Ski Touring is not in itself an intrinsically accident prone activity although it is difficult to compare reported accidents rates between nordic and resort based ski-ing activities. In ski centres Doctors expect ski-ing accidents and record injuries which result from them accordingly, elsewhere the system is less likely to pick them up. The Aviemore practice has, however, started to look at freeheel ski injuries and has suggested that as telemark techniques become more popular and speed and steepness of descents increase injuries may rise. Using the appropriate gear and being aware of the dangers are the best protection from injuries directly attributably to ski-ing.
General Procedures for Accident Response
Although not intrinsically accident prone ski touring takes its devotees to places where help is not immediately available and where first aid as a first line of defence is particularly important. In Scotland, however, it is first aid, not expedition medicine, which is needed and once initial aid has been given the priority should be to get aid and get the injured person off the hillside. In winter hypothermia is a constant threat and all First Aid needs to give appropriate weight to this in forming an action plan. Where the accident is serious help should be summoned as quickly as possible by mobile phone or by some members of the party going for help. This should not normally involve leaving the injured party alone. So nordic skiers are advised to ski in company and are ill advised not to ensure that they equip themselves with appropriate basic first aid materials and the skills to use them. We will look here at the common problems you may face and the appropriate content for a first aid kit to meet them, remembering that weight is at a premium.
New boots, rucked socks, tired footbeds, we have all suffered from blisters at some time and they can ruin a good day. The sooner the problem is tackled the less the severe the consequence. Basically if the skin is intact and the area generally clean there is no need to do anything other than apply a suitable plaster. The new generation of Hydrocolloid blister plasters, such as Compeed,Sorboskin etc, ensure that the wound does not dry out and ensure rapid and scar free healing. No first aid kit should be without plasters suitable to treat the heal and underfoot. This generation of plasters is also recommended for the treatment of minor cuts and grazes, and where cuts and grazes are clean should be sufficient in themselves.
Where wounds have dirt embedded in them it is best to wash them thoroughly with an antiseptic and use an antiseptic cream before plastering them.
In the absence of a hydrocolloid plaster you need to use something which removes the pressure from the blister point by padding around it and cutting a hole in the first layers of padding over the blister area.
Where there is any doubt about the cleanliness of the cut or graze or where there is a danger of scarring from deep grazing or cuts, stitching may be required and medical assistance should be sought as soon as practical.
If a cut or graze is bleeding profusely the emphasis should be on stopping the bleeding. This is done by drawing together the edges of the wound and applying pressure using a sterile pad. Raising the bleeding wound above the injured person's heart is recommended where possible. In nordic activities, serious bleeding is likely to be associated with broken bones, head injuries from falls, or impaling yourself on ice axes, poles etc. in these circumstances stopping bleeding is a critical part of dealing with the broader problem. Trying to stop the circulation of blood by the use of a tourniquet is strongly not recommended as it greatly increases the probability of permanent damage.If bleeding does not stop an experienced first aider can apply pressure at the first pressure point above the wound. Where something is impaled in the wound the pressure should be applied around the impaled object. you should not seek to remove deeply embedded objects. Where sterile materials are not available the most appropriate spare clothing should be use to form the pressure pad.
If the the person is conscious and able to move and the injury is to hand, foot or limb, the basic nmenonic is ICE. The affected limb should be immobilized, cooled with ice pack, and elevated above the patient's heart. In winter conditions in the mountains this needs to be modified to take into account the risk of hypothermia and frostbite, and in most winter circumstances it will be inappropriate to uncover limbs to the wind and cold. Keeping warm is the first priority both for the injured and the rest of the party.
Loss of consciousness, any paralysis or inability to move limbs or severe shooting pains after an accident are signs which must be treated with great care and are normally in themselves sufficient cause to seek immediate help from the Rescue Services. If any of these signs are present professional medical treatment should be sought as soon as practical.
Head injuries that have fractured the skull or compressed the brain and cause damage to the brain require professional attention. The danger signs are soft areas on the skull, clear fluid discharge from nose or mouth, loss of consciousness,confusion, laboured breathing, flushing of face and high temperature, asymetrical pupils.
Severe bleeding from scalp wounds must be staunched by the use of sterile pads and firm pressure on the wound.
Further information on treating head injuries, which are a more common occurence in climbing accidents can be found at: http://scotclimb.org.uk/safety/headinjury.shtml
Definition
Damage to the spinal cord, which is enclosed by interconnected bones
called ‘vertebrae’, may cause quadriplegia, paraplegia or chronic
painful conditions. The casualty may complain of pain in their neck or back,
and may lose feeling or have a tingling sensation in their limbs. Another
sign of a spinal injury may be if the casualty’s arms and legs feel
heavy or stiff.
