Are you prepared for winter sports injures?
Are you prepared for winter sports injures?
The tragic deaths of Sonny Bono and Michael Kennedy last season brought winter sports injuries to the headlines, but EDs in many regions see an increase of these injuries each winter season. "The National Electronic Injury Surveillance System reported that there were 45,000 sledding injuries each year in the United States that require ED treatment," notes Lisa Bernardo, RN, PhD, assistant professor at University of Pittsburgh School of Nursing (PA).
Each year, there are 50-60 million visits to slopes by downhill skiers, and for every 1000 visits, three will result in injury serious enough to require immediate medical care, notes Valerie Neylan, MD, FACEP, associate residency director at University of Illinois Hospital in Chicago. "Also, as many as 40% of alpine ski related injuries of minor severity are never reported to a physician," she says.
One study reviewed statewide data on sled injuries for a five-year period.1 "We thought about studying sledding injuries because we do see quite a few such injuries in our ED each winter, and we wondered if other trauma centers saw the same types of injuries," Bernardo says.
The study found that 226 children aged 2-18 years were admitted to trauma centers for sledding injuries, and the majority of patients were male. "The average ICU length of stay was 1.2 days, and the average length of hospital stay was seven days," says Bernardo. "Almost half of the ISS scores were considered moderate severity. There were seven children who died from sledding injuries; most died from being struck by moving vehicles."
The four most frequent injury circumstances were hitting a trer, hitting a stationary object, being struck by a moving vehicle, and falling from the sled. "Many children sustained head and chest injuries. By far, children hit by moving vehicles had more severe injuries, especially to the head and face," says Bernardo.
Here are some ways ED nurses can prepare for winter sports injuries:
Be prepared for sled injuries. "ED nurses should be prepared for such injuries and should be alert to signs of head, chest, and abdominal injuries, including shock," Bernardo recommends. "Being alert to signs of low body temperature from exposure to the cold is another consideration," she says. "Also, the psychosocial concerns of the child and family, such as guilt and anxiety, especially when hospitalization is necessary, should be addressed."
Expose the child to ascertain the extent of the injuries, while being alert to signs of internal bleeding from blunt force chest and abdominal trauma, says Bernardo. "Keeping the patient warm during the ED treatment would help to promote comfort as well. Keeping the parents and children involved in their care and current on ongoing treatments is also important," she notes.
Have prevention materials available. "ED nurses can help prevent sledding injuries by having printed sledding prevention materials available in the ED, such as a poster board or printed pamphlets in the waiting room or treatment areas," says Bernardo. (See "Sled Riding Safety" prevention tips on page 55 of this issue.)
Be a guest speaker. "Volunteer to speak at schools and parent-teacher groups on the dangers of sledding and how to sled safely," suggests Bernardo.
Participate in local media stories. "Most TV and radio stations need to provide free public service announcements for a certain amount of hours ," notes Warren Crow, RN, CCRN, MICN, director of CareLink Mobile Critical Care in Greensboro, NC. "Provide them with some prevention tips for winter. It can be as simple as writing a letter to the editor of a local newspaper. The letter may never be printed but ends up on a reporter’s desk as a possible feature. Explain that you are an emergency nurse, this time of year you see so many winter injures, [and] here are some very simple things that would prevent them."
Know what type of injuries to expect. "There are different injury patterns for different sports," notes Crow. "Skiing injuries tend to cause knees and lower extremity, or hand/thumb injury due to inappropriate use of ski poles. Snowboarding tends to primarily cause upper extremity injuries, such as wrists and ankles."
Skiing injuries at speeds as low as 20 mph can be fatal, notes Neylan. "Collision accounts for 5% of all injuries on the slope, but accounts for more than 60% of all hospital admissions. High speed collisions with immovable objects like trees, support towers, or machines, can lead to fatalities, as with Kennedy and Bono," she says. "According to the National Safety Council, there were 36 skiing deaths in the 96-97 skiing season nationwide."
Sledding is generally considered a benign sport, but injuries are common, says Neylan. "The most common injuries are lacerations, followed by contusions and sprains," she notes. "Serious injuries occur in as many as 20% of sledding injuries. Tobogganing produces injuries to lower extremities because of [participants being in the] seated position."
