title: Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage?
abstract: BACKGROUND
  Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols.
  
  
  METHODS
  Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern.
  
  
  RESULTS
  Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001).
  
  
  CONCLUSIONS
  The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority.
authors.affiliation: Dept. of Emergency Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hasler
authors.affiliation: Dept. of Trauma and Reconstructive Surgery, University of Greifswald, Greifswald, Germany.
authors.forename: Uli
authors.initials: U
authors.lastname: Schmucker
authors.affiliation: Dept. of Orthopedic Surgery, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Evangelopoulos
authors.affiliation: Dept. of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, USA.
authors.forename: Ron E
authors.initials: RE
authors.lastname: Hirschberg
authors.affiliation: Dept. of Emergency Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.affiliation: Dept. of Emergency Medicine, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos