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OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-01
INJURY
Forearm laceration (1)
Degree of Difficulty = 3
E1NVIRONMENT
Top of beginner slope (0)
HIV (1)
PERSONNEL
Single patient (0)
Trained rescuers (0)
Untrained assistants (1)
GENERAL SCENARIO DESCRIPTION
A 17-year-old skier is sitting in the snow helping a friend with their bindings. An out-of-control beginner
snowplows off the chair lift and skis over the patient’s forearm, causing a deep laceration.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to a skier down on the top of the beginner hill. Equipment and
available personnel to be sent upon request.
PATIENT SUMMARY
The patient was bleeding from the laceration with evidence that blood has run down her arm into her
sleeve and dripped on the snow. Bleeding stops with direct pressure but inspection of the laceration
reveals that it is deep and will need medical attention.
VITAL SIGNS
Time in minutes
Pulse and respirations
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Throughout
As found
SCENARIO OBJECTIVE
Assessment
Verify scene safety; obtain permission to assist
Primary assessment; reveals a deep laceration on the forearm
Request needed equipment and personnel
Secondary assessment reveals history of HIV
Rote Skills
Standard Precautions and cleanup
Bleeding control: direct pressure and bandaging
Transportation plan
Problem Management
Direct bystanders with confidence, including use of Standard Precautions. Ensure proper cleanup of the
bloody snow according to local protocol.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-01
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: top of beginner slope
Equipment: Toboggan with standard area equipment
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: 2-inch forearm laceration
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT(S)
Position: You are sitting in the snow holding your bleeding forearm.
Answers to SAMPLE
Signs and symptoms: bleeding from forearm laceration
Allergies:
none
Medications:
none
Past history:
HIV positive
Last meal:
report actual
Events leading:
you were sitting in the snow helping a friend with her bindings. An outof-control beginner snowplowed off the chair lift and skied over your
forearm, causing a deep laceration.
Behaviors: You are concerned about the blood. You have put direct pressure on the laceration. When
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
questioned, you inform the rescuer that you are HIV positive. Friends know this.
SPECIFIC COMMENTS FOR EVALUATORS
This scenario addresses bleeding control with HIV present and use of bystanders. There is also the legal
issue because state laws vary on 17-year-old minors.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-02
Degree of Difficulty = 3
INJURY
ENVIRONMENT
PERSONNEL
Severe bleeding of lower arm (3)
Rear of store in shopping area of
Single patient (0)
your resort (0)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
A shopper has slipped and fallen through a display case in the rear of one of the resort’s gift shops.
He/she is bleeding severely from a lower arm laceration.
INFORMATION GIVEN TO TRAINEE
You have been sent from the aid room to one of the area’s gift shops. Equipment and personnel to be sent
upon request.
PATIENT SUMMARY
You find that a shopper has fallen into a display case. The patient has extensive bleeding from an arterial
laceration in the arm. You further realize that you have not brought your pack and will need much more
Standard Precautions protection.
VITAL SIGNS
Time in minutes
Pulse and respirations
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Throughout
As found
SCENARIO OBJECTIVES
Assessment
Verify scene safety, obtain permission to assist
Primary assessment: reveals lower arm laceration
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions: Universal precautions (patient and bloody area); emphasize improvised Standard
Precautions techniques until further protection arrives
Bleeding control: direct pressure and bandaging
Shock management
Oxygen administration
Problem Management
Direct others with confidence. Develop transportation plan - determine how to transport patient to patrol
room and definitive medical care
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-02
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Rear of gift shop, lots of blood, broken glass
Moulage: Lots of blood on floor and patient
Equipment: Wheelchair or gurney if requested
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT(S)
Position: You are sitting, bleeding profusely surrounded by shards of broken glass.
Answers to SAMPLE
Signs and symptoms: bleeding from laceration on lower arm
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
Events leading:
floor wet from melting snow, patient in ski boots
Behaviors: You’re not feeling well and are very concerned with the loss of blood.
SPECIFIC COMMENTS FOR EVALUATORS
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
The bleeding is severe. There is considerable risk for Standard Precautions contamination due to the high
volume of blood loss, and the quantity of broken glass at the site. Having no pack, the rescuer must
determine if Standard Precautions can be managed in situation while waiting for further help to arrive.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-03
INJURY
Laceration of hand (1)
Degree of Difficulty = 1
ENVIRONMENT
Aid Room (0)
PERSONNEL
Single patient (0)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
Immediately upon opening, a father of one of the racers comes into the aid room with a deep cut on the
palm of his right hand. He received this cut while sharpening his daughter’s skis for the race.
