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Technical Bulletin #3

Sudden Cardiac Arrest (SCA) in the Ski Area

Welcome to our new series of Technical Bulletins for the working patroller.  We at the Association of Professional Patrollers strive to provide outstanding educational opportunities to patrollers and a certification program for the ski patrol professional.

During the afternoon of New Year’s Eve, December 31, 2015, Ski Cooper Ski Patrol, located in Leadville, Colorado, received a report from Lift Operations of a possible “heart attack” just outside the resort’s backcountry access gate. Patrollers and maintenance personnel quickly responded with a cardiac pack, including an AED and Cascade CPR toboggan. A medical helicopter and ALS ground ambulance were requested immediately. The first patrollers arrived on scene within three minutes and found a pulseless and apneic  52 year old male skier with bystander CPR in progress. The patient’s friends reported that he was skinning-up just outside the ski area boundary when he had suddenly collapsed without warning. The AED was applied and advised “no shock”. CPR was continued until more patrollers arrived and the toboggan was hooked up in preparation for snowmobile transport to the First Aid Room at the base area. Interviewing of the witnesses revealed no pertinent medical history. 

The patient was transferred to the CPR toboggan via backboard, and transported approximately 10 minutes to the base area with CPR in progress. On arrival at the First Aid Room, a pulse check revealed a strong carotid pulse. CPR was stopped and arriving EMS personnel initiated ALS care. The patient was transported by air ambulance to a large regional medical center. Total time from when the call was received to helicopter transport was 56 minutes including response time, on-scene care and packaging, toboggan transport, ALS interventions in First Aid Room, and loading the patient.

News article-  http://leadvilletoday.com/2016/01/02/latest-news-january-3-sun/

What can be learned from this case:

High performance CPR and the use of an AED are the gold standard for treatment of sudden cardiac arrest.

CPR in a toboggan is a challenge and less than optimal. In this case, CPR was performed for 10 minutes in a toboggan; with one rescuer was at the head and the other straddling the patient.  Rotation of the compressor during toboggan transport was difficult at best. One rescuer cannot perform effective CPR for more than a few minutes, particularly at high elevation.

Ski area resources such as ski school can be used to secure a landing zone or assist with crowd control.  Maintenance personnel were some of the first on scene and were a tremendous help. With instruction from patrollers, maintenance personnel assisted with CPR and AED use and toboggan loading and transport.

Use the National Incident Management System (NIMS) and Incident Command principles.  This incident involved a variety of ski area personnel and two outside agencies including an ALS ambulance and medical helicopter. With all those moving parts, it is imperative to have a designated and trained Incident Commander who is responsible for coordinating resources.  Additionally, it is critical to designate a senior or lead rescuer on scene to be in command. This individual is responsible for gathering information about the patient and events, coordinating CPR and AED use (including rotation of compressors and packaging of patient), and ordering procedures.

Call for resources early. An ALS ambulance and medical helicopter were requested immediately. The ambulance was already at the First Aid Room when the patient arrived, and the helicopter arrived just four minutes later because of the early request. Resources can always be cancelled if they are not needed.

Sudden cardiac arrest is the most challenging and time-critical incident that EMS systems are responsible for handling. Ski Patrols share this same challenge and responsibility, and need to have a plan in place to provide high quality CPR and rapid deployment of the AED.  

This patient was found to have a blocked left anterior descending coronary artery (LAD), and had a full neurological recovery, an astounding result for approximately 30 minutes of cardiac arrest in a remote location.  Congratulations to Cooper Ski Patrol, Colorado for a job well done! 

Submitted by  Brady Walters  Cooper Ski Patrol, Colorado

Robert Walters is on the APP Board and holds  degrees in Education, Fire Service Administration and  Fire Science. He presently is the Team Coordinator for the Technical Rope Team and Ski Response Team at Jackson County Search and Rescue and is a Technical Rescue Instructor.  In addition, he responds with a Fire Department Technical Rescue Team and practices paramedicine with a community ambulance service.  He can be reached at mcwalts@charter.net.

All views are the opinion of the author and do not represent the Association of Professional Patrollers or its sponsors.

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