First Aid Essentials

Introduction

There can be extreme joy with snow sports. Excitement. Adrenaline. The breathlessness experienced after achieving a perfect run or, through luck or skill, narrowly avoiding catastrophe.

That’s a good day.

A bad day?

When gravity, weather and snow conditions, fatigue or a momentary lack of concentration combine, you catch an edge, and host a yard sale*. Or worse still, you suffer an injury worthy of a Ski Patrol rescue that keeps you away from the snow for the rest of the season. Maybe permanently.

Of course, prevention is better than cure so, do your best to prepare for your chosen activity on the slopes to prevent winter sports injuries. Snowsafe Australia has some great advice for safety and preparation, but that’s a whole different subject.

This blog is about injuries common to snow sports and how to manage them.

The Numbers of Winter Sports Injuries

According to the Australian Institute of Health and Welfare (AIHW), the reported number of injuries for snow sports against the number of participants for 2019 – 20 aged 15 and over, was 5 per 1000.

So how many people are skiing and snowboarding?

Approximately 277,000 participants in snowboarding and skiing for 2019 – 20 aged 15 and over, according to AusPlay.  Add another thousand or five for children under 15 years!

Safety on the Slopes

There is some great information on how to manage an accident while skiing or snowboarding on the Snowsafe website.

Here is a brief over of the main points you need to know in case of an accident on the slopes.

To get to the casualty you should approach from the side or up from below their position, especially if the slopes are icy.

If the slopes are icy it is important to keep your skis or snowboard on. If you can take them off, cross your skis, or place your board upright in the snow, uphill from the casualty. You can also get someone to stand uphill of the casualty to give a warning to others using the slope, if possible.

Do not remove the casualty’s skis or snowboard, and leave the casualty where they are if it is safe to do so.

Reassure the casualty and keep them warm. Wait for the ski patrol.

Winter Sports Injuries

From the  AIHW, in 2019-20 there was a total of 1,654 hospitalisations due to Winter sports injuries. 59% of those were injuries due to falls. 

The most common injuries were fractures at 60% with dislocations and soft tissue injuries combined at 27%.

Fractures mean broken bones: arms, legs, ribs. Dislocations and soft tissue injuries refer to dislocated joints: shoulder, knee, wrist, and soft tissue injuries: sprains and strains of wrists, ankles, muscles, and tendons.

Concussion from head injuries is always a concern.

It is recommended that the Ski Patrol manage all first aid on the slopes. However, there may be occasions when they are delayed, not available, or you are some distance away from them such as cross-country skiing.

If this is the case you may have to provide some First Aid to the casualty.

Joints

When muscles, tendons and ligaments are cold they have less elasticity and are therefore more prone to injury. It is also well known that sporting performance is reduced in cold conditions. When these two factors combine, falls are more likely and injuries are usually more severe.

Statistically, ligaments and muscles acting on the joints of the knees, shoulders, wrists, and spine are the most common soft tissue injuries from falls while skiing or snowboarding.

Joints absorb shocks and give us movement; ligaments support parts of the joints and tendons join the muscles to the bone.

As mentioned before, joints connect bones. They provide stability to the skeleton and allow movement.

Joints are held together and supported by ligaments. Smooth cartilage prevents friction as the bones move against one another.

In freely movable joints, the entire joint is enclosed inside a membrane filled with lubricating synovial fluid, which helps to provide extra cushioning against impact.

In general, the greater the range of movement, the higher the risk of injury. This is because the strength of the joint is reduced.

There are different types of joints allowing different movements.

• Ball and socket joint –  where the rounded head of one bone sits within the cup of another, for example, the hip joint or shoulder joint. Able to move in all directions
  
• Saddle joint – allows movement back and forth and from side to side, but does not allow rotation, such as the joint at the base of the thumb.
  
• Hinge joint –where the two bones open and close in one direction only such as the knee and elbow joints.
  
• Condyloid joint –movement without rotation, such as in the jaw or finger joints.
  
• Gliding joint –where the smooth surfaces slip over one another, allowing some movement, such as the wrist joints.

Common Joint Injuries Include:

• Dislocations – when two connected bones slip out of position in a joint.
  
• Fractures and breaks.
  
• Sprains and strains – of the Ligaments and Tendons around the joint.
  