INFORMATION GIVEN TO TRAINEE
You were asked to open your patrol room early this morning for a ski race. An adult male walks in for
assistance.
PATIENT SUMMARY
Adult male walked into the aid room holding his right palm/hand in an attempt to stop bleeding from a
cut. The cut appears deep, and is bleeding profusely. The hand will need stitches. The patient states he cut
his hand while sharpening his daughter’s skis.
VITAL SIGNS
Time in minutes
Throughout
Pulse and respirations
As found
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
SCENARIO OBJECTIVES
Assessment
Verify scene safety, obtain permission to assist
Primary assessment reveals laceration with significant bleeding
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control and bandaging: laceration. Use direct pressure and bandages correctly.
CMS before and after bandaging
Problem Management
Patient stabilization – control bleeding
Treat for shock as appropriate
Verbalize appropriate transportation plan
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-03
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: In the aid room
Equipment: 4 x 4, or 2 x 2 gauze pads, roller gauze; any other material used for bleeding control and
bandaging
Moulage: 2-inch laceration on right palm/hand. Blood, tubing for continuous-flow bleeding if available
Weather: Indoors
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Walked into the aid room
Answers to SAMPLE
Signs and symptoms: laceration on palm/hand
Allergies:
none
Medication:
none
Past history:
none
Last meal:
doughnut 35 minutes ago
Events leading:
cut hand while sharpening daughter’s skis
Behaviors: You have minor pain from laceration. Assist trainee with bandaging if asked.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
SPECIFIC COMMENTS FOR EVALUATORS
Laceration is bleeding freely, but stops once direct pressure is applied adequately.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-04
INJURY
Degree of Difficulty = 6
ENVIRONMENT
PERSONNEL
Severed fingers (2)
Bottom of the hill close to a snow Multiple patients (1)
Lower leg fracture (2)
gun (0)
Intoxicated bystander (1)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
A worker was preparing the snow gun at the bottom of the hill for the night’s snowmaking activity. The
fan was warming up, and s/he was clearing some snow and ice from the area of the gun close to the fan
when s/he heard someone very close yell as s/he fell. S/He was startled by the yell and pushed his/her
hand into the fan.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured worker at the bottom of the hill.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient #1 has the ends of the little and ring fingers amputated at the first joint, and the end of the middle
finger is also cut pretty badly.
Patient #2 has a lower leg fracture
Bystander is intoxicated.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
VITAL SIGNS
Time in minutes
Throughout
Patient #1
Patient #2
Pulse and respirations
Pulse and respirations
p + 12, r + 6
p + 8, r + 4
to as found
to as found
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify
management for risk management concerns; prioritize amputations over leg injury; determine need to
locate the amputated parts; deal with amputated parts if located
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills
according to skill performance guidelines - Bleeding Control and bandaging - moderate; packaging of
amputated part; Injury/Fracture Management - lower leg; Lifting Techniques; use of Standard
Precautions; deal with intoxicated bystander; deal with bloody snow gun/snow
Leadership
Direct others appropriately and with confidence; continued communications with patient and
team members; ensure correct OEC skills of helpers where appropriate; monitor entire situation and all
participants in regards to adhering to Standard Precautions and local infection control plan. Notify/request
area manager - injured employee, intoxicated bystander
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-04
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Bottom of the hill near a snow gun
Moulage: The hand should show amputations of the little and ring fingers around the first knuckle, and a
severe laceration to the end of the middle finger (use an exam glove with tied off fingers to represent
amputated fingers. Amputated fingers are laying on the ground. The only one that needs much blood is
the middle finger.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient #1 - you have dropped to your knees and are sitting on your heels holding your injured
hand.
Patient #2 - you are half sitting, half lying on your injured side with your skis still on.
Answers to SAMPLE
Signs and symptoms: Pt. 1 severed fingers; Pt. 2 lower leg pain
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Events leading:
Patient #1 - you were getting the snow gun ready to start up when
someone who sounded like they were right on top of you yelled. You
were startled and your hand must have gone into the fan. Patient #2 - you
were coming into the bottom of the hill too fast and didn’t think you
could stop in time to miss the worker. You yelled, and fell just short of
the snowmaker.
Behaviors: Patient #1 - you seem to be doing pretty well at first. Later, you begin to go into shock. The
pain is not too bad at first, but it gets worse as time goes by. The degree to which your condition
deteriorates will be determined by how you are handled by the rescuer. If the problem is staged close to
the aid room, you could walk there with an escort if asked early in the problem. If not moved early, you
become too shocky to trust walking.
Patient #2 - you feel really badly for causing the worker to be hurt. You report feeling a little pain
in your leg right above the boot, and that area is quite tender when palpated. You are cooperative.
