Working with a ski patrol

Dr Mike Langran, a GP in Aviemore, Scotland, describes his work in snow sports medicine.

How did you become involved in snow sports medicine?

I came to work in Aviemore in 1993 as a GP registrar and did a project on snow sports injuries during one of the busiest seasons in the past 20 years. It whetted my appetite and I've been involved ever since.

I learnt to ski at 15 and I've been a telemark/Nordic skier since the age of 17. I'm not the world's best skier, but I can hold my own.

How do you combine work as a ski patrol doctor with being a full-time GP?

My role in the Cairngorms ski patrol came about through my research project. The team realised I was interested and began to call me when I was on the mountain to assist them from time to time. The more injuries I dealt with, the more I realised I could have a role - it developed from there.

I work full time at the surgery, but in winter I use a combination of study leave, holiday and weekends to spend time with the ski patrol. The main ski season is December to April.

I sometimes also employ locums, to give me more time on the mountain. It's a voluntary role but one I am passionate about.

What does the work with the ski patrol involve?

I arrive on the mountain at about 8am, hours after my colleagues, the real heroes doing the hard work.

I spend a couple of hours at the base station collecting control data for my research and occasionally dealing with early morning injuries in the car park. I then head up to the slopes and catch up with the patrol team.

From then, it's completely unpredictable. Some days I have very little to do and can enjoy the skiing, but other days I spend tending to injuries and illnesses all day long.

I carry ski patrol and ambulance service radios as well as my mobile, so I am easy to contact. The patrol doesn't need my help with every injury, but if casualties need strong pain relief or have more serious injuries, I get involved. On average, we see two or three injuries for every 1,000 people on the mountain, so most people go away happy and never see me.

There's a well-defined pattern of injury - skiers tend to sustain knee sprains, whereas snowboarders are prone to wrist and upper limb injuries. We reduce dislocated shoulders in the patrol room with about a 90% success rate. In my experience, the sooner they're put back, the better. We don't see many serious injuries - perhaps a dozen or so every season.

What are the main challenges of working on the ski slopes?

The two main challenges are that you are a long way from anywhere and the environment can be quite hostile. You have to bear this in mind with everything you do and adapt your casualty management procedures accordingly.

For example, it's often too wild in winter to expose yourself and your casualty in order to gain IV access to give pain relief. So for the past 10 years I have used intranasal diamorphine in both adults and children, to good effect.

I also use a special electronic stethoscope, which allows me to listen through multiple layers of clothing using a Bluetooth headset. This means we can transport casualties off the mountain wrapped up against the cold, but I can still monitor them on the journey.

We've also adapted our management of potential spinal injuries, so we rely on vacuum mattress support without a cervical collar until we can get the casualty into a sheltered environment.

You have to have a deep respect for the mountains and winter weather and always consider your own safety when heading off to a rescue.
Ski patrol training

What do you most enjoy about the work?

There's a great team spirit in the ski patrol. We all get on well, share the same interests and sense of humour.

I call the mountain my branch surgery and even on the roughest of winter days, it really is a fantastic place to be.

Ski patrol medicine offers me an extra dimension to my work. It challenges me at times, but it's ultimately very rewarding. It has introduced me to so many great friends all over the world and given me experiences that I would never have had otherwise.

How did you begin promoting evidence-based ski medicine?

We've had a case control study at the five ski centres in Scotland since 1999 and it now covers almost 3m skier days, with data on almost 11,000 individuals. I use this database as the mainstay of my research to try to identify the risk factors associated with injury.

This led to papers in several publications, but the challenge is getting the information out to the public. With this in mind, I set up my website and it's grown steadily.

The idea is to translate the research findings into language that people can understand. A lot of myths and inaccuracies surround topics such as helmets, wrist guards and the overall risk of injury on the slopes. If by providing accurate information, I can help prevent one injury, that's a good thing.

Every season I receive hundreds of emails from people who have been injured, looking for advice on rehabilitation and injury prevention. It's very satisfying to help these people get back on the slopes and stay safe in the future.

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