• Overuse injuries such as tendonitis – making the same movements repeatedly over time, the body’s joints and surrounding tendons and muscles become irritated and inflamed.
  
• Osteoporosis – bones that are weakened from a loss of bone density, due to a lack of calcium. As a result, the bones that make up the joint may break easily.
  

Signs and Symptoms of a Dislocation

• Pain, Swelling, and Bruising
  
• Instability of the joint and/or loss of ability to move the joint
  
• Visibly deformed joint where the bone looks out of place

Management of a Dislocation

DO NOT try to replace or reduce a dislocation. Leave that for the Ski Patrol, Ambulance or Medical Professional.

Follow these steps:

1. If the injury is to a limb: Check for any circulation and if absent, move the limb gently to try and restore it.
   
2. Call 000 for an ambulance, or in this case, Ski Patrol.
   
3. Place and support the limb using soft padding and bandages.
   
4. Use icepacks, if possible, over the joint.
   
5. If the shoulder is dislocated, support the arm in a position of least discomfort use a sling if needed and apply an ice compress.
   
6. If the wrist is dislocated, support using a sling and apply an ice compress.

When using ice, make sure to apply it for ten minutes with 1 Hour rest in between or 20 minutes on / 2hrs off.

Sprain and Strains due to Winter Sports Injuries

The difference between a sprain and a strain is that a sprain injures the bands of tissue that connect two bones together, while a strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone.

Ligaments are bands of tough elastic tissue around your joints. They connect bone to bone, give your joints support, and limit their movement. You have ligaments around your knees, ankles, elbows, shoulders, and other joints.

A sprain is when a ligament supporting a joint is overstretched or torn. Sprains commonly happen in the ankle, knee, or wrist.

Strain

Strains on the other hand occur when a tendon, or muscle, is overstretched or torn.

Tendons are tough, flexible, and inelastic bands of fibrous connective tissue that connect muscles to bones.

Strains are often the result of repetitive movements and from overtraining without adequate time for rest and muscle repair in between workout sessions.

Common areas affected by strains are the leg, foot, calf, groin, hamstring and back.

Signs and Symptoms for Strains and Sprains

This include:

• Pain, bruising and swelling in the affected area
  
• Sudden pain in the affected area along with loss of power in the affected limb
  
• The muscle in the affected limb is tender to the touch

Sprains and Strains Management

To manage strains and sprains we can follow our R.I.C.E.R. action plan

• Rest – encourage the casualty to stop any activity and make them comfortable
  
• Ice – Apply an icepack, wrapped in cloth, to the injured area
  
• Compression – apply an elastic bandage, if available, over the injured area. Not too tight, you need to allow for circulation
  
• Elevate – elevate the injured area above their heart height if practical
  
• Refer – refer them to a medical professional to have the area looked at.

When treating using R.I.C.E.R. you should also do no Harm.

NO

• Heat – apply no heat to the injury
  
• Alcohol – No alcohol
  
• Running – do no activity that might affect the injury
  
• Massage – do not massage the injury.

This method should be used within the first 48–72 hours (depending on severity) after the injury to speed up the recovery process.

Winter Sports Fractures

Fractures, although painful, are often not life-threatening injuries. However, it is important they are managed correctly to ensure the healing process – around four to eight weeks to heal, depending on the age and health of the person and the type of break –  can run its course without any disruptions such as infection, permanent deformity, or lifelong disability.

There are different types of bone fractures. Some are more severe than others, depending on the strength and direction of the force, the bone involved, and the person’s age and general health.

As a First Aider, it is important you can recognise the different types of fractures so you can apply the correct First Aid.

Different Types of Fractures Include:

• Closed or simple fracture – the broken bone has not pierced the skin
  
• Open or compound fracture – the broken bone juts out through the skin, or a wound leads to the fracture site.
  
• Greenstick fracture – A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks like what happens when you try to break a small, “green” branch on a tree. This can occur in children because their bones are more flexible than an adult’s bones
  
• Hairline fracture – the most common form is a stress fracture, often occurring in the foot or lower leg because of repeated stress from activities such as jogging or running
  
• Complicated fracture – structures surrounding the fracture are injured. There may be damage to the veins, arteries or nerves, and there may also be an injury to the lining of the bone (the periosteum)
  
• Comminuted fracture – the bone is shattered into small pieces. This type of complicated fracture tends to heal more slowly
  
• Compression fracture – occurs when two bones are forced against each other. The bones of the spine, called vertebrae, can have this type of fracture. Older people, particularly those with osteoporosis, are at higher risk.