Intoxicated bystander - you may be played as a friend of patient #2, or just someone who
happened on the scene. You’ve been skiing most of the evening, between stops up at the bar for your
favorite beverage. You stop on the scene and are just generally a pain. You can try being “helpful,” or you
can tell everyone you get sick at the sight of blood, and you think you’re going to throw up, etc. You are
persistently distracting until dealt with in an assertive manner. You do respond well when put in the hands
of a competent individual.
SPECIFIC COMMENTS FOR EVALUATORS
You must have snow guns with a fan that are accessible from the ground for this scenario. The decision to
use a toboggan or not should be based on the location chosen, the availability of alternative transportation,
and the personnel available. Area management “courtesy” or “host” staff person is available and should
be requested by the trainee, to be used to deal with the intoxicated bystander.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-05
INJURY
Contusion – right thigh (2)
Degree of Difficulty = 2
ENVIRONMENT
On trail next to lift tower (0)
PERSONNEL
Single patient (0)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
A skier in search of the last bit of untouched snow on the hill has fallen under the lift line and into a lift
tower. S/He has a contusion of the right thigh where s/he collided with the tower. His/Her skis released
immediately during the fall.
INFORMATION GIVEN TO TRAINEE
Dispatch: You are called to respond to an injured skier under a lift line. Skier is not able to ski back to the
lodge. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient is able to stand and can put some weight on injured leg (this is not a femur fracture). You
have used your scissors to expose the injured area and see a large area of localized swelling that is black
and blue.
VITAL SIGNS
Time in minutes
Pulse and respirations
Pulse and respirations
Appropriate care
Bleeding not controlled
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Throughout
As found
p + 10; r + 4
(after 10 minutes)
SCENARIO OBJECTIVES
Assessment
Verify scene safety (include stopping the lift), obtain permission to assist
Primary assessment reveals contusion of right thigh, and MOI information rules out femur fracture
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Soft Tissue injury management - contusion of right thigh—monitor possible internal bleeding
Lifting Techniques; loading/position in toboggan
Problem Management
Management is interested in starting the lift as soon as possible so the trainee needs to determine how
soon s/he can move the patient from under the lift
Verbalize appropriate transportation plan
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-05
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Below a chair lift, next to a tower
Equipment: Toboggan with standard area equipment
Moulage: deformity for swelling and black and blue makeup for the skin
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Sitting up on the ground, right leg extended; knee straight
Answers to SAMPLE
Signs and symptoms:
deformity, swelling, and bruising on thigh
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
Events leading:
you were trying to ski the last bit of untouched snow on the hill,
going pretty fast when you caught an outside edge, fell hard on
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
your right side, and slid hard into the tower. Your body made
contact with the lift tower at your mid-right thigh.
Behaviors: You are in a lot of pain with a lump on your right thigh. You’ve tried to stand and found that
you can put some weight on it. You can take a very small step or two, but you quickly gave up trying to
ski back to the lodge because of the pain.
SPECIFIC COMMENTS FOR EVALUATORS
Area management may be notified by the trainee for risk management concerns, but this should not be
rated as a critical issue, unless such notification would be a requirement at your area. Treatment of the
swelling and transportation to a medical facility are the only emergency care issues.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario # 18-06
INJURY
Laceration - moderate bleeding
Degree of Difficulty = 2
ENVIRONMENT
Off the trail in the trees (1)
(1)
PERSONNEL
Single patient (0)
Trained rescuers (0)
Allergic to penicillin (0)
GENERAL SCENARIO DESCRIPTION
This skier was "skiing the fluff" in the trees when he skied too close to a tree and cut his lower thigh on a
protruding branch. Both skis are on.
(If no trees are available, this problem could only be used if something off a groomed trail could
reasonably produce this injury as well as providing the "off the trail" difficulty.)
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call of an injured skier in the trees. Equipment and available personnel to be sent
upon request.
PATIENT SUMMARY
Bleeding control is the only emergency care issue. The location and fact that the patient tends to want to
minimize the problem and has to be convinced of the wisdom of the trainee's actions and suggestions are
also significant issues here.
