Remote First Aid

First Aid Advice for Skiers and Riders

What You Need to Know Part 2: Altitude, Impact and Dehydration.

To continue our coverage on first aid tips for winter sport related ailments, we look at some not so uncommon problems and useful tips to avoid injury, and provide slope-side assistance. Remember, it is always best to seek professional medical help. But if you’re in a remote area where help is not available, the following suggestions can make a world of difference.

High altitude/dehydration

Heading from sea level to the high mountains presents skiers with a classic “double whammy” – less oxygen and increased risk of dehydration – and requires an adjustment period. Add greater exposure from the sun, and the dangers that altitude pose become very real.

“High altitude is a significant factor” for potential injury, said Dr. Bojan Zoric, former physician for the US Ski Team. “It diminishes your athletic ability by 20 to 30 percent. You really have to pay attention to that fatigue factor, and that dehydration factor.”

Furthermore, visitors to high-altitude resorts should take caution to limit their alcohol intake when they first arrive in town (admittedly not an easy task if you’re on vacation). In the worst-case scenario, you can ruin a multi-day outing by hitting the hill, and après ski activities, too hard too quickly.

“There, you’re just dehydrating yourself more,” said Zoric. “And you probably didn’t sleep very well. It’s a recipe for disaster.”

The key is to ease into your high-altitude escape. Give your system time to acclimate. Drink often, but avoid coffee, alcohol, and other diuretics.

Impact injuries

Skiing combines a slippery surface and speed. That mixture is a classic setting for accidents, whether between skiers, skiers and immovable objects (like a tree or padded tower), or just catching an edge. My daughter Maddi once got body slammed simply by making the mistake of looking back just as her skis hit some soft, spring snow (classic mashed potatoes). The skis grabbed, and her momentum sent her cartwheeling, ending her day (we did have the Ski Patrol staff check her for a possible concussion, but fortunately she was just shook up).

For impact injuries, I employ the procedures I learned taking a basic CPR (cardio-pulmonary resuscitation) course. First and foremost, remain calm: A clear mind and a quiet demeanor is essential to help the injured person relax. I prefer the acronym DR. ABC, which stands for Danger, Response, Airway, Breathing, and Circulation. Here’s how each step breaks down:

Danger. Whether the injured skier is part of your group, or someone you come across, you want to have someone contact Ski Patrol without delay. Then assess the situation, making sure that you, and the injured skier, can be seen from uphill to avoid further accidents.

Response. Evaluate the injured person by asking them to describe how they feel. You can often gauge the severity of the injury simply by their response, including whether they’re conscious and/or coherent. If they can’t respond, proceed quickly to steps A, B, and C.

Airway. Make sure the victim’s airway is open by tilting the head back with the chin facing up.

Breathing. Make sure that the victim is breathing. Listen for exhales, feel for air coming out of the mouth or nose, or look for a rising chest.

Circulation. Check for a pulse and visual signs of circulation, including a healthy complexion and blinking of the eyes.

The information you gather through this assessment – especially if the victim is cognizant and can describe how the accident occurred and what their pain level is – can be a huge benefit to the Ski Patrol staffers once they arrive. If there’s a delay, make every effort to keep the injured skier or snowboarder calm, warm and still. This can be easier said than done, especially if the accident victim is in a great deal of pain.

If you suspect a spinal or head injury, don’t attempt any movements. If it’s an extremity, such as an arm, wrist, or leg, immobilize the injured body part (ski poles make great temporary splints) and elevate it to reduce swelling. Apply compression and ice only if you can keep the rest of the body comfortable while doing so. If the victim is bleeding, apply pressure to the wound, and a tourniquet to stem further blood loss.

These are relatively high-level actions, and there is no substitution for a fully trained medical professional. But in the moment, swift, assured action can prevent an injury from becoming more severe. And if you have the chance to take a CPR course, do it.


Last, hypothermia is a particular concern for backcountry skiers. Hypothermia, as defined by WebMD, can occur when “the balance between the body’s heat production and heat loss tips toward heat loss for a prolonged period.” Accidental hypothermia usually happens after cold temperature exposure without adequate clothing.

These days, specialized, high-tech gear designed for windy, icy environments at altitude can be found at reasonable price points. So if you’re heading to the high country, dress appropriately.

However, keep in mind that hypothermia can still occur in milder environments, according to WebMD, depending on a person’s age, body mass, body fat, overall health, and length of time exposed to cold temperatures. Tell-tale signs include shivering, which may stop as hypothermia progresses (shivering is a sign that a person’s heat regulation systems are still active), slow, shallow breathing, confusion and/or memory loss, drowsiness or exhaustion, slurred speech, loss of coordination, fumbling hands, stumbling steps, and a slow, weak pulse. In severe hypothermia, the victim may be unconscious.

If Ski Patrol isn’t available, move the victim carefully to a warm, dry shelter as soon as possible, removing any wet clothes, hats, gloves, shoes, and socks. Protect the person against wind, drafts, and further heat loss with warm, dry clothes and blankets. Use your own body heat if necessary, and offer warm liquids, while avoiding alcohol and caffeine, which accelerate heat loss.

If the hypothermic person is unconscious, call for help right away. CPR should be given immediately if you can’t find a pulse and there is no sign of breathing. However, be sure to feel for the pulse for an entire minute before starting CPR, since the heart rate may be extremely slow. Don’t start CPR if there is a heart beat present. In the absence of signs of breathing or a pulse, continue CPR until Ski Patrol or backcountry rescue members arrive.

Related Posts:
First Aid Advice for Skiers: Part I
Skiing Advice for Intermediates
Skiing Etiquette
How to Find a Ski Partner