2003 refresher - National Ski Patrol

NATIONAL SKI PATROL ❚ OUTDOOR EMERGENCY CARE 

B ❂ 

C Y C L E 

2003 refresher 

study guide 

BRIAN W. ROBB

Introduction 

J 

Reality Programming 

Judging by recent trends in television programming, people just can’t seem to get enough reality. Viewers 

can watch everything from distrustful castaways surviving challenges in exotic locales to crazed individuals 

doing battle with each other and their various phobias. Change the channel and they might see police officers 

in hot pursuit of a car thief or housemates getting caught up in a quagmire of personality conflicts. 

Imagine, for a moment, a new series—one in which hidden cameras are placed in your patrol facilities 

and your ski hat is outfitted with a “patroller cam.” What sort of “reality” would viewers see when they 

tuned in What would you want them to see 

It can be unnerving to feel the eyes of a vigilant audience watching your every move, but as you’ll discover 

at your Outdoor Emergency Care refresher this fall, it can also help you focus on the proper application 

of skills. And after awhile, those skills become second nature to you and confidence replaces any 

trepidation you might have felt initially. 

This patroller cam idea might sound a bit far-fetched, but the truth of the matter—the reality—is that 

we serve in the public eye and project a certain image as we perform our patrol duties. The public often 

takes us for granted and assumes that we will be there to assist in case of an emergency. They assume correctly. 

That’s what we’re there for. 

Of course, there’s more to our reality than the public might perceive. Like all this new television programming, 

patrolling is unscripted so we never know what we’re going to encounter on any given day in 

the aid room or on the hill. We do know, however, that there are certain kinds of injuries that are more 

common than others. 

It’s true that the outdoor sports industry gets more exciting each season, with innovations in equipment 

and recreational possibilities. It’s also true that these developments give people more ways to enjoy 

themselves and more opportunity to injure themselves. Despite new gear options and evolutions in sport, 

however, many of the injuries managed by nonurban rescuers share similar characteristics. 

To help you respond more effectively to these types of injuries, the Outdoor Emergency Care Refresher 

Committee has modified the refresher cycles slightly to ensure that patrollers refresh on “Common 

Outdoor Injury Management” annually. In fact, this year’s Cycle B refresher treats it as an “in-depth” topic. 

This change is intended to help you focus on the most common injuries you see each year, which include 

shoulder girdle, forearm/wrist, and knee injuries. You will review the mechanisms and patterns of these 

injuries, the anatomy and physiology involved, and the emergency care for each. This information will be 

woven into skills stations and/or scenario presentations. 

Apart from your on-the-hill experience, your annual OEC refresher is often the only hands-on opportunity 

you have to demonstrate proficiency in new emergency care challenges. The NSP helps prepare 

you to meet such challenges by apprising you of the latest trends in both the snowsports industry and in 

emergency response and care. The OEC Refresher Committee assists with this by developing and recommending 

training materials that will help you optimize your OEC refresher experience. 

The annual refresher is designed to prepare you for the coming season’s challenges by offering many 

opportunities to fine-tune your skills, with no time constraints imposed. It is also a time for you to work 

with your peers, individually and in teams. Proving that you can perform a series of specific skills says 

something about your abilities, but the real test comes when you’re the first responder on the scene and 

the “patroller cam” is on. 

Your instructors act as facilitators who present ways for you to review important skills and content. 

They are there to help you improve your old skills, possibly acquire some new ones, and do whatever is 

necessary to help you continue to be a confident and effective rescuer. Remember that, ultimately, your 

refresher experience will only be as good as the effort you put into it. 

2003 Refresher Study Guide ❚ 2 ❚ Ski Patrol Magazine

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Refresher Program 

The OEC refresher program provides OEC 

technicians with a continuing education opportunity 

to renew and demonstrate competency 

in required OEC knowledge and skills while 

using a variety of equipment and techniques. 

To maintain membership in the NSP for the 

upcoming ski season, members must successfully 

complete the annual OEC refresher. The 

only NSP members exempt from this requirement 

are those registered candidate patrollers 

who are enrolled in an OEC course, those 

members who completed a full OEC course 

after May 31 of the current calendar year, and 

those members who are registered as medical 

associates (M.D.’s and D.O.’s). 

A refresher is not the equivalent of a challenge 

for a candidate patroller entering the NSP 

system with previous emergency care or 

medical training. 

A patroller who wishes to renew active status 

from an inactive registration or a missed 

patrolling season must complete the refresher 

cycle(s) missed during the inactive period. 

(Only those patrollers with a non-expired 

OEC certification may renew their certification 

by making up missed refreshers. Speak 

with an instructor if you have a current OEC 

certification and need to coordinate a makeup 

refresher.) 

Patrol training usually includes local patrol, 

area, and resort protocols not contained within 

NSP’s Outdoor Emergency Care Program, and 

these skills are often taught in courses that run 

concurrent with OEC training. The NSP is 

not responsible for the content, instruction, 

or scheduling of these additional classes. Your 

refresher may cover these non-NSP topics 

of instruction, which include: 

❚ CPR or AED certification 

❚ Chairlift evacuation procedures 

❚ Additional local patrol dryland or 

on-the-hill training 

Each patroller should consult with his or her 

local patrol, area, or resort for schedules, topics 

to be covered, and other requirements. 