VITAL SIGNS
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Time in minutes
Pulse and respirations
Pulse and respirations
Appropriate care
Bleeding not controlled
As found by trainee
p + 10; r + 4
Throughout
(after 10 minutes)
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals a laceration of the lower thigh
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control - direct pressure
Bandaging - correctly bandage wound
Ski removal
Lifting Techniques; loading/position in toboggan
Problem Management
Standard Precautions cleanup of the area
Treat for shock as appropriate
Verbalize appropriate transportation plan
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-06
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Off the trail far enough to provide for some decision making about moving the patient,
but not so far that it becomes a major rescue mission
Equipment: Toboggan with standard area equipment
Moulage: Ripped jeans/sweats and a 3" laceration on the lower thigh with continuous bleeding that can be
slowed and then stopped if proper care is given. Be sure that the patient is well schooled in the use of a
blood-pumping device so that the proper bleeding pattern can be portrayed for both proper and improper
care patterns. Medic Alert tag for allergy to penicillin.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are semi-reclining (leaning on an elbow) on your side, or leaning up against a tree with
both skis on.
Answers to SAMPLE
Signs and symptoms: thigh laceration with moderate bleeding
Allergies:
penicillin (you have a Medic Alert tag that is worn under clothing, but
available if the trainee looks)
Medications:
none
Past history:
none
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Last meal:
report actual
Events leading:
you were "skiing the fluff" at a pretty good rate of speed, and just didn't
see the branch until it was too late to avoid it
Behaviors: You were skiing in jeans or sweats, which are ripped showing a rather nasty looking wound
with plenty of blood. While you did fall when hitting the branch, the "cut" is your only injury and you tell
the trainee that. You have local pain around the wound, but show no other signs of more significant
injury. Blood is evident on your clothing and the ground, and you are concerned about the amount of
blood and the way the laceration looks, but not hysterical about it. In fact, you have the idea that you
might be able to get back on the slopes once the bleeding is under control. If the trainee mentions
splinting the leg, you question why that would be necessary, but agree to the precaution if properly
explained. If the trainee suggests going to the hospital (for stitches), you are also resistant to that idea, but
can be persuaded that you need medical attention. The penicillin allergy should not be mentioned until
late in the problem (if at all) if not solicited during the secondary survey.
SPECIFIC COMMENTS FOR EVALUATORS
Area management may be notified by the trainee for risk management concerns, but this should not be
rated as a critical issue, unless such notification would be a requirement at your area.
The bloody snow should be dealt with in accordance with local protocols. Bleeding will be controlled
with direct pressure, application of 4 x 4s.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-07
INJURY
Head laceration (1)
Degree of Difficulty = 2
ENVIRONMENT
Patrol room (0)
HIV exposure (0)
PERSONNEL
Single patient (0)
Trained patrollers (0)
Agitated patroller (1)
GENERAL SCENARIO DESCRIPTION
A patient is brought to the patrol room with a scalp laceration. He is HIV positive, and the patroller who
treated him on the hill was exposed.
INFORMATION GIVEN TO TRAINEE
You are on duty in the patrol room. A patient is brought in by a fellow patroller.
PATIENT SUMMARY
The patient has a scalp laceration that has bled quite freely.
The patroller who brought the patient in from the hill realizes he did not use universal precautions, and
becomes extremely agitated.
VITAL SIGNS
Time in minutes
Patient
Patroller
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Pulse and respirations
Pulse and respirations
As found by trainee
p + 8 to as found by trainee
Throughout
SCENARIO OBJECTIVES
Assessment
Verify scene safety, obtain permission to assist
Primary assessment reveals a scalp laceration, past history reveals HIV positive
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control - direct pressure
Bandaging - correctly bandage wound
Problem Management
Treat for shock as appropriate
Use of area’s exposure plan for patroller not using Standard Precautions
Notify management for risk management concerns per area protocol
Use procedures to minimize the spread of blood and contaminated waste in the patrol room, in the
toboggan, and on the snow at the scene of the accident
Facilitate privacy and treatment of patient
Deal with animosity of patroller
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-07
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Patrol room, or simulated environment
Moulage: A scalp laceration and bloody hair covered with a bandage and stage blood or red magic marker
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You walk into the patrol room with the other patroller
Answers to SAMPLE
Signs and symptoms: head laceration with moderate bleeding
Allergies:
none
Medications:
weekly injection for HIV and white blood cell maintenance;
don’t know name
Past history:
HIV positive
Last meal:
report actual
Events leading:
you fell and bumped your head, and did not realize that it was bleeding
until a patroller said something about it. At that point you told the
patroller you were HIV positive.
Behaviors: You are rather annoyed that the patroller you encountered on the hill is so agitated and angry
with you, and remind him you told him about the HIV as soon as you knew you were bleeding. It is not
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
your fault that he didn’t wear gloves, or say something about the bleeding before he touched you. You are
fairly cooperative, but insistent that your rights to privacy are protected.
INSTRUCTIONS FOR “EXPOSED” PATROLLER
You are very agitated and say things like, you’ve been a patroller for 25 years and never thought about the
seriousness of universal precautions. Sure, you did the stuff at the refreshers, but never thought this would
happen to you. You are mad at the patient, but actually are more upset with yourself for your lack of care.