It’s good to remember that not all fractures are of a person’s arm or leg. Trauma to the head, chest, spine, or pelvis can fracture bones such as the skull and ribs. And, if this isn’t bad enough, these fractures are further complicated by damage to the underlying body parts that the bone normally protects for example the lungs or brain.

Some of these fractures can be difficult to manage using first aid only as they may be life-threatening injuries. Always call 000 (Ski Patrol) if you suspect this type of fracture.

Signs and Symptoms of Bone Fractures

The symptoms of a fracture depend on the particular bone and the severity of the injury but may include:

• Pain, swelling and bruising
  
• Deformity or an inability to use the limb
  
• A bone sticking out through the skin
  
• Grating noise when the limb is moved

Complications of a Fracture May Include

• Blood loss – bones have a rich blood supply. A bad break can make you lose a large amount of blood
  
• Injuries to organs, tissues, or surrounding structures – for example, the brain can be damaged by a skull fracture. Chest organs can be injured if a rib breaks
  
• Shock

Fracture Management

As with any First Aid incident, our primary action plan is DRSABCD and calling Ski Patrol or Triple Zero (000).

If you know the casualty has a broken bone, or you suspect a bone fracture, you should:

• Keep the person still – do not move them unless there is an immediate danger, especially if you suspect a fracture of the skull, spine, ribs, pelvis, or upper leg.
  
• Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing.
  
• If a bone is protruding, apply pressure around the edges of the wound.
  
• If bleeding is controlled, keep the wound covered with a clean dressing.
  
• Never try to straighten broken bones.
  
• For a limb fracture, provide support and comfort such as a pillow under the lower leg or forearm. However, do not cause further pain or unnecessary movement to the broken bone.
  
• Use a sling to support an arm or collarbone fracture.
  
• Raise the fractured area if possible and apply a cold pack to reduce swelling and pain. Do not raise the fractured area if it causes the casualty further pain or discomfort.
  
• Stop the person from eating or drinking anything until they are seen by a doctor, in case they need surgery.
  
• Reassure and monitor their condition and, if you feel you need medical help, call Triple Zero (Ski Patrol) for an ambulance.

Apply a splint to the fractured limb. Splints do not have to be professionally manufactured. Items like wooden boards and folded magazines can work for some fractures. You should immobilise the limb above and below the fracture using padding between the splint and the limb. If you can, apply two splints, placing one on each side of the fracture.

It is also a good idea to use wide bandages if possible so you’re able to check the casualty’s circulation in both the area of the injury and throughout their entire body.

Head Injuries – Concussion

A concussion is common in Snow Sports and can be challenging to identify and manage across sporting settings, from recreational environments to elite teams.

A concussion is a mild traumatic brain injury that follows some trauma to the head. It’s usually diagnosed by a doctor, and symptoms of concussion can persist for up to three weeks after trauma.

Advise the casualty to be alert for any danger signs over the next one or two days, such as:

• persistent vomiting,
• loss of coordination, or
• bad or worsening headaches despite pain-relieving medication

Any trauma to the head may result in a concussion, and sometimes the signs and symptoms of concussion are difficult to recognise.

It is especially important that all casualties who have sustained a head injury, regardless of severity,  seek assessment by a health care professional or at a hospital.

Conclusion

Well, that was a fairly large blog, but it has given you some excellent information about common winter sports injuries (If I do say so myself…). And for those unaware of the meaning of “Host a yard sale” when used in snow sports, according to the Urban Dictionary – “When a skier or snowboarder eats it on the slopes and loses all of their gear.”

If a skier loses his skis, poles, hat, goggles, and anything else, you can shout “YARD SALE” from the ski lift above him.

For all you gapers and Jerrys out there, check this out, you might learn something!

And lastly, for more on Head and spinal injuries, check out my blog on that subject.

Well, that’s that. Until next time… Stay safe!

Winter, Frostbite & Hypothermia

We all know how cold, wet, and miserable this time of year can be in most parts of southern Australia.