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Get Ready 

It’s your responsibility to check with your 

patrol or region to determine when and where 

the refresher will be held. If you have a conflict, 

contact the OEC region administrator or check 

your division website for an alternate date. 

Do not wait until the last minute to do this. 

Please notify your patrol representative in 

advance if you will not be able to attend your 

patrol’s refresher. Prearrange attendance at 

another refresher with the instructor of record 

or patrol representative for that area. 

Allow yourself plenty of time to study the Outdoor 

Emergency Care references listed in this 

study guide for Cycle B. All references are to 

the fourth edition of Outdoor Emergency Care. 

Review the refresher topics for this cycle. 

Read the “Scenario Discussion Forum” section 

of this study guide, write answers to the text 

questions and action questions that follow 

each scenario, and bring your answers to the 

refresher. This forum is also available as a 

downloadable Word or PDF document in the 

Education/OEC section of the NSP website at 

www.nsp.org. 

Use the skill guides in this study guide and 

in the fourth edition OEC text to review and 

practice the skills you will be asked to demonstrate 

during this year’s refresher. 

Dust off your aid belt, vest, or pack; restock it; 

and be ready to go! 

Requirements (What to Bring) 

The 2003 Refresher Study Guide with completed 

Scenario Discussion Forum text and action 

questions. 

Your current OEC, CPR, and NSP member 

cards. (You may obtain a duplicate OEC card 

from the national office by mailing a check or 

money order for $5 [made payable to NSP] to 

the national office at 133 South Van Gordon 

Street, Suite 100, Lakewood, Colorado 80228. 

Enclose a note asking for a new OEC card and 

allow three to four weeks for delivery.) 

A fully stocked aid belt, vest, or pack and any 

additional items required at the refresher 

you will be attending. Dress appropriately to 

participate in both indoor and outdoor 

refresher activities. 

R YOU READY TO ROLL 

This season, use the 

following list of R’s to 

help you get the most 

out of your training. 

Refresh your OEC skills 

and knowledge to be as 

sharp as possible when 

you respond to an 

accident scene. 

Refresher 

Review content 

Remediate problems 

Recall information 

Remember the facts 

Retain the knowledge 

Reinforce the skills 

Patrolling 

Respond to the call 

React to the scene 

Remedy the situation 

Rescue the injured 

Ski Patrol Magazine ❚ 3 ❚ 2003 Refresher Study Guide

Record Keeping 

❚ If you attend another region or patrol’s 

refresher, be sure to fill out the “Supplemental 

Roster Information” form on page 5 of this 

study guide and submit it to the instructor of 

record. This will ensure that the instructor has 

all the information he or she needs to verify 

your completion of the refresher on a roster 

submitted to the national office: your NSP 

membership ID number, name as it appears in 

national registration records, address, and 

patrol affiliation. To document your attendance 

for your patrol representative, use the “Completion 

Acknowledgment” form on page 5. 

❚ Make sure the instructor of record signs and 

dates your OEC card on the line for Cycle B 

and returns it to you. 

❚ Also, please complete and hand in the “2003 

Cycle B OEC Refresher Assessment and 

Evaluation” form on page 23. 

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CPR Policy 

All active NSP members must hold a current 

Professional Rescuer CPR certification from 

the American Heart Association, the American 

Red Cross, the National Safety Council, the 

American Health and Safety Institute, or 

Medic First Aid. 

The certifying body need not issue a new certificate 

unless the certificate expires before the 

start of the upcoming ski season. 

All active NSP members must demonstrate 

their CPR skills each season, regardless of the 

certifying agency’s requirements or the expiration 

date on the card. 

Cycle B Refresher Topics 

A. ANNUAL TOPICS 

1. Common Outdoor Injury Management 

(in-depth topic)—chapters 14, 24, and 25 

(This and all of the following chapter 

references are for the fourth edition 

OEC textbook) 

2. Neurological Injury Management 

(in-depth topic)—chapter 26 

3. Patient Assessment—chapters 7 and 30 

4. Airway Management and Oxygen 

Administration—chapter 6 

5. Shock Management—chapter 9 

6. Cold-Injury Management—chapters 2 and 15 

B. CYCLE-SPECIFIC TOPICS 

1. Anatomy and Physiology—chapter 4 

❚ Musculoskeletal System 

❚ Nervous System 

❚ Urinary and Reproductive Systems 

(also chapter 23) 

2. Orthopedic Trauma—chapters 24 and 25 

❚ Pelvis, hip, and femur injuries 

❚ Traction splinting 

❚ Spinal immobilization 

3. Environmental and Medical Emergencies— 

chapter 15 

❚ Environmental Injuries 

❚ Cold 

❚ Heat 

❚ Altitude 

❚ Solar 

❚ Electrical 

❚ Water Emergencies 

4. Specific Injuries—chapters 23 and 26 

❚ Injuries to the abdomen and genitalia 

❚ Application of a standing backboard 

❚ Helmet removal 

5. Transportation and Extrication—chapter 27 

❚ Positioning patients—log roll 

6. Local Needs 


2003 CYCLE B OEC REFRESHER 

Completion Acknowledgement 

Have this signed by the instructor of record at the refresher and return it to your NSP patrol representative or patrol director to verify 

that you have attended and successfully completed all requirements for the 2003 refresher. Please print. 

