Hello All!
This will be the last email update/education for the 2025-26 season. What a weird year… But hey, you play the cards you’re dealt.
Thank You!
Thank you for all of your attention, interest, and commitment to becoming better medical providers this year. We began the year with totally new protocols and your critical reading, application, questions, and feedback on those helped to refine the initial protocol document into a foundation that we can use and improve year on year.
I’m honored to be a part of your organization. Your expertise, experience, and investment in your job makes it a real pleasure to be your medical director. I hope that you felt supported, and if there is anything that I can do over the summer or during the next season to improve the service that I’m providing, please let me know.
Learnings from the Year
Cooperation
Working with other services is hard. We’re all trying to do the best we can with what we have, but sometimes coordination with clinic or EMS providers is challenging. We’ve developed a good flow with the new St. Charles clinic, and we’re working to keep coordination with our ground EMS partners smooth. In any setting, doing what you think is best for the patient, and doing it in an impeccably professional way, is always defensible.
Resuscitation Priorities
ABCs or CABs, take your pick, but when dealing with a “big sick” patient, it’s critical to get the access you need to manage a patient’s airway or control critical bleeding. Sometimes this means urgent patient repositioning. You can’t work well in the bottom of a hole or up against a tree. Take the 30-60s you need to reposition the patient so that you can deliver quality interventions.
Spinal Motion Restriction
Hard boards and hard collars for all trauma patients are going the way of the dinosaur. Backboards should be thought of as patient spatulas, and we want to get patients off of them as soon as we can. Securing a patient in a toboggan or on a gurney with adequate padding is perfectly good for restricting spinal motion in most patients. Use extra caution in those with neurological complaints or deficits.
Scene Leadership
In both training and in our complex Code 3 & 4 calls, having an experienced patroller in a hands-off, scene direction role can help a scene to run very smoothly. If you’re part of one of these scenes, be clear about whether you’re narrowly task focused (“I’m the airway provider”) or in a leadership role (“I’m in charge of the big picture”).
Neurogenic Shock
Patients with high spinal injuries can develop hypotension and bradycardia along with their neurological symptoms. Be wary of this possibility in any patient experiencing symptoms of significant weakness or paralysis after traumatic injury. Supporting blood pressure with judicious use of IV fluids and epinephrine is the best way for us to help protect these patients’ chance of recovery.
Airway Micro-Skills
It takes training and attention to become excellent at using CPR masks, OPAs, NPAs, and particularly BVMs. Be intentional about training your familiarity with these interventions and how you plan to use them on a critical patient. This isn’t an algorithm that you want to learn on the job.
New Directions
While this year was a great start, I have some priority areas to target over the summer. If there are other topics that you think need another look, please let me know!
Head Injury
Which patients need to go to the clinic or by EMS? Who can go home with their family member by private vehicle? These decisions are challenging, and the protocols don’t currently offer great guidance. This is gristle I’ll be chewing all summer.
Pill Packs
We introduced these this winter in startup style -> move fast, break stuff. I learned that we’re not able to buy in bulk an separate (that’s a pharmacy’s job), and apparently, people need water to swallow pills. So this needs a bit of ironing out. I have a dream of adult-sized chewables and clear-cut age/size limits on who we can dose.
Protocols vs Guidelines
There’s some thinking that the use of “protocols” is too limiting. Situations are always dynamic and always different. Though it seems like sematics, I’m considering transitioning the guiding document to “clinical care guidelines” or similar, to acknowledge that there isn’t always a “right” way to do something.
Closing
Thank you again for all you did this year. I appreciated working with you, teaching you, skiing with you, and working in the clinic alongside you. I hope that you’ve all planned some well-deserved breaks and time away before diving into your summer work. For those of you on Bike Patrol, I’ll see you in June for refresher. For the rest of you, I hope to see you again next Fall!
Don’t hesitate to reach out to me with any questions, thoughts, feedback, or needs. Any time, all summer.
Best,
Patrick
Big Mountain Medical 