First Tracks and Cracks – You and four college friends who flew in to help celebrate your birthday are doing an early season (Dec.) backcountry ski near Leadville.  Everyone is doing fine and though you are tired and it’s getting a bit late (3:00 pm) you decide to do one last run.  You slap the skins back on and slowly retrace your traversing route up the slope to try that still untracked old avalanche path that leads back towards your cars.  Trailing your friends you watch as they enter a glade of widely spaced trees when suddenly Terry veers off her track (maybe she hit a rock sticking up through the still thin base) and goes flying into a tree.

Scene and Primary Assessment: It’s cold and getting late, Terry is on the cold ground, but otherwise nothing

Secondary Physical: You get to her almost immediately and she is sitting up moaning, complaining of excruciating pain in her lower right forearm where she smacked the alder.  She feels a bit nauseous and reports a slight headache, but denies hitting her head (she was wearing helmet).

SAMPLE: Symptoms as described in Physical; allergic to penicillin; on birth control pills; no relevant past history; last ins and outs normal; in terms of Events just slightly tired before crashing.

Vitals: Round 1 – Initial HR 116, RR 28, AO x 4.  Round 2 – HR 80 and RR 20; AOx4.

Setting: It is 16 degrees F., no wind, high overcast.  Snowpack about 3 feet deep, first 6 inches powder then hardpack.  You all have daypacks with avalanche gear (shovel, probe, and transceivers), an extra layer of clothing, some snacks, and about a liter of water.  One guy has half an ensolite (sleeping) pad.  It is about a half mile and still 1000 vertical feet down to the parking lot.

What do you do?  What are you worried about?  Write an assessment, list of anticipated problems, and plan.


What do you do?: Scene safety!  Get her off the ground on to half ensolite pad.  Good physical, SAMPLE history, vitals.  Reassure and keep warm.  Examine, and if necessary, splint arm.

What are you worried about?: Why does she have a headache?  That might be the biggest concern.  Can she travel on her own?  Is her nausea just because of pain?

Assessment: 21 year old female skier crashed into tree at relatively high velocity.  Complaining of unstable lower right arm, slight headache, and nausea.  Patient moved to sleeping pad and arm splinted.

Anticipated Problems: Hypothermia.  Altitude?  Possible TBI???  Frostbite?  Evac?  Depending on spine assessment, neurological deficit?

Plan: Assuming it is just an unstable arm, splint it and get/keep Terry warm, especially the hand distal to injury.  Carry her pack and everyone put skis on packs and walk out, breaking trail for Terry.  Transport to local clinic/hospital to have arm examined.