Chapter 1: Intro to Outdoor
Emergency Care
Birth of Patrol
• 1936 – Minnie Dole breaks his ankle at Stowe,
waits at the top for 2 and a half hours, and
ends up sledding down on part of a tin roof,
unsplinted, and realizes, “hey, there should be
someone there to make sure things like that
don’t happen. Maybe someone to patrol the
mountain..?”
• A star is born!
Patrol at War!
• WWII – NSP (Nat’l Ski Patrol) initiates the first Air
Force Search and Rescue units, complete 52
missions
• Minnie Dole convinces US Army chief of staff that
the army needs dope skiers who can shoot while
they ski (Pierce Brosnan style), so Army creates
what eventually becomes the 10th Mtn. Division
• ’44 – 10th goes to Europe, runs train on Nazi’s and
playerhaters jealous of our unbelievable skiing
Meaningless Patrol History….
• ‘39 – NSP works with American Red Cross
• ’88 – OEC first developed by Dr. Warren Bowman
• Bowman creates idea of “intermediate care,” which is
what we practice. (write that down, actually)
• Intermediate Care – providing care for a patient in a
wilderness situation, continue during transport
(toboggan, generally speaking), and further continue
care in a first aid room or Patrol Hut.
• Then, patient -> hospital. We are the intermediaries
between the injury and the hospital, where the patient
will receive the rest of his medical attention, thus
“intermediate care”
OEC Today
• OEC = primary curriculum taught to first
responders worldwide, “gold standard” of
emergency care in nonurban environments
• Middlebury teaching of OEC = waaaaay chiller
than standard
Training Overview
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First: Patrol Basics
2nd: Human anatomy and physiology
3rd: Assessing patients
4th: Providing care to the patients (which
involves “practicals” – basically practicing
what you would do to actually help people)
Oh, the places you’ll go (and things
you’ll know). How to:
• Assess safety, and maintain it at a rescue scene
• Use proper techniques to prevent unprotected contact
with body fluids
• Assess a patient’s level of responsiveness
• Establish and maintain an airway
• Assess respiration and provide adequate ventilation
• Control bleeding
• ID and address life-threatening problems
• Save lives!!!!!
• And more: p. 10 of the book.
Certification
• To receive OEC certificate of completion, OEC
candidates must successfully complete the
OEC course (obvi)
• Includes: written exam, and practical exams
• To be a Midd Patroller, also includes: Midd
written exam (much more stringent than the
OEC)
Ethical Issues
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Respecting Autonomy (patient’s choice to refuse care)
Do no harm (nonmaleficence) - standard.
Benefit others (beneficence) – standard.
Be just – balancing the rights of the indiv. Vs. those of
others (drunk/disorderly patients and the safety of
those around them)
• Be faithful – loyalty to your fellow patrollers, loyalty to
a patient (not leaving them..)
• Be cool – in every situation, ask “what would Luke
Rahlson do? Then don’t do that
Good Samaritan
• Ski Patrol viewed as “good samaritans”
(people who help other people but expect
nothing in return)
• Therefore, how are we protected from legal
harm? Good Samaritan Laws
Good Samaritan Laws
• They protect patrollers – we’re not liable for any act or
omission in giving any assistance or medical care if:
• 1 – the act of omission is not one of gross negligence
(pretty impossible to become a Midd patroller if you’re
“grossly negligent”
• 2 – the assistance or care is provided without fee or
other compensation
• 3 – the assistance or medical care is provided at the
scene of an emergency, in transit to a medical facility,
or through communications with personnel providing
medical assistance
Gross Negligence
Gross Negligence
• “An intentional failure to perform a manifest
duty in reckless disregard of the consequences
as affecting the life or property of another,
and it also implies a thoughtless disregard of
the consequences without the exertion of any
effort to avoid them. Gross negligence can
also be considered a wanton or reckless
disregard of the injured person by the
rescuer.”
Doctrine of Public Reliance
• When in uniform, OEC technicians are
expected by the public to come to a patient
and provide care when someone is
injured/needs help
• Therefore, the public relies on us, and we are
legally bound to provide assistance to a
person in need of such care, unless such an
action places the safety of the rescuer (you) in
doubt
Legal Terms
• Abandonment: leaving a patient before either
you’ve finished providing care, they have been
transported to a hospital, they’ve asked you to
cease providing care, or continuing such care
places the rescuer (you) in harm’s way
• Negligence: performance below standards of
training
• Breach of Duty: failure to perform a promised act
or obligation of due care
• Duty to Act: a person’s legal obligation to provide
something to another individual
Assumption of Risk
• When a skier/boarder/TELE-ER!!!!! Chooses to
participate in a totally extreme winter sport,
they assume that the sport has inherent risks.
• So, if they get injured, it is officially their fault.
Documentation
• Part of being a patroller is filling out paperwork
during and after providing care. Sucks, but it’s
necessary in order to:
• A) prevent you from getting sued,
• B) establish and maintain an accurate record of
events,
• C) give other medical care providers an accurate
picture of the patient’s state, and the severity of
injuries sustained
• So do your paperwork, do it well, and that way,
its all good baby baybaaaaay
Scope of Training
Scope continued…
• OEC = standard of training
• Standard of Care: set by local protocols
• So, we train you to be able to be the chillest
possible, and you follow local protocols to
know to what degree you provide care
• Because other “level of care” providers (i.e.
doctors) may be better able to perform more
advanced procedures – who wants to see RD
perform complicated surgery?
• Me, actually…
Joint Statement of Understanding
• When patrolling, you are patrolling as an
“agent” of the ski area, and not on behalf of
the NSP.
• So, NSP doesn’t control the Patrol activities of
the bowl.
• Steve does.
Consent
• Before providing care, we need to obtain consent. “May I help
you?” “Pleeeeeaaaaaaase?”
• Expressed Consent: consent given when a competent injured
person gives permission to provide first aid treatment and
transportation
• Informed Consent: consent given by a patient in full knowledge of
the facts, implications, and possible future consequences of
treatment (feeling “all better”)
• Minor Consent: consent from parent or legal guardian to treat a
minor
• Implied Consent: when someone’s unconscious, or unable to give
consent, consent is implied. When you come across people off duty,
snoozing in the bottom hut, you do not have implied consent to
mess with them, but taking pictures is OK
Refusal
• Patients can refuse care, so if they refuse then
document it, get them to sign it, and let them
do their own thing
• If someone is in life-threatening condition, it’s
usually best to provide treatment. The legal
risk of not providing treatment outweighs the
legal risk of not listening to them
Assault and Battery
• Assault: placing somebody into a position
where he or she reasonably fears that battery
will occur
• Battery: the act of touching someone without
his or her consent
Privacy
• What happens at the bowl, stays at the bowl.
• For real though, you need to keep medical
information about injured persons private
• Don’t tell people’s dirtiest secrets, like what
Luke Rahlson keeps under his bed…
Teamwork
• Work as a team. nuff said.
Homework
• Survivor.
• Wednesday nights, 8/7 central, the material
will be tested….
Thanks
• Photo cred to Kate, Chloaaay, and Laura
Newman