Action
Call for help immediately.Sunburn is the commonest burn in skiers. Ultraviolet rays penetrate hazy cloud and the higher the altitude the more they burn; each 300m altitude adds four percent to the rays\rquote intensity. The snow further reflects the sun's rays. Thus, even on an overcast day, skiers should ensure that they are adequately protected against the sun. Wear a peaked cap with a neck cover. Sunglasses should have blinker sidepieces and nose shields. Use high Sun Protection Factor sunscreens and remember to p rotect lips and noses. Badly burnt skin goes bright red and blisters. Plain moisturisers such as aqueous cream or Aloe Vera may be applied to unbroken skin; medical advice should be sought once off the hill for widespread blisters and broken skin. \par Headache, vomiting and fainting followed by confusion may indicate a range of conditions from gastroenteritis to septicemia. These are also the signs of sunstroke. Sunstroke is uncommon in the Winter and first aiders need to be very confident that the victim is suffering from sunstroke before they attempt to cool him/her down.
Paracetamol will relieve most headaches, mild muscular pain and reduce fever. It causes less irritation to the stomach and fewer sensitivity reactions than aspirin. The dosage is 1g every 4-6 hours, and not more than 4g in a 24 hour period. \par \par NSAIDS e.g. ibuprofen These are useful for reducing inflammation such as in sprains, tendonitis or bursitis. Ibuprofen can be bought over the counter without a pres cription. The main side effects are stomach upset, nausea, rash, fluid retention at altitude and they can cause internal bleeding/ stomach ulcers. Medical advice should be sought if you are taking any other medication, suffer from stomach problems, asthma or are allergic to aspirin. The dosage of ibuprofen is 200-400mg 3 or 4 times a day, preferably taken with food.
Stronger painkillers containing codeine e.g. panadeine may be purchased over the counter. Often these are combined with paracetamol. Care must be taken not to take these in conjunction with plain paracetamol, as the body cannot metabolise more than 4 g of paracetamol in 24 hours. More than this amount of paracetamol can lead to liver damage. Some people are particularly sensitive to codeine and may suffer from dizziness, nausea and disorientation. Constipation may also occur. Advice should be sought from the pharmacist if you suffer from any medical condit ion or are taking other medication.
Dehydration is loss of water and important blood salts like potassium (K+) and sodium (Na+). Vital organs like the kidneys, brain, and heart can’t function without a certain minimum of water and salt. Severe dehydration thus influences both bodily functions and decision making.
Everyone should drink lots of fluid during strenuous exercise. Thirst is often a poor indicator of dehydration and people often underestimate the amount of fluid they need. During a tough workout in a hot environment, the body can lose two litres of fluid per hour through sweat. Ski tourers should attempt to balance their effort over the day and avoid sweating too much by over exerting themselves when climbing. Nonetheless, anyone who ski tours should take the following precautions:
Serious dehydration requires medical attention but reasonable precautions will ensure that dehydration is avoided in normal recreational ski touring.
| Item | Uses |
|---|---|
| 2 triangular bandages | General bandaging and sling support. |
| Small pack of gauze swabs | Wound dressings and cleaning wounds. |
| 1 roll Micopore Tape | General purpose and holding dressings in place. |
| 1 small and 1 large wound dressing | Major cuts and wounds |
| Roll of 5cm adhesive stretch bandageF | Support, securing dressings and preventing blisters. |
| Butterfly sutures | Closing cuts. |
| Elastoplasts | Minor cuts grazes and small blisters. |
| Hydrocolloid Blister Dressings (Compeed, Sorboskin etc) | Foot blisters, minor cuts |
| 1 tnarrow 1 broad crepe Bandage | General support and in particular for ankle and knee joints. |
| Safety pins assorted | Multiple uses including large pins used for pinning clothing for support. |
| Medicated wipes | Cleaning wounds, hands etc. … |
| Asprin and other pain killer. Ipbruleve or equivalent | Pain relief, (Asprin for heart) |
| Clean plastic bags /Clean cling film | Cold compress if filled with snow or cold water or temporary burns dressing. |
| Scissors | |
| Tweezers | Removing small objects from wounds. |
| Surgical gloves | Infection prevention |
A good guide to the what and why of constructing a First Aid kit for use
in the wilderness is available from the Wilderness
Medical Association
All Hillwalkers and nordic skiers are strongly advised to attend a (Mountain)
First Aid Course.
A site with good summary advice on most first aid situations
This link takes you directly to the actions appropriate to common first aid situations. The using this site link on this page will allow you to explore the whole self instruction package.
Utah Mountain Biking:First Aid
A particularly full first aid page for mountain bikers covering common off road injuries. Remember the advice is american and should be interpreted for use elsewhere.
First Aid Manual: Emergency Procedures for Everyone, at Work, at Home, at Leisure by St John Ambulance Paperback , 288 pages, 2002,Dorling Kindersley ,ISBN 0751337048
The official training manual for all three first aid providers, offering emergency procedures for everyone at home, at work, or at leisure. This edition is fully restructured and redesigned with bright colour-coded chapters for easy access on all the latest information on procedures.
New Practical First Aid
British Red Cross Paperback - 96 pages ( 1999)
Dorling Kindersley; ISBN: 0751319635
First Aid on Mountains
Steve Bollen Paperback - 38 pages ( 1990)
British Mountaineering Council; ISBN: 0903908719