Before I joined ski patrol as a patroller, some of my physician friends were medical associate members and I felt like that would be the natural course for me. Medical associate members are integral to the ski patrol, though they are not usually involved in the transportation of patients on the mountain; they instead staff an urgent care clinic on the mountain with their wealth of medical knowledge. These members are typically family medicine, sports medicine, or emergency medicine physicians. I decided that I would rather be out skiing and learning new skills and decided to become a patroller. Instead of being in a stuffy office and waiting for patients to come in, I was learning how to handle a toboggan, improving my skiing, setting up ropes and signs, learning avalanche control, and personally relished all the secret powder stashes on the mountain. It is quite enjoyable to ski from the first chair in the morning until the last chair in the evening. If you are thinking of joining a patrol, either as a patroller or a medical associate, I’ll share my experience and start with some definitions:

A ski patrol is a group of like-minded individuals who like to ski or snowboard and to help others. If you like these things, then patrolling may be something for you to look into. To become a patroller, one must find a host patrol to join and train with. Persons in training are considered candidates or Associate Members. Once training is completed, then they become full patrollers. Over 600 patrols are located in the US, Canada, Europe, and Asia with more than 30,000 members; 98% of all patrollers in America are members of the National Ski Patrol (NSP). There are different types of memberships defined by the NSP:

Membership Categories

Associate Member- An individual who has a need or desire to take National Ski Patrol courses and be associated with the National Ski Patrol.

Patroller- A person who provides emergency care to injured or ill area guests; also may be responsible for a wide variety of area safety activities. (A skiing or snowboarding position).

Nordic Patroller- A person who provides emergency care to injured or ill area guests; also may be responsible for a wide variety of area safety activities (A skiing position).

Auxiliary Patroller- A person who provides emergency care to injured or ill guests, but may not transport guests off the hill/slope; may help lead training and education activities. (Skiing or snowboarding skills are helpful but not always mandatory.)

While most potential members join as candidates to become ski (or bike) patrollers, other ways to join National Ski Patrol include:

EMT or Paramedic - if you wish to be part of a patrol, you can join with modified training requirements.

Physician Partner - volunteer physicians (M.D. or D.O.) who assist with Outdoor Emergency Care training and general medical training of patrollers; not required to provide emergency care or on-hill patroller duties.

Mountain Host or Bike Host - for those interested in becoming a patroller, hosts are trained as first responders through an NSP first aid course. 

A National Ski Patrol member is typically a “person willing to work hard, devote many hours, and continually enhance personal knowledge and skills.” In wilderness medicine communities, these traits are nearly ubiquitous among us. To become a patroller, one must complete at least two elements of training; OEC certification, and the ski and toboggan test (Outdoor Emergency Transportation, OET). Each individual patrol may also have additional training that they require for their area.

The OEC manual, now in its sixth edition, is the national standard of training for ski patrollers. It contains introductions to emergency medical systems (EMS) in the US, and takes you through rescue basics like lifting, triaging, patient assessment, and communications. There are chapters in the manual describing airway management, cardiovascular emergencies, anaphylaxis, shock, musculoskeletal injuries, and many more. In order to obtain this certification, one generally takes a 12-16 week course, a written exam, then a standardized practical exam with patient scenarios (including transferring patients to a higher level of care) to demonstrate competency. This may or may not be offered at your individual patrol and travel may be required to attend these courses. If you have substantial patient care experience, defined as a current EMT/Paramedic, MD/DO, PA/NP, or RN/LPN, then there is an option to challenge the practical exam without having to go through the whole OEC course, but it’s beneficial to take as many classes as possible so you’ll practice working with other trainees.

There is also the skiing and toboggan handling test OET, which must be done through your own patrol. An OET evaluator will need to observe your skiing/boarding and toboggan handling skills; once you have passed OEC and OET, you will be registered as a patroller through the NSP website. Some patrols offer a mentoring program for first season patrollers before they are cut loose on their own. Advanced certifications that may be obtained through the NSP include:

Advanced Certifications

Senior Patroller- NSP members who aspire to the upper levels of skiing/snowboarding and Outdoor Emergency Care proficiency. Three options; Senior, Alpine Senior, and Nordic Senior.