Patroller: 

NSP Member I.D. #: 

Patrol Affiliation: 

Refresher Location and Date: 

Name of OEC Instructor of Record: 

Signature of OEC Instructor of Record: 


Supplemental Roster Information 

After completing the refresher, fill out this form and submit it to the instructor of record. This will help the instructor document your 

completion of this year’s OEC refresher requirements to the national office. Please print. 

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CUT HERE 

Patroller: 

NSP Member I.D. #: 

Address: 

City: State: Zip: 

E-mail Address: 

Patrol Affiliation: 

Region: 

Refresher Location and Date: 

OEC Instructor of Record: 


Skill Guides 

These are provided for review purposes. Each patroller will be required to demonstrate these skills at the refresher. 

(CPI) = Critical Performance Indicator 

Steps marked with the CPI designation are critical to proper patient care and must be demonstrated to satisfy performance criteria. 

Use of Oxygen and Airway Adjuncts—Oropharyngeal and Nasopharyngeal Airways 

Objective: To demonstrate the correct use of oropharyngeal and nasopharyngeal airways. 

SKILL YES NO NOTATIONS 

❚ Initiates BSI precautions. (CPI) 

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Selects proper size oropharyngeal airway by measuring from 

the corner of the mouth to the angle of the jaw. 

OR 

Selects proper size nasopharyngeal airway by measuring from 

the tip of the nose to the earlobe. Coats the airway with a 

water-soluble lubricant. 

If using an oral airway, opens the mouth using an appropriate 

technique. 

❚ Inserts the airway using an appropriate technique. (CPI) 

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Did the trainee or OEC technician adequately demonstrate 

the performance criteria of this skill 

OROPHARYNGEAL AIRWAY 

Sizes the airway. 

NASOPHARYNGEAL AIRWAY 

Opens mouth with cross-finger technique and inserts airway. 

Rotates airway 180° and rest flange on lips and teeth. 

Sizes the airway. Inserts lubricated airway into larger nostril. Rests flange against the skin. 


Use of Oxygen and Airway Adjuncts—Suctioning of the Oral Cavity 

Objective: To demonstrate the correct use of suctioning equipment. 



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Assembles, turns on, and tests device. 

Opens the mouth using the crossed-finger technique. 

Inserts rigid tip catheter without applying suction (measures length 

from corner of mouth to angle of jaw and inserts catheter no farther 

than distance measured). 

❚ Applies suction for no longer than 15 seconds while the rigid catheter (CPI) 

is twisted or rotated during withdrawal. 

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SUCTIONING THE AIRWAY 

Measures catheter from corner of mouth to earlobe. Opens mouth and inserts catheter to depth measured. Applies suction no more than 15 seconds. 


Use of Oxygen and Airway Adjuncts—Administration of Oxygen 

Objective: To demonstrate the correct use of oxygen equipment. 



❚ Assembles oxygen cylinder and regulator, and checks for leaks. (CPI) 

❚ Chooses a delivery device by patient need. (CPI) 

❚ Selects nonrebreathing oxygen mask, connects to regulator, 

prefills the regulator, and initially adjusts oxygen flow 

to 12 to 15 L/min. 

❚ Selects nasal cannula, connects to regulator, and adjusts oxygen 

to 6 L/min maximum. 

❚ Applies the appropriate oxygen delivery device to the patient and (CPI) 

verifies that the patient receives oxygen. If using a nonrebreathing 

mask, readjusts the flow rate to keep the bag half full on inhalation. 

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When finished providing oxygen, closes the oxygen tank. 

❚ Bleeds regulator device to “0.” 

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ASSEMBLING OXYGEN CYLINDER AND REGULATOR 

Cracks valve, briefly. Assures the use of gasket. Aligns regulator on valve stem. Attaches oxygen supply tubing. 

OXYGEN DELIVERY DEVICES 

COURTESY OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 


Nonrebreathing mask 

Nasal cannula 


Use of Oxygen and Airway Adjuncts—Use of Pocket Mask for Artificial Ventilation 

Objective: To demonstrate the correct use of oxygen equipment for artificial ventilation. 



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Assembles mask components as necessary, using device-specific, 

one-way valve. 

Sizes and inserts proper size oropharyngeal or nasopharyngeal airway 

using appropriate technique. 

Connects oxygen to pocket mask. 

Adjusts oxygen supply to 15 L/min. 

Maintains open airway and mask seal. 