You never really paid attention to the infection control plan, and now you want your fellow patroller to
deal with your concerns quickly, and let you know what else you have to do about this situation. You
actually ask to be treated ahead of the patient.
SPECIFIC COMMENTS FOR EVALUATORS
This scenario is designed to give the trainee the opportunity to demonstrate understanding of the exposure
control plan of the area, and use it to do the necessary things to care for the patient, other patroller, patrol
room, toboggan, accident scene, and any supplies or materials involved.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario # 18-08
Degree of Difficulty = 4
INJURY
Impaled object (2)
ENVIRONMENT
In trees on side of trail (0)
Dislocated shoulder (2)
PERSONNEL
Single patient (0)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
The skier got into the trees inadvertently, fell forward, broke his ski pole without a basket and landed on
the sharp edge impaling it into his thigh.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier in the trees by the side of the designated slope.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has half of a ski pole imbedded into his/her thigh, and a dislocated the shoulder on the other
side of his/her body.
VITAL SIGNS
Time in minutes
Pulse and respirations
Throughout
p + 20, r + 6
to as found by trainee
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals ski pole imbedded into thigh; pain in opposite shoulder
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control - direct pressure
Bandaging - stabilization of ski pole in thigh
Ski removal
Fracture/dislocation management - shoulder. Correctly splint shoulder
CMS before and after splinting
Lifting Techniques; loading/position in toboggan
Problem Management
Patient stabilization - impaled object should be stable for transport
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Notify management per local protocol for incident investigation
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-08
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: In trees by the side of any slope
Moulage: A broken ski pole without a basket should be impaled in the muscular portion of the thigh—
should be protruding at least several inches to a foot, and appear to be broken off. Blood should be shown
around the injury only.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT(S)
Position: You are lying on the side with the impaled object, holding the arm of your injured shoulder
against your body, with the lower arm perpendicular to the body. Skis are still on.
Answers to SAMPLE
Signs and symptoms: impaled ski pole in thigh and shoulder pain
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
Events leading:
you got going a little too fast and couldn’t avoid the treed area. You fell
forward into the pole, which broke in two and then pierced your thigh,
and then landed hard on the other arm.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Behaviors: You are upset and in pain, but cooperative. You don’t want to alter your arm position by
much, and do not want to bring the lower arm across your body as that is very painful. You are somewhat
alarmed by the impaled object, and if it is moved you yell out in pain. You seek reassurance, but do not
become obstructive about it.
SPECIFIC COMMENTS FOR EVALUATORS
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario # 18-09
INJURY
Laceration with arterial
Degree of Difficulty = 4
ENVIRONMENT
Ski shop at base (0)
bleeding (2)
PERSONNEL
Single patient (0)
Trained rescuers (0)
Sprained ankle (2)
GENERAL SCENARIO DESCRIPTION
A ski shop employee was trying to lift skis onto a display rack using a stool instead of a ladder. He leaned
too far, and fell to the floor, twisting his ankle and cutting the inside of his arm on a ski. There is spurting
bleeding from an arterial laceration, with blood on the patient, skis, and floor.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to the ski shop where an employee has fallen.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has spurting bleeding from a laceration to the lower arm, and a sprained ankle from the fall.
VITAL SIGNS
Time in minutes
Pulse and respirations
Throughout
As found by trainee
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals laceration with spurting (arterial) bleeding, and sprained ankle
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control - direct pressure
Bandaging - correctly bandage wound (hemostatic bandaging if available per area protocol)
Fracture/sprain management - ankle sprain. Correctly splint ankle
CMS before and after splinting
Lifting Techniques; loading/position in toboggan
Problem Management
Patient stabilization
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Scene management - incident site cleanup
Notify management for incident investigation for an injured employee
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-09
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Ski shop (or other appropriate area, i.e., repair shop, ski storage room, etc.)
Moulage: Open wound, approximately 2 inches, with major bleeding and blood on the patient and
surrounding area. The bleeding can be slowed and then stopped if proper care is given; direct pressure
will stop the bleeding after 1 minute. Be sure the patient is well schooled in the use of the blood-pumping
device so the proper bleeding pattern can be portrayed for both proper and improper care patterns.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT(S)
Position: You are lying on the floor tangled in a pile of skis.
Answers to SAMPLE
Signs and symptoms: arm laceration with bleeding, and ankle pain
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
Events leading:
you were standing on a stool, trying to reach up over your head to get
something. You overextended your reach, lost your balance, and fell,
cutting your arm on a ski edge and twisting one foot as you landed on it.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Behaviors: You are embarrassed about the accident, and show concern about the mess caused by the
bleeding. Your ankle hurts a little, unless palpated or moved; then it really hurts. You cannot stand on it.