Certified Patroller- The highest level of certification for alpine patrollers. Includes independent study and testing on 6 core competencies; Avalanche, Low angle lift evacuation, OEC, Outdoor Risk Management (ORM), Skiing/Riding, and Toboggan.

Nordic Master Patroller- NSP members who aspire to the upper levels of nordic/backcountry patrolling; equipment types, patient care knowledge required, and backcountry survival skills.

The main purpose of patrollers is to assist in caring for injured skiers/boarders and making mountain recreation safer and more fun for everyone! Patrollers are well-respected members of the outdoor industry who do good every day. At many mountain resorts, nordic centers, state and national parks, and other areas of winter recreation, there are paid patrollers, and unpaid patrollers, who are volunteers. No matter what type of patrollers we are, as we challenge ourselves, skills are perfected. As we patrol together, our friendships are strengthened.

Benefits

Whether you’re a volunteer or paid patroller, some resorts may offer free season passes for your entire family, others just offer one for you personally. Either way, you get to ski or board for free on our off-duty days, and you get to help others with your medical knowledge. That’s a win-win scenario! I also saw the quality of my professional work improve while gaining a lot of fulfillment helping others, skiing, and teaching my three kids to ski.

Medical Calls

Please keep in mind, this was my first season as a patroller. I don’t know if my future years will resemble the first, but they might. One of my first calls was near the bunny hill and we had a hyperventilating, screaming 10-year-old boy hugging his left arm which was also crossing his torso. He was inconsolable and wandering around without any parents and I wasn’t able to get much of a history. Another patroller found his mother and I assessed his clavicle–it appeared to be a fracture and I wrapped him with two triangle bandages. After locating his mother, we were able to gather the necessary information and instead of taking him to the first aid room, we sent him on his way in a personal vehicle to seek a higher level of care than we could provide because it appeared to be a closed fracture.

I also truly enjoyed utilizing basic medical evaluation skills. For me, this is defined as medicine without the use of expensive tests, basically just your hands and the information you have in your brain–essentially wilderness medicine. Being trained in pathology, I have not had the opportunity to rely on physical diagnosis skills as much as I have on the mountain; it is very fulfilling to use these skills for the benefit of the patient and the patrol. There were more minor injuries that I was able to help with, including the son of our dispatcher who fell and hurt his hand. I carefully evaluated it and with the help of a fall on outstretched hand (FOOSH) history, pinpointed what I thought was likely a small fracture in his capitate. I mentioned this with the disclaimer that I don’t have x-ray vision, but that’s what this smells like to me. Later, our dispatcher told me that he had indeed fractured his wrist and showed me the x-ray on her phone, which demonstrated a capitate fracture. It felt good to know my skills hadn’t fully deteriorated as a pathologist.

We also had two fairly serious medical events this year that involved Life-Flight; the first was a lacerated spleen and multiple rib fractures, and the second was a femur fracture. Both were injuries sustained by novice skiers unable to stop or slow in expert/intermediate terrain that they shouldn’t have been on.

I am confident that doing this experiment was one of the best things I have ever done. I recognize that my experience was overwhelmingly positive and in my short tenure on the patrol, I haven’t yet heard of a single patroller who quit because they didn’t like it. I also see the world through rose-tinted glasses, but I’m fine if that’s the curse that I have to live with. I feel like I’m using my skills and living life to the fullest. If you love to ski or board, I would strongly recommend exploring the possibility of joining a patrol in whatever capacity best fits you.

Many patrols hold their OEC courses in the fall, with OET training done “on-the-hill” during the winter season. Some patrols initiate training candidates with OEC, while others require passing OET before the medical training begins. If you’re thinking about becoming a patroller, start to inquire at your local patrol today!