❚ Demonstrates adequate ventilation (rate and depth) on a manikin. (CPI) 

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OROPHARYNGEAL AIRWAY NASOPHARYNGEAL AIRWAY POCKET MASK 

Inserts proper size oropharyngeal or nasopharyngeal airway using appropriate technique. 

Maintains mask seal. 


Use of Oxygen and Airway Adjuncts—Use of Bag-Valve-Mask for Artificial Ventilation 

Objective: To demonstrate the correct use of oxygen equipment for artificial ventilation. 



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Assembles bag-valve-mask components, including reservoir. 

Sizes and inserts proper size oropharyngeal or nasopharyngeal airway 

using appropriate technique. 

Connects oxygen supply to bag-valve-mask. 

Adjusts oxygen supply to 15 L/min. 

Maintains open airway and mask seal. 

❚ Demonstrates adequate ventilation (rate and depth) on a manikin. (CPI) 

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OROPHARYNGEAL AIRWAY 

NASOPHARYNGEAL AIRWAY 

Inserts proper size oropharyngeal or nasopharyngeal airway using appropriate technique. 

BAG-VALVE-MASK 


Maintains mask seal. 


Patient Assessment—Responsive Trauma Patient 

Objective: To demonstrate the ability to determine the baseline condition and specific injury or injuries in a responsive trauma patient. 


SCENE SIZE-UP 


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Determines that the scene is safe. 

Determines the nature of illness (NOI) and/or the mechanism 

of injury (MOI). 

Notes the number of patients and the responsiveness of each. 

Evaluates the need to disentangle or extricate the patient(s). 

Considers c-spine immobilization. 

Notes the need for personnel or equipment. 

(CPI) 

INITIAL ASSESSMENT—RESPONSIVE PATIENT 

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Offers to assist/obtains the patient’s consent. 

Confirms general impression of the patient and/or level 

of responsiveness (LOR). 

❚ Assesses airway, breathing, and circulation (ABCs). (CPI) 

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Assists breathing or performs CPR as necessary. 

❚ Checks for severe bleeding: intervention = control bleeding. (CPI) 

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If the patient has abnormal ABCs or presents a poor general 

impression, the rescuer performs the rapid body survey, obtains 

baseline vital signs, obtains the SAMPLE history, and provides 

rapid transport. 

Obtains the chief complaint. 

❚ Calls for transport, equipment, assistance, and/or EMS as needed. (CPI) 

Skill Guide continued on page 12 

ASSESSMENT OF A RESPONSIVE TRAUMA PATIENT 

Determines scene safety and the mechanism of injury. 


Patient Assessment—Responsive Trauma Patient (continued) 

Objective: To demonstrate the ability to determine the baseline condition and specific injury or injuries in a responsive trauma patient. 


FOCUSED HISTORY AND PHYSICAL EXAM—TRAUMA PATIENT 

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Conducts a trauma-focused physical exam of the area of chief 

complaint; confirms chief complaint. 

Obtains SAMPLE history. 

Exposes and inspects only what is necessary to determine the 

appropriate emergency care. 

Stabilizes and maintains the patient’s body temperature. 

Determines the appropriate baseline vital signs. 

Provides care for the chief complaint, i.e. conducts interventions. 

Transports patient off the hill. 

Performs a detailed physical exam as necessary. 

Performs ongoing assessment. 


the performance criteria of these skills 

ASSESSMENT OF A RESPONSIVE TRAUMA PATIENT (continued) 

Obtains patient’s consent. Assesses head, neck, and back. Determines chief complaint. 

Performs focused assessment. Determines baseline vital signs. Exposes and inspects only what’s necessary. 


Patient Assessment—Rapid Body Survey 

Objective: To demonstrate the ability to perform a rapid body survey on a patient. 



❚ Maintains c-spine immobilization, as necessary. (CPI) 

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Does not expose the patient unnecessarily. 

Performs the head-to-toe, hands-on, clothes-on exam using the 

DCAP-BTLS mnemonic to assess the patient. 

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Examines the head (skull, facial bones, pupils, ears, nose, mouth). 

Examines and palpates the neck (cervical spine, anterior neck, 

medical-alert tags). 

Examines and palpates the chest (noting any abnormalities 

and deformities). 

Examines and palpates the abdomen (all quadrants) and pelvis. 

Examines and palpates each lower extremity (noting any 

abnormalities, and evaluating circulation, motion, and sensation 

[CMS]). 

Examines and palpates each upper extremity (noting any 

abnormalities, evaluating CMS, and looking for medical-alert tags). 

Examines and palpates the back and buttocks. 


the performance criteria of these skills 

RAPID BODY SURVEY 

Assesses the head. Assesses the neck. Assesses the chest. Assesses the abdomen. 

Assesses the pelvis. Assesses the lower extremities. Assesses the upper extremities. Assesses the back. 


Traction Splinting 

Objective: To immobilize a fracture of the femur using a traction-splinting device. 



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Assesses the limb using DCAP-BTLS and notes the mechanism 

of injury to determine the presence and location of a fracture. 

Manually stabilizes the fracture site and limb. (Note: Continuous 

manual stabilization must be maintained until a splint is applied 

and secured.) 

