Christopher Van Tilburg, M.D. from Providence Occupational and Travel Medicine Clinic.

February 28, 2012
"Doc to clinic," crackles the radio strapped to my chest. 

"On my way," I report after digging the radio from under several layers of ski clothing. From above Silver Bowl, I was about to drop into Heather Canyon. Not now: I need to go to work. Fortunately, it's a one-run, five-minute, 2,000-foot commute. 

I schuss to Mountain Emergency Services, the ER at Mt. Hood Meadows where I've worked as a doc for 13 seasons. 

First patient of the day: dislocated shoulder in a young snowboarder jibbing in the half pipe. After a quick X-ray, I have the patient take some deep breaths, and "pop." Instant pain relief as the shoulder sucks back into place. After a few minutes, about half the patients have the same question as this young ripper: "Can I go back out snowboarding?" 

I cross my arms, smile and shake my head. 

Crashes in the half-pipe can be risky, but collisions on the slopes lead to some of the most severe injuries, says my boss, Dr. Mike Murray, who has served as medical director of MES for 28 years. 

"Shaped skis changed the way skiers ski the hill," Murray says. Skiers make wider, higher-speed turns than in years past. Snowboarders also have a natural tendency for big turns but have a blind spot when turning heel side. Also consider: High-speed detachable quad chair lifts "have more people on the ground than in the air," Murray says. With all those people carving big turns, "skiers and snowboarders are more likely to smack into each other now than in the old days." 

Critical injuries are not the norm, but they do happen. 

After one bad crash that occurred when I was on duty, ski patrol tobogganed in a patient in respiratory arrest. With the ER team, we jumped into action, resuscitated the patient and brought her back from the brink of death. Just as a thick fog lifted, we were able to load her into a Life Flight helicopter, which landed for a few seconds at the bottom of Stadium Chair Lift. 

More commonly, we treat lots of wrist fractures from snowboarders in the half pipe and skiers with torn knee ligaments. On those cold, clear, icy mornings, the first injury is often direct from the parking lot, from one unaccustomed to walking in ski boots. 

The stats 

According to the National Ski Area Association, skiing and snowboarding are relatively safe: 40 deaths and 40 life-threatening injuries per year nationwide. Considering the 400 winter resorts hosting 10 million annual snow riders at an average of six visits, that's a little more than one per million visits. Compare that to the yearly 39,000 auto deaths, 3,600 swimming drownings and 900 bicycle deaths. 

Mt. Hood Meadows has had nine deaths since 1999. In 2004, two snowboarders died, one after hitting a log. In 1999 a skier died after hitting a tree. In 2007, two died: one suffocated in deep snow, an affliction called snow immersion asphyxiation. SIA is a little-known danger gaining more awareness. During the banner snowfall of 2010-11, nine died of SIA in North America after falling into tree wells upside down, deep snow or creeks, and then suffocating. 

Last season, the worst ever at Mt. Hood Meadows, four snowboarders died. Two were terrain park deaths and one died in deep snow in a creek. In years past, most deaths at ski resorts resulted from high-speed impact with ice, rock or a tree. 

Asked to compare snowboarders and skiers when it comes to injuries, Murray says: "It's hard to tell if it's the device or pilot. Put a young guy on anything and he's more likely to get hurt." Nowadays, snowboarders are more injury-prone: skiers have 2.6 injuries per 1,000 days skiing; for snowboarding it's nearly triple at 7.0, according to the NSAA. 

Equipment matters 

One of the important things to think about when it comes to slope safety is equipment. Shorter, wider skis and twin tips have lessened serious knee injuries, according to NSAA. Improper binding maintenance is now cited as the biggest factor contributing to leg injury. 

Head injuries have decreased 35 percent thanks to widespread use of helmets, according to a2010 study published in the Canadian Medical Association Journal. 

Although not yet implemented at Mt. Hood Meadows, this year Jackson Hole Mountain Resort and Aspen Skiing Company required all employees to wear helmets when on snow. Vail Resorts implemented the requirement in 2009. 

I use one -- every single day I'm on the mountain, whether I'm working, skiing with my daughters or touring the sidecountry of Vista Ridge. 

Helmets are also super warm when you hunker down on Shooting Star Chair Lift in one of those blustery Gulf of Alaska storms. 

 
Are lifts running? Meadows emergency clinic is open  It's one of the most remote emergency rooms in the U.S., but inside, Providence
Mountain Emergency Services looks like any small emergency room, with gurneys, exam lights, a cadre of medical supplies and, thanks to Providence's upgrade, state-of-the-art digital radiology. Except that no one is wearing scrubs -- the staff is bedecked in outdoor clothing, in case the need arises to respond to an emergency on the hill with a complete portable advanced life support kit. 


The clinic sees 500 patients a season at no charge for first aid: ibuprofen, a Ziploc of snow, a triage by an experienced emergency nurse. An additional 1,100 check in as emergency department patients for a doc exam and X-ray if indicated. 

Started by Gresham-based Legacy Mount Hood Medical Center in 1984, MES was taken over by Providence Hood River Memorial Hospital in 2003. In 2008, Mt. Hood Meadows built a 4,000-square-foot, LEED-certified building for the ER. It is open every day and night the lifts are spinning. 

 
Be safe on the slopes  

The best way to prevent getting carted into the slopeside ER? Here are a few suggestions. 

Wear a helmet. 

Dress in warm, weatherproof clothes; prepare for rain, snow and wind, even if the forecast says sun. 

Get your ski bindings checked annually by a reputable shop. 

Ski and snowboard in safe weather and snow conditions, and on slopes that are within your skill limits. 

In the terrain park, follow Smart Style rules -- especially look before you leap. 

Always go with a buddy. 

Stash a small safety kit in your parka: whistle, cellphone, hand-warmers and a snack. 

Be wary of tree wells when cruising the trees on powder days.