However, winter is also the season when millions – 4,1882,000 in 2019 to be exact! –  of people make their annual pilgrimage to the Victorian snowfields of the Australian Alps, and the phrase “Don’t go out there…. It’s FREEZING!”, becomes meaningless and is ignored.

Of those 4.1 million almost half are day visitors which means over 2 million will stay at least one night on whatever mountain they are visiting.

As with any concentration of people there is a risk of injuries. Combine that concentration with physical activities such as skiing, snowboarding, hiking etc, and you increase that risk of injury many times over.

In this post I am going to talk about Hypothermia and frostbite. The follow up post, Part 2, will cover physical injuries you may encounter on the snowfields, sprains and strains, broken bones, head injuries etc.

The Human Body and Hypothermia

Our bodies constantly adapt their temperature to environmental conditions. Our internal body temperature, called the core temperature, is regulated by a part of our brain called the hypothalamus.

The hypothalamus checks our current body temperature and compares it with the normal body temperature of about 37°C.

If our temperature is too low, the hypothalamus makes sure that the body generates and maintains heat. If, on the other hand, our current body temperature is too high, heat is given off or sweat is produced to cool the skin.

The hypothalamus automatically adjusts keep our internal body temperature at an average of 37°C.

If our core temperature falls below, 37°C then we may experience Hypothermia.

What is Hypothermia?

Exposure to cold conditions can lead to generalised cooling of the body, localised cold injury, and/or Hypothermia (a combination of the prefix ‘hypo-‘, meaning ‘below’, and the word ‘thermē’, which translates from the Greek as ‘heat’).

Hypothermia occurs when the body’s temperature drops below 35°C and it cannot warm up by itself.

As the body temperature falls, systems and organs progressively fail until death occurs.

Hypothermia may develop rapidly, for example by falling into icy water.

However, it is more common that hypothermia is a gradual process, such as when someone experiences prolonged exposure to cold conditions such as cold weather, lying on a cold floor, or being buried under snow by an avalanche.

Infants and the elderly are at a greater risk of hypothermia. 

Infants because they have a larger surface area compared to body weight so they can lose body heat faster than older children and adults.

And the elderly because their ability to become aware of temperature change is impaired due to the loss of nerve endings to the skin. Also, less fat on their body which has an insulating function, and a lower metabolic rate, means they generate less body heat themselves.

Ok, how does the body lose heat anyway?

Well, basically there are four ways that the human body loses heat:

• Conduction – by direct transfer from the body to an object that is cooler than the body. For example, lying on a cold surface will pass body warmth to the surface away from the body.
• Convection – air or liquid flow across the skin drawing off heat . For example, wind will increase heat loss, as will water that is cooler than body temperature.
• Radiation – electromagnetic waves distribute heat into the ambient environment For example, exposed skin will allow heat to be drawn off if the air temperature is less than the body – the exposed head of a person is a strong source of heat loss, particularly in children.
• Evaporation – fluid on the skin turns to vapour, drawing off heat. Moist skin will lose heat more rapidly, such as in someone who is wet, clammy or has exposed moist skin, such as burns.

So now you understand why it is so important to stay dry, sheltered from the wind, and wear good quality warm clothing when enjoying our wonderful snow-covered peaks.

Oh… and don’t forget… keeping your feet warm and dry as well.

What happens when body temperature starts to fall?

A couple of things usually occur which can indicate that the person’s body temperature is falling and they, and their bodies, are trying to keep warm.

They are:

1. Behavioural – the person will try and move around to generate heat and seek shelter from further heat loss.
2. Physiological – the body moves blood from the extremities to the core to keep it warm.

• Body hair stands on end to trap a layer of warm air around us (goose bumps),
• We shiver to make more heat, and
• Our body (the hypothalamus) releases hormones to speed up our metabolism to create more heat.

If these measures don’t work, yep you guessed it, hypothermia will result.

Hypothermia Signs and Symptoms

So, as I mentioned earlier, hypothermia is usually a gradual process with the person going through various stages.

Mild hypothermia: 32–35°C body temperature

• The casualty will be shivering – the body trying to keep warm by stimulating muscles.
• Their skin will be pale and cool – blood supply restricted to keep internal organs warm.
• They may have impaired coordination, slurred speech with possibly delayed responses.