❚ Assesses the circulation, motion, and sensation (CMS) of the limb. (CPI) 

❚ Realigns the limb if needed. (Note: Manual traction should be applied (CPI) 

at the knee until the limb is straightened and the ankle hitch is applied.) 

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Applies an ankle hitch. 

Prepares the immobilization device and materials to be used. 

❚ Positions the splint properly under the limb and against the ischial (CPI) 

tuberosity or pelvic bone (depending on the splint type) without 

excessive movement or elevation of the limb. 

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Applies the splint, including any necessary cradles, supports, etc. 

Applies mechanical traction at the ankle. 

Secures the limb properly in the splint. 

Reassesses the CMS function of the limb. 



TRACTION SPLINTING 

First rescuer stabilizes fracture site manually. 

Second rescuer removes skis/snowboard. 

First rescuer realigns fracture. 

Rescuers place leg in splint. 

Rescuers secure patient to long backboard. 


Spinal Immobilization 

Objective: To demonstrate spinal immobilization techniques using a long or short spinal immobilization device. 

Note: The use of a web-strap system is the method of choice. Any device chosen must be applied correctly and in accordance 

with the manufacturer’s instructions. 



❚ Uses manual stabilization techniques to firmly stabilize the head (CPI) 

and neck. (Note: Continuous manual stabilization must be maintained 

until the head is mechanically immobilized and secured.) 

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Assesses mechanism of injury and neurologic functions to determine 

nature and extent of injury. This assessment must include circulation, 

motion, and sensation (CMS) in the patient’s extremities. 

Applies a rigid collar (or equivalent) without excessive movement 

of the head/neck. 

Transfers the patient as a unit onto spinal immobilization device 

without excessive movement, maintaining spinal integrity, and 

properly positions patient on spinal immobilization device. 

Fills any voids present under the neck or along the spine as necessary. 

❚ Adequately secures the torso and pelvis to the spinal immobilization (CPI) 

device. (Note: The torso and extremities must be mechanically 

secured before the head and neck.) 

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Secures the patient’s extremities to the immobilization device. 

❚ Secures the patient’s head to the spinal immobilization device. (CPI) 

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Reassesses the CMS in the patient’s extremities. 



IMMOBILIZING A PATIENT ON A LONG BACKBOARD 

Applies manual stabilization. Applies cervical collar. Rolls patient and examines the back. Centers patient on the backboard. 

Secures the torso, pelvis, legs, and feet. Secures the head. Checks all straps and reassesses distal function. 


Application of a Standing Backboard 

Objective: To demonstrate the application of a backboard on a standing patient who may have a spinal injury. 



❚ The first rescuer stands behind the patient and manually stabilizes (CPI) 

the patient’s head and neck in an anatomically neutral position. 

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A second rescuer applies a rigid cervical collar. 

The second rescuer then inserts the backboard from the side, 

under the first rescuer’s arm and behind the patient. 

Two rescuers stand facing the patient, one on either side. Each inserts 

one hand under the patient’s armpit and grasps the handhold on 

the board near or slightly above the armpit. 

Two rescuers grasp a handhold near the top of the board with 

their free hands. 

A fourth rescuer stabilizes the foot of the board. 

❚ Lowers the board to the ground while manual stabilization (CPI) 

of the head and neck is continually maintained. 

❚ Centers the patient by axial sliding, and straps him or her to the (CPI) 

board using standard techniques. 

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APPLICATION OF A STANDING BACKBOARD 

Manually stabilizes head and neck. Applies cervical 

collar. 

Grasps handholds. Prepares to lower the patient. Lowers backboard to the ground. 


Helmet Removal 

Objective: To demonstrate the correct removal of a helmet from a trauma patient who may have a head or neck injury 

or obstructed airway. 



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The patient’s head and neck is manually stabilized by placing 

a hand on each side of the helmet, fingers holding the patient’s 

mandible. A second rescuer unbuckles the chin strap. 

❚ The second rescuer manually stabilizes the patient’s head and neck (CPI) 

at the occiput and chin. 

❚ The first rescuer spreads the sides of the helmet and begins to ease it (CPI) 

off the patient’s head. 

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The second rescuer slides his or her hand up the neck to the back 

of the head and prevents flexion of the neck. 

The first rescuer resumes manual stabilization of the cervical spine. 

The patient is immobilized as appropriate. 



HELMET REMOVAL 

Places one hand at lower jaw, other at junction of 

head and cervical spine. 

Second rescuer stabilizes the head and neck at the 

occiput and chin. 

First rescuer spreads sides of helmet and eases 

it off. 

First rescuer resumes manual stabilization of the 

cervical spine. 


Lifting Techniques—Log Roll 

Objective: To demonstrate manual lifting techniques to move patients onto other devices. 



❚ Manually stabilizes the head and neck in an anatomically neutral (CPI) 

position. 

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Positions sufficient rescuers on the same side of the patient with 

rescuers’ hands placed on the opposite side of the patient’s body. 

Moves the patient as a unit, taking body mass into consideration. 