SPECIFIC COMMENTS FOR EVALUATORS
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-10
INJURY
Impaled object in thigh (2)
Degree of Difficulty = 5
ENVIRONMENT
PERSONNEL
Deeply moguled slope (1)
Single patient (0)
Difficult transport (1)
No trained help (1)
GENERAL SCENARIO DESCRIPTION
A skier attempted a twisting aerial in a tightly moguled area, lost control, and did a tumbling fall,
breaking his/her pole and impaling it into the posterior thigh.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier on the mogul hill. The trainee is told that there is
a lift evacuation in progress elsewhere at the area, leaving only bystander assistance available. The
toboggan should be brought to the scene with him/her. The only place the sled can safely be positioned is
about 10–12 feet downhill from the scenario.
PATIENT SUMMARY
The patient’s leg is at about 40 degrees of flexion, and is held firm in that position. The pole is imbedded
in the posterior thigh approximately 6 inches. There is no femur involvement. Distal neurovascular status
of the leg is normal.
VITAL SIGNS
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Time in minutes
Pulse and respirations
Throughout
p + 20, r + 5
to as found
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify
management for risk management concerns; determine a safe location for the toboggan; plan for
extrication and evacuation
Problem Management
Appropriate use of bystanders and equipment; appropriate treatment and transport plan; OEC
skills according to skill performance guidelines. Bleeding Control, Bandaging - stabilize impaled
object. Use of Oxygen, Lifting Techniques; use of Standard Precautions; secure the impaled object
sufficiently to allow effective transport; safely cover the distance between the patient and toboggan; direct
witnesses to management for statements. Depending on the length of the exposed end of the impaled ski
pole, trainee should verbalize it may have to be cut to a shorter length prior to moving the patient.
Candidate should be asked to verbalize the local blood-borne pathogen cleanup plan.
Leadership
Direct others appropriately and with confidence; continued communications with patient and
bystander helpers; calm reassurance of skier; monitor entire situation and all participants in regards to
adhering to Standard Precautions and local infection control plan
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-10
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: A relatively steep, tightly moguled area must be available, or well simulated, with the
only safe toboggan location approximately 10 feet from the patient.
Moulage: Impaled piece of ski pole, with broken end inserted into posterior thigh. Bleeding is not a
significant issue.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying head downhill on your uninjured side, with the knee of the injured leg flexed and
fixed at about 40 degrees, and with the pole protruding from the injured leg.
Answers to SAMPLE
Signs and symptoms: impaled piece of ski pole in posterior thigh
Allergies:
none
Medications:
none
Past history:
none
Last meal:
report actual
Events leading:
you were attempting a twisting aerial and lost control. Your hand was
behind you and your pole hit a mogul so hard that it snapped in half, and
during the tumbling the force carried it into your thigh.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Behaviors: You are in a great deal of pain in the area of the injury, but you do not have specific pain when
the femur is palpated. Any attempt to move the pole or your knee causes you to scream in pain. As long
as you don’t have to move your leg you can help with the attempts to move or reposition yourself.
SPECIFIC COMMENTS FOR EVALUATORS
This patient may be transported in the prone position if it prevents catching a mogul edge with the pole.
Bleeding is controlled with application of 4 x 4s and direct pressure. The author of this scenario points out
that “significant patroller ingenuity and bystander directions are necessary to stabilize, extricate, and
transport this unusual, difficult injury.”
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-11
INJURY
Severe bleeding (2)
Degree of Difficulty = 5
ENVIRONMENT
Moderate to difficult slope (0)
Leg fracture at boot top (2)
PERSONNEL
Trained rescuers (0)
Angry parent (1)
GENERAL SCENARIO DESCRIPTION
The accident occurred on a moderate to difficult slope. A 10-year-old skier, skiing with their parent, hits a
large branch that was lying on a groomed slope. S/He has a 2” cut in the area of the brachial artery. When
the rescuer arrives, patient is alert, oriented, and cooperative. Parent is angry because the branch should
not be in the middle of the slope.
INFORMATION GIVEN TO TRAINEE
You are called to a scene on a more difficult slope just over the crest of a hill. Dispatch reports that
witnesses from the chair reported seeing blood. Equipment and available personnel to be sent upon
request.