Prevent winter sports injuries
You can do a lot to prevent winter sports injuries from occurring, says Crow. "Prevention and education is important. If you are located in winter recreational areas, do whatever you can to remind people of the basics of safety," he recommends.
Make sure equipment is in good condition. "Skiers should have their binders appropriately adjusted and get them checked every season. A lot of people forget to do that," says Crow. "Most places that sell skis will be glad to check your equipment, and they are the experts. I encourage people to start thinking about getting them checked on Labor Day weekend, because if you wait until the day before you want to go skiing, you may never do it.
If the binding is too tight, it will not release under force and can seriously damage the knee, notes Valerie Neylan, MD, FACEP, associate residency director at University of Illinois Hospital in Chicago. "Failure of the release mechanism accounts for 43% of downhill skiing injuries, and 70% of lower leg fractures and serious knee injuries," she says.
The type of boot used is important, says Neylan. "Some of the newer boots have prevented many ankle and foot injuries," she notes. "Over the last 25 years, tibial fractures were reduced 72% and fibrial fractures 43% by improved boot design. The low boots that are used in cross country skiing don’t support the ankle as well. Ankle movement is freer and absorbs more stress, so [the ankle is] more susceptible to injury."
Remember to stretch. "Stretching exercises are important. This is something that teenagers always forget," says Crow. "Younger kids are more active but teens aren’t as active, so we start seeing adolescent knee injuries. Remind them to take time to stretch out."
Don’t use streets for sledding. "Encourage people not to use the streets for sledding. If you do, the streets should be closed to traffic by their municipality," says Crow.
Use a steerable sled. Steerable devices like sleds are safer than tubes and cardboard boxes, says Crow. "Many sleds that are on the market now cannot be steered effectively," he notes. "Help parents and children to understand that once you are going down a hill, you have little ability to maneuver."
Don’t sled down an incline onto water. "People think there is firm layer of ice there and will sled out onto the ice," notes Crow. "But the reality is, the further out you get, the thinner the ice layer is, and the sled can carry you a long way."
Wear layered clothing. "Teach people that multiple layers are better at retaining heat and will help keep muscles loose," says Crow. "Putting on two or three layers of thin Goretex keeps muscles warm. You certainly want to prevent any hypothermia to your digits and nose, which are areas that get neglected.
Use sunscreen. "Put sunscreen on any exposed skin," Crow advises. "Two years ago you couldn’t find a sunscreen product at a ski resort, but it has become very prevalent. On a bright day, the UV rays can be very damaging to any skin which isn’t covered. A lot of people apply lotions as a wind protector, when they should actually be using sunscreen."
Get proper hydration. "Because it’s cold, people tend not to drink as much," Crow says. "If you’re on the slopes or at a snowboard park, you may have to stop children and say, it’s time to take a drink and eat appropriate snacks,’ something that has some good carbohydrates in it. Kids get so excited by winter sports that they don’t do that."
Know your level of expertise. "Nearly 50% of snowboarding injuries occur in beginners, and a major factor in skiing injuries is experience level. A novice has 2 to 3 times the injury rate to an experienced skier," notes Neylan. "Skiers who get injured are often going too fast for their level of expertise and the conditions. Take lessons to learn proper technique, and master the appropriate slope before going to a higher level."
Avoid alcohol and fatigue. "Most skiing injuries occur in the afternoon when people are tired and hungry. The last run of the day is the most dangerous, when most accidents happen, so recognize your physical limits," Neylan advises. "When an individual has consumed alcohol, injuries tend to be more serious as alcohol consumption prevents the skier from being able to concentrate, so they are more predisposed to cold injuries."
Reference
1. Bernardo L, Gardner M, Rogers K. Pediatric sledding injuries in Pennsylvania. J Trauma Nursing 1998;5:34-40.
Sources
For more information about pediatric sled injuries, contact the following:
• Lisa Bernardo, RN, PhD, University of Pittsburgh School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261. Fax: (412) 383-7293. E-mail: [email protected]
• Warren Crow, RN, CCRN, MICN, CareLink Mobile Critical Care, 1034 E. Lindsay St., Greensboro, NC 27405. email: [email protected]
• Valerie Neylan, MD, FACEP, University of Illinois Hospital, 1740 W. Taylor, Suite 1600, Chicago, IL, 60612. E-mail: [email protected]
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