basic skill that is often overlooked, but one of the most important things to have in your patroller pack. A good patroller will be engaged with the patient by asking questions and, most importantly, listening to the responses to help further assess the situation.
Years ago, I transported a terminally ill patient in an ambulance to her home to die. She was scared, tired, and knew her time was coming. As there wasn’t much patient care to attend to, I simply talked to her, held her hand, and listened to her talk about her life and family. She died shortly after arriving home. I can only hope I offered her some solace and compassion in her final hours. I would want a caregiver to do the same for myself and my family.
A few days after my accident, one of the younger patrollers called me to follow up on my care and ask how I was doing. I know it is protocol at that ski area to do so and was appreciative. As a patient, the gesture was understood and fairly standard, but the delivery from the patroller was heartfelt and showed genuine empathy. It was obvious I was not the first follow-up call he had made in his career, and he had been working on his communication skills over time.
I appreciated his efforts to help me off the mountain, but more so his efforts to make me, the patient, feel engaged and informed. That quality is something every patroller needs to work on and cultivate.
In the meantime, I’ll see you on the hill … next year!
Chris Huskinson is a volunteer patroller at Kelly Canyon Ski Resort near Idaho Falls, Iowa.
This piece first appeared in the Summer 2019 issue of Ski Patrol Magazine.