PATIENT SUMMARY
Patient is sitting, holding a hand over the bleeding area. There is blood on the snow. Patient is concerned
about the blood but screams when you attempt to take off the ski on his right foot. Parent is very angry
and upset about the branch left on the hill and is threatening to sue the area.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
VITAL SIGNS
Time in minutes
Pulse and respirations
Initial
P = 100, R = 20
5 minutes
P = 104, R = 18
10 minutes
P = 100, R = 18
15 minutes
P = 112, R = 2 if bleeding is
not controlled
SCENARIO OBJECTIVES
Decision Making
Secure scene; patient assessment to include MOI and SAMPLE; correctly identify and find all injuries;
prioritize bleeding over fractured leg; recognize need to calm parent and incorporate him into the
treatment until additional rescuers arrive; assure the parent you will report this issue to management.
Request needed equipment and additional help.
Problem Management
Standard Precautions; OEC skills: bleeding control and bandaging; recognition of possibility of
compensated shock in a child due to the amount of blood loss; fracture management - lower leg;
develop transportation plan including the parent in a decision whether to call EMS or reassess in the aid
room; notify management due to large branch on slope; documentation to include possible boot tracks
within the snow and slope sweep in the morning.
Leadership
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Develop a treatment and transportation plan. Address concerns of parent in a calm manner and include in
the care of the child until additional help arrives. Give clear instructions in a calm manner. Notify
management. Documentation needs to include the boot tracks and the opening shift report.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-11
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Advanced terrain with branch located just over a lip where it is hard to see
Equipment: Toboggan with standard area equipment
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: Severe bleeding of the brachial artery
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is sitting holding the arm where it is bleeding.
Answers to SAMPLE
Signs and symptoms: severe bleeding upper arm; lower leg pain
Allergies:
none
Medication:
Ritalin
Past history:
none
Last meal:
report actual
Events leading: had just challenged parent to a race down the hill
Behaviors
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Patient: You are cooperative, alert, with normal vital signs upon initial take. When attempting to take off
the ski on the right foot you scream that your leg hurts. Fifteen minutes after the rescuer arrives,
if bleeding is not controlled by direct pressure and O2 initiated, you state you feel like you might
throw up and you are beginning to look pale with increased pulse and respirations. You are
frightened by all the blood and are afraid that your parent is angry with you.
Parent: Is irate and wants to know why management does not address these problems better. You are
willing to calm down some when the rescuer promises to address this issue with management
and asks for your help in the care of your child.
SPECIFIC COMMENTS FOR EVALUATORS:
This scenario provides the opportunity to teach a number of issues including bleeding control,
compensated shock in a child, and legal issues related to slope conditions that includes slope check in the
morning. You suspect that it was dragged there by some kids, but you need to check the morning sweep
report.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-12
INJURY
Thumb Amputation (2)
Degree of Difficulty = 2
ENVIRONMENT
Snow-tubing park (0)
PERSONNEL
Single patient (0)
Trained help upon request (0)
GENERAL SCENARIO DESCRIPTION
You have been called to your resort’s snow tubing area for an amputated thumb. Thumb was tangled up
in the snow tubing lift wire and the snow tube attachment strap. Patient was then forcefully dragged ten
feet up the hill. The right thumb is severed at the first knuckle.
INFORMATION GIVEN TO TRAINEE
You have been dispatched to the bottom of the tubing park for an adult with a hand injury. Equipment and
available personnel to be sent upon request.
PATIENT SUMMARY
Patient is sitting toward the bottom of the snow tubing lift. There is minor bleeding from the missing
thumb site. Amputated thumb is located a short distance uphill (approximately 3 feet) covered by snow.
Upon reaching the patient he explains that he was in the process of hooking his tube up to the lift when he
slipped and his right thumb became tangled up in the lift wire and tube strap. Patient angrily states that he
was "dragged for ten feet by my thumb" before it was ripped from his body. Patient is experiencing
significant pain (8 out of 10).
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
VITAL SIGNS
Time in minutes
Pulse and respirations
Initial
5 min
P = 92, R = 16
P = 94, R = 18
10 min
P = 94, R = 18
15 min
P = 96, R = 18
SCENARIO OBJECTIVES
Assessment
Verify scene safety, ensure the lift is shut down and that tubers will not run into the patient or rescuers;
obtain permission to assist
Primary assessment reveals amputated thumb, minor bleeding
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control and bandaging, correctly stop bleeding and bandage stump
Locate the severed body part, correctly treat (package) the part and send the amputated thumb with the
patient
Oxygen administration per area protocol
Problem Management
Patient stabilization - ensures that patient’s amputated thumb is kept with the patient
Treat for shock as appropriate
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scene management - keeps area clear of extraneous personnel
Verbalizes appropriate transportation plan
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-12
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Near bottom of tubing park
Equipment: Dressings, bandaging, plastic bags, blanket, toboggan
Moulage: amputated thumb - clay model of missing thumb approximately 3 feet from patient, partially
covered by snow, bloody snow. Blood at “stump” of thumb
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Sitting near the bottom of the tube park, amputated thumb is a short distance uphill
Answers to SAMPLE
Signs and symptoms: minor bleeding from stump of missing thumb, pain
Allergies:
none
Medication:
none
Past history:
none
Last meal:
35 minutes ago
Events leading:
thumb got caught in tubing tow wire and tube strap, dragging patient and
amputating thumb at first knuckle
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Behaviors: You are angry that your thumb got caught in the tubing tow wire and tube strap. You are in
significant pain, 8–10.
