After having conversations with some old time patrollers and reading Skip King’s articles in SAM, I have thought about how the various inputs could possibly alter the existing relationships between mountain ops and ski patrol. There seems to be a reasonable relationship between NSAA and NSP, as there should be, since their executive offices are in the same building.
There is an ongoing dialog about liability and worker’s compensation insurance that seems prevalent on the internet. Quite frankly I believe much of that input is without full knowledge of the facts as it may pertain to a specific resort or to specific state as to where a patroller works or volunteers.
What I do see as a significant possible change is the question or concern over medical oversight. The NSP is taking steps to address the question of how medical oversight and field medical practice would be accomplished outside the formal EMS system. The NSP is also working with NSAA to draft a quality assurance guideline that could be used to develop medical quality assurance plans for their ski patrols, potentially involving physician-level medical oversight. In my limited scope of knowledge I see a whole host of issues in mandating medical oversight for all ski patrols.
Researching this issue I found an excellent article on this subject in Wilderness & Environmental Medicine, 23, 106-111 (2012). I am including the author’s last paragraph as it conveys his very sensible thoughts. The impressive aspect of his summation is that his view point is through the lens of the resort customer, which is something I hope no one in the process of trying to wrestle this issue loses sight of. Dr. Hawkins’s remarks:
Let me conclude by sharing my own opinion. As in most areas of both EMS and wilderness medicine, the complexity and variety of operational environments confounds any single answer. I find it hard to argue that increased physician involvement, increased medical oversight, increased interoperability with traditional EMS and other healthcare systems, and increased quality assurance is not a good thing for our snowsports patients. I also believe there is little face validity to the argument that any of these interventions will increase risk or insurance premiums—each of these interventions are used in other areas of healthcare to reduce risk and reduce insurance premiums.
Personally, I have a short-term and long-term perspective. In the short term, I am reminded of Voltaire, who two and a half centuries ago wrote “le mieux est l’ennemi du bien.” In this case, I would paraphrase that to be “the best can be the enemy of the good.” Would I want my family on a ski vacation to be cared for by certified and properly trained patrollers, operating within an EMS system and under the credentialing and quality management oversight of a licensed physician endorsed by the state to serve in this role? Sure. Is that a realistic standard for every ski area at this time? Probably not. Good— indeed excellent— care is delivered around the world by ski patrollers who work in systems that do not include all those elements. I am sympathetic to the argument that environments are individual, and that we should not let a national regulatory concept of “best” lead to the jettison of the “good,” with the paradoxical result of decreased service and increased complexity. In some places, EMT certification may be best; in others, OEC; whereas in still others, combinations of both work well. Physicians may, and should, have varying levels and types of involvement in different ski areas. But our obligation as healthcare professionals is to strive, whenever possible, for the best, not just the good, for our patients. In the long term, is the vision of certified and properly trained patrollers, operating formally within a state EMS system and under the credentialing and quality management oversight of a licensed EMS-WM physician, an appropriate goal? Absolutely. Is it realistic to think that, as EMS, WEMS, and ski patrols evolve, this goal is attainable at large and small ski areas across the country? Based on the high respect I hold for all of these communities of providers, I most certainly think it is.
Seth C. Hawkins, MD, FAWM
Department of Emergency Medicine
UNC-Chapel Hill School of Medicine
Having been involved in senior management at two top-tier ski resorts, I possess deep respect and admiration, if not a bit of jealousy, for what patrollers do and why they do it. It takes strong leadership skills, unending learning, relentless practice, and, above all, an extraordinary capacity to care for injured skiers on the hill.
Steep Management, LLC, through its involvement in LiftShack and prior experience in ski area management, is in a unique position to help the fusion between mountain management, its patrollers, the local EMS, hospital, clinics, and the ever increasing role of a state’s chief medical officers.