❚ Rolls the patient toward the rescuers on command from the leader (CPI) 

(at the head) onto the uninjured side if possible, keeping the body 

in line. (The patient’s arm may be alongside the body or elevated, 

based on local protocol.) 

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Places the spinal immobilization device beside the patient and 

underneath as far as possible without excessive movement. 

❚ Rolls the patient onto the device on command from the leader, (CPI) 

keeping the body in line. 

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LOG ROLL 

Rolls patient and examines the back. Centers patient on the backboard. Secures the torso, pelvis, legs, and feet. 


YOUR NAME: 

Scenario Discussion Forum 

The Scenario Discussion Forum has become an essential part 

of the OEC refresher and the Refresher Committee has received 

an overwhelmingly positive response to its use. The following 

pages contain the three scenarios that will be discussed at your 

refresher. 

❚ Carefully read these scenarios, each of which is based on an 

actual incident. 

❚ Answer the text and action questions that follow each 

scenario, using additional paper if necessary. While specific 

answers to the text questions can be found in the fourth 

edition of Outdoor Emergency Care, keep in mind that there 

are many correct answers to the action questions. The latter 

are provided primarily to stimulate discussion at your 

refresher’s Scenario Discussion Forum. 

❚ Bring your written answers to the refresher and be prepared 

to participate in the discussion forum. 

❚ The “Scenario Discussion Forum” is also available in a Word 

or PDF format in the education/OEC section of the NSP 

website, www.nsp.org. 

respirations, 22 and halting. At 1415: pulse, 126 and thready; 

respirations, 28 and shallow. At 1425: pulse, 132 and weak; respirations, 

26 and shallow. 

Text Questions 

1. List four benefits of applying a traction splint to a mid-shaft 

femur fracture. 

a. 

b. 

c. 

d. 

OEC, 4th ed., chapter 25 

2. How does the emergency care for a fractured pelvis differ 

from that for a fractured proximal femur (hip) 

SCENARIO 1 

It’s a cold, sunny day and you’re on duty at the top shack. At 1405, 

a nearby lift operator relays a report from someone on the lift 

who said he saw a snowboarder lying unconscious in the 

Awesome-Awesome Terrain Park, just below a big tabletop jump 

known as Big Kahuna. You quickly get to the scene and find a 

16-year-old female snowboarder surrounded by other riders. 

Lying in a twisted position with her legs and pelvis prone, the 

girl is crying out in pain. A friend tries to console her. When 

questioned, the friend says that the girl “hucked big air and took 

a digger right on the flattop.” The patient complains of pain in 

the middle of her right thigh, in the left hip area, and in the lumbar 

region of the spine. She denies having lost consciousness. 


3. In detail, describe the application of the particular traction 

splint used by your patrol. Include any patrol-specific protocols, 

such as special transport considerations, whether the 

boot is left on or taken off, and equipment recovery issues. 

She is oriented to place but not to time or situation. Your 

rapid body survey reveals acute tenderness and swelling of the 

right mid-thigh and acute tenderness of the left hip and proximal 

left thigh. There is point tenderness of the lumbar spine. 

You note no other findings. At 1410: pulse, 122 and strong; 



YOUR NAME: 

4. What differences would you expect to see when assessing a 

pelvic fracture versus a proximal femur fracture 


Action Questions 

1. List the possible injuries or medical conditions the patient 

in this scenario may have experienced. Please provide your 

reasoning. 

SCENARIO 2 

It’s mid-afternoon on a cloudy and somewhat breezy day. The 

air temperature is 21°F. The attendant at the bottom of lift #4 

reports that a guest just skied into the snowmaking pond below 

the lift. You’re near the top of “Revenge,” a groomed expert run 

that ends alongside the #4 chair, so you indicate that you’ll 

respond. Upon making the hard right turn past the lift base, you 

see a young man waving his arms. He points down a short 

embankment to his two friends and tells you that the three of 

them were racing. His friend Joe was in the lead but couldn’t 

hold his line around the corner and went through a split-rail 

fence and into the pond. 

2. Describe, in order of priority, the emergency care you would 

provide for the patient in this scenario. Include any applicable 

patrol-specific protocols. 

3. Describe the scene management issues that exist within this 

scenario and how your patrol would deal with them. 

Near the pond you see two young men. One is lying on his 

side, with his head uphill and his feet at the edge of the pond. He 

is wet from head to toe and breathing deeply. The second young 

man is standing next to him and is wet from the knees down. 

The snowmaking pond is covered with a film of ice except for a 

10-foot swath where the skier went in. 

You identify yourself and ask the patient on the ground his 

name and if he is okay. He says, “Joe. I’m (expletive deleted) 

cold and my leg really hurts.” The skier who is standing says he 

is fine and that he pulled Joe out of the pond. 