SPECIFIC COMMENTS FOR EVALUATORS
Proper packaging of amputated thumb includes wrapping the amputated part in a sterile dressing
moistened with clean or sterile water or saline solution and placing it in a plastic bag. Next, place the
plastic bag in a container filled with 1/4 ice and 3/4 water. Candidate should verbalize sending “thumb” to
hospital with patient.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 18
Scenario #18-13
INJURY
Laceration with arterial
Degree of Difficulty = 6
ENVIRONMENT
Near Event Area (0)
PERSONNEL
Multiple patients (1)
bleeding (2)
Obnoxious friend (1)
Distal Radius Fracture (2)
Trained rescuers (0)
GENERAL SCENARIO DESCRIPTION
The patrol is at a snowboard race. A racer loses control and falls on his wrist, breaking it. His momentum
takes him into the side, where he collides with a spectator. His board hits the spectator in the back of the
leg, causing a laceration, bleeding, and severe pain. The spectator and her friend and other race officials
are gathering around making it difficult to deliver patient care.
INFORMATION GIVEN TO CANDIDATE
Dispatch: A snowboarder at the bottom end of the racing area has crashed into some spectators.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient #1 is the racer with the wrist injury and is in moderate pain. He does not give the patroller much
trouble.
Patient #2 is the injured spectator. S/He is angry about being hit and has severe leg pain; s/he will be
difficult for the patroller to manage.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
An obnoxious friend, not hurt, keeps butting in with advice.
VITAL SIGNS
Time in minutes
Pulse and respirations
Patient #1: as found
Patient #2:
Initial
p = 94; r = 20
5 min
p = 100; r = 22
10 min
p = 104; r = 20
15 min
p = 106; r = 20
SCENARIO OBJECTIVES
Decision Making
Verify scene safety by ensuring race is stopped until patients are removed; Patient assessments: correctly
identify all injuries; request EMS; notify management for risk management concerns; prioritize treatment
for Patient #2 over Patient #1; call for oxygen; use of pressure dressing to stop bleeding or, if ineffective,
a tourniquet. Request needed equipment including trauma pack and additional rescuers.
Problem Management
Standard Precautions; OEC skills: bleeding control and bandaging: laceration; fracture management:
radius; oxygen administration per area protocol. Develop transportation plan; coordinate transfers to
EMS.
Leadership
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Develop scene management plan; provide clear assignments and directions to other rescuers; direct others
appropriately and with confidence; direct and calm communications with patient; ensure correct OEC
skills of helpers where appropriate; monitor entire situation and all participants
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Scenario #18-13
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Run used for races
Moulage: Simulated laceration with fake blood on the back of spectator’s leg (hamstring area, arterial
spurting); putty lump on the racer’s wrist
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Both patients are on the ground at the edge of the race course; the racer will still have the board
attached to his/her feet. The spectator is mad; s/he will be combative with the racer until controlled.
Spectator’s friend is obnoxious and keeps butting in giving advice, questioning process until
controlled/distracted.
Answers to SAMPLE
Signs and symptoms: Patient #1 - bump on wrist; Patient #2 - bleeding laceration on back of leg
Allergies:
none for either patient
Medications:
none for either patient
Past history:
none for either patient
Last meal:
report actual
Events leading:
racer lost control during race, hurting self and spectator on landing
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.
Behaviors
Patient #1 is in pain and is embarrassed that he hit someone.
Patient #2 is mad that she has been hit and is upset because she can’t flex her leg and blood is spurting.
Obnoxious friend has no injuries but is very opinionated about what should be happening.
Both spectators will calm down with firm direction.
SPECIFIC COMMENTS FOR EVALUATORS
Securing the area, controlling all parties, assessment, identification of the priority patient, and care for all.
Respirations and pulse for patient #2 will be elevated if bleeding is not controlled, with respirations being
elevated more due to mood than bleeding.
©2012 National Ski Patrol
Outdoor Emergency Care, 5th Ed.