Moderate hypothermia: 28–32°C body temperature

• The casualty will stop shivering and experience increasing muscle stiffness.
• They will be confused and become less responsive.
• Their blood pressure will drop, and they will have a slow, irregular pulse.

Severe hypothermia: Less than 28°C body temperature

The casualty may display all the signs and symptoms of moderate hypothermia as well as

• be very cold to touch, unresponsive, rigid,
• dangerous heart rhythms
• cardiac arrest
• or they may appear lifeless, with fixed and dilated pupils, particularly if they have a weak slow pulse.

Never assume a person is dead. A person with severe hypothermia may only take one breath per minute, with a heart rate of less than 20 beats per minute.

Hypothermia Management

When you notice the signs of hypothermia, you should apply the following guidelines:

• Follow DRSABCD. Don’t forget you need to be aware of your own risk of developing hypothermia in cold environments and should monitor your own status as well as that of the affected person.
• Dial Triple Zero (000) for an ambulance if the casualty’s condition is severe.
• If possible, move the casualty to a warm, dry place, remove any wet clothing from the casualty and if they are fully conscious give them a warm sugary drink, no alcohol or coffee.
• Avoid any excess activity and help the casualty to lay down in a comfortable position.
• Warm the casualty with blankets or an emergency blanket making sure you cover the casualty’s head to maintain body heat. You can also use body to body contact to warm the casualty.
• Use heat packs and place them on the neck, armpits, or groin. Be careful not to burn the casualty.
• Reassure and stay with the casualty until medical aid arrives.

Frostbite (or Freezing Cold Injury)

Frostbite occurs when tissues freeze.

This happens in cold environments when blood vessels constrict and reduce blood flow and oxygen to the extremities such as the fingers and toes. However, it can affect any part of the body.

Management of a freezing cold injury is the same as for severe hypothermia plus rewarming of the affected parts.

• When rewarming, it is important that you warm them up slowly. Use body heat and blanket. DO NOT rub the affected tissue or use radiant heat (i.e. sit by a fire).
• Affected fingers may be placed in the opposite armpit, the armpit of a companion, or a warm hand over a frostbitten cheek or ear while feet can be reheated on the warm abdomen (under clothing) of a companion
• If you have rewarmed frostbitten body parts you must ensure that re-freezing does not occur.

Remember to continually monitor the casualty’s breathing. If their breathing stops, start cardiopulmonary resuscitation (CPR) immediately. Continue CPR until the person starts breathing on their own, medical help arrives, you become exhausted, or it becomes too dangerous to continue.

Once the colour and consistency of the skin have been restored, the person can safely resume normal activity, provided they increase their insulation and take precautions against recurrence i.e., refreezing.

The Impact of Alcohol in Hypothermia and Frostbite

One last note, if you are a fan of the ‘Après Ski’ activities. all toasty by the chalet fire, with a snifter of brandy or whatever you prefer to warm your toes, be aware of the effect of alcohol on your body.

Alcohol relaxes the blood vessels allowing more blood to flow near the skin. This makes people feel cosy, giving a flushed appearance, and a warm sensation.

However, blood flowing near the skin increases the rate of heat loss, and the alcohol slows down your metabolism, which slows down internal heat generation.

If you have had too much to drink, there is now a significant risk of hypothermia if you go outside in cold weather.

Alcohol also impairs judgement, so you are less likely to recognise the environment, your own physical condition, and then less likely to take protective measures against heat loss.

This also applies to any other mind-altering substance.

Conclusion

• In all cases of hypothermia, the first thing to do is to prevent any further heat loss. Do this by removing the four ways that heat loss occurs mentioned earlier i.e.: conduction, convection, radiation, and evaporation.
• Follow DRSABCD. Don’t forget you need to be aware of your own risk of developing hypothermia in cold environments and should monitor your own status as well as that of the affected person.
• If possible, move the casualty to a warm, dry place, remove any wet clothing from the casualty and, if they are fully conscious, give them a warm sugary drink, or coffee.
• Warm them slowly – body heat. No friction or radiant heat from the fire.
• No alcohol – Don’t be PISSED on the PISTE!

If you DO go to the snow even for just a day trip, remember: keep warm and dry and watch out for your family and friends.

Well, that’s that. Until next time… Stay safe!

Adrian