Upon questioning Joe, you learn that he is 17 years old and 

determine that he is oriented times three. He is shivering hard 

and reports that he did not lose consciousness. Your focused 

survey identifies acute tenderness, swelling, and a mild lateral 

angulation deformity just above the left knee. Joe’s pulse is 116 

and strong, and his respirations are 20 and deep. Your rapid 

body survey does not reveal any other injuries. The distance 

from the edge of the pond to the split-rail fence next to the side 

of the run is about 15 feet and the slope is gradual with a few 

rocks and brush along the bank. 


YOUR NAME: 


1. What emergency care would you provide in a situation 

involving potential hypothermia 


1. What do you think has happened to the two skiers near 

the pond 

2. What are your chief concerns 


2. In an incident involving a potential knee and/or distal femur 

injury how would you immobilize the injury in the field 

3. What equipment would you request 

OEC, 4th ed., chapters 24 and 25 

4. Upon calling the aid room for assistance, how much help 

would you request Please provide your reasoning. 

3. Upon bringing Joe to the aid room, what procedures would 

you follow if advanced life support (ALS) is deemed necessary 

5. How would you proceed with the on-scene emergency care 



YOUR NAME: 

SCENARIO 3 

You are called to an incident at the top of an intermediate lift at 

your area. Upon approaching the scene, you find a middle-aged 

woman sitting hunched over in the snow, in obvious distress. 

There is a puddle of blood between her legs. She is crying with 

pain and tells you that she fell as she tried to exit the lift and 

landed very hard on her board, with her crotch smacking the 

snowboard binding. The woman further relates that her friend, 

who was sitting next to her on the lift, fell on top of her. She complains 

that her entire 

pelvis “just feels weird.” 

She denies any other significant 

injury. 

On assessment, compression 

of the pelvis 

elicits severe pain in the 

right groin. Providing for 

her privacy with the help 

of other patrollers who 

have now arrived, you 

expose the groin area and 

discover a deep laceration 

running across her right labia and into her upper thigh. Her left 

labium is extremely swollen (almost to the size of a small orange) 

and has a bluish discoloration. She has obviously lost a great deal of 

blood. Her initial vital signs are pulse, 120 and strong; respirations, 

20 and shallow. After five minutes, her pulse is 112 and still strong. 


1. List the components of the external and internal female 

genitalia. 

3. True or False: The internal, non-pregnant female genitalia is 

easily injured in trauma. Why 



1. What probable injuries are involved in this scenario 

2. What is an important question to ask this patient 

3. Describe, in order of priority, the emergency care you would 

provide for the patient in this scenario. 


2. What internal organ and anatomical structures does a pelvis 

fracture most frequently lacerate 

4. In what position would you transport this patient How 

might this position be different if she were pregnant 




Assessment and Evaluation 

This form is designed to help local instructors, patrol officers, and the OEC Refresher Committee review and improve the annual 

OEC refresher. Please take the time to make appropriate comments as you work through your refresher. Please “assess” at least six 

OEC stations. Give each station a “temperature:” Is it average, does it leave you “cold,” or are you “hot” to do more We greatly appreciated 

last year’s responses and look forward to receiving your feedback again this year. 

ONGOING ASSESSMENT 

Station Skill or Topic Instructor(s) What did you like best How would you improve Temperature 

Number Name about this station this station (circle one) 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Cold 

98.6 

Hot 

Please rate the following items using a modified AVPU Scale. 

REFRESHER EVALUATION 

Refresher Overall 

Awful Variable Praiseworthy Unequaled 

1 . . . . . . . . . . . . . . . .2 . . . . . . . . . . . . . . . .3 . . . . . . . . . . . . . . . .4 . . . . . . . . . . . . . . . .5 . . . . . . . . . . . . . . . . .6 . . . . . . . . . . . . . . . .7 . . . . . . . . . . . . . . .8 . . . . . . . . . . . . . . . .9 

Refresher Study Guide 


1 . . . . . . . . . . . . . . . .2 . . . . . . . . . . . . . . . .3 . . . . . . . . . . . . . . . .4 . . . . . . . . . . . . . . . .5 . . . . . . . . . . . . . . . . .6 . . . . . . . . . . . . . . . .7 . . . . . . . . . . . . . . .8 . . . . . . . . . . . . . . . .9 

Training Environment (Facility and Equipment) 


1 . . . . . . . . . . . . . . . .2 . . . . . . . . . . . . . . . .3 . . . . . . . . . . . . . . . .4 . . . . . . . . . . . . . . . .5 . . . . . . . . . . . . . . . . .6 . . . . . . . . . . . . . . . .7 . . . . . . . . . . . . . . .8 . . . . . . . . . . . . . . . .9 

Additional Comments: 

Please return this evaluation to the refresher instructor of record before you leave the refresher. 

NAME (OPTIONAL): 

PATROL: 

DIVISION: NUMBER OF YEARS PATROLLING: EMT OR PARAMEDIC NURSE OR M.D. 


2003 refresher 

❂ 

NATIONAL SKI PATROL ❚ OUTDOOR EMERGENCY CARE 

study guide 

Your Input Is Appreciated 

TThe National Ski Patrol is committed to offering the best possible training resources so that patrollers can provide the best possible 

patient care. The OEC Refresher Committee fully recognizes that the quality of this educational opportunity is dependent on the 

constructive and creative feedback we receive from the individual patroller. The OEC Refresher Assessment and Evaluation offers you 

the opportunity to give us that feedback. 

❚ Reflect on the OEC refresher activities you just completed. 

❚ Fill out the OEC Refresher Assessment and Evaluation. Remember, your responses should be oriented to the OEC material covered. 

❚ Feel free to offer training ideas and suggestions. They may shape future training. 

❚ Please contact any of the National OEC Refresher Committee members or OEC supervisors (listed below) or the NSP national 

office (online at education@nsp.org) if you have additional concerns or questions. 

❚ Remember, the quality of your refresher hinges on your input! 

NATIONAL OEC REFRESHER 

COMMITTEE 

John Dobson 

Wintergreen Patrol 

Route 1, Box 525 

Roseland, VA 22967 

(434) 325-1024 

jdobson4@aol.com 

Nancy Pitstick 

Brighton Patrol 

1579 E. Parkridge Dr. 

Salt Lake City, UT 84121 

(801) 943-7609 

npit@sisna.com 

Cathy Setzer 

Boyce Park Patrol 

36 Northgait Dr. 

Slippery Rock, PA 16057 

(724) 458-5451 

cvsetzer@zoominternet.net 

Brigitte Schran 

Summit at Snoqualmie Central 

Patrol 

21704 141st Ave. S.W. 

Vashon Island, WA 98070 

(206) 463-3447 

rowyn@blarg.net 

Stephen Francisco 

June Mountain Patrol 

4933 Noeline Ave. 

Encino, CA 91436-1214 

(818) 389-1661 

stazski@aol.com 

Thom Rabaglia 

Devils Head and Cascade Patrols 

W 10990 Lakeview Dr. 

Lodi, WI 53555 

(608) 592-7397 

thomas.rabaglia@dot.state.wi.us 

DIVISION OEC 

SUPERVISORS 

Alaska Division 

Paul Brooks 

PO Box 111252 

Anchorage, AK 99511-1252 

(907) 346-2938 

pdbrooks@gci.net 

Central Division 

Deb Endly 

2300 Overlook Dr. 

Bloomington, MN 55431 

(952) 884-8126 

ezcompany2@msn.com 

Ed Humphrey 

315 Center St. 

PO Box 143 

Miamiville, OH 45147 

(513) 831-0344 

ehumphrey@cinci.rr.com 

Mary Griffin 

2739 Bowers Harbor Rd. 

Traverse City, MI 49686 

(231) 223-4428 

skigolfemt@aol.com 

Eastern Division 

William F. Halsey 

3586 Whistlestop Ln. 

Elbridge, NY 13060 

(315) 689-7335 

ezsailin@twcny.rr.com 

Edward C. McNamara 

103 Flanagan Hill Rd. 

Sterling, MA 01564 

(978) 422-8016 

emcnamara@cmemsc.org 

Paul Tracy 

148 Allwood Rd. Unit 4A 

Clifton, NJ 07014-1616 

(973) 472-0327 

Dennis A. Zercher 

4035 West Market 

York, PA 17404 

(717) 792-2121 

zerden@juno.com 

European Division 

Lynore Ward 

CMR 480 Box 1111 

APO, AE 09128-1111 

0049-711-680-4372 

lward@t-online.de 

Far West Division 

Sandra Jo Bradley 

1798 Fairhaven Ct. 

Oakley, CA 94561 

(925) 625-8646 

nspsam@aol.com 

Douglas Hill 

9072 Biola Ln. 

Garden Grove, CA 92844-2204 

(714) 638-2103 

dch@cadwest.com 

Intermountain Division 

Greg Bala 

2857 W. Meadowlark Ln. 

Idaho Falls, ID 83402 

(208) 522-2710 

Bala@srv.net 

Northern Division 

Lisa Ellis 

1010 Bonnie Brae 

Casper, WY 82601 

(307) 472-7017 

lisaellisoec@aol.com 

Pacific Northwest 

Division 

Kathy Alexander 

19409 Cherokee Rd. 

Bend, OR 97702 

(541) 382-0044 

kat@bendcable.com 

Elizabeth Dodge 

18808 Wallingford N. 

Seattle, WA 98133 

(206) 525-8946 

dodger@ix.netcom.com 

Professional Division 

Leif Borgeson 

133 S. Van Gordon St., Suite 100 

Lakewood, CO 80228 

(303) 988-1111 

lborgeson@nsp.org 

Rocky Mountain Division 

Ann Gassman 

PO Box 4449 

Dillon, CO 80435 

(970) 468-5599 

anngassman@juno.com 

Southern Division 

Judith Kay-Monaghan 

5966 Norham Dr. 

Alexandria, VA 22315 

(703) 971-7841 

jkaymonaghan@aol.com 

Canada 

Suzanne H. Kenney 

#207-1460 Pemberton Ave. 

Squamish, BC 

BC VON 3G0, Canada 

(604) 892-1029

2003 refresher - National Ski Patrol

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