Abstract
The National Ski Patrol (NSP) used the American Red Cross Advanced First Aid (AFA) course until 1987 (phased out in 1993) to train patrollers in emergency care. Skills illustrated in the AFA textbook include 21 bandages, 16 splints and slings, 14 emergency lifts and carries as well as several automobile extrication techniques, and 2 methods for lowering a patient on a backboard from a high building or cliff. 1 AFA students practiced backboarding not only on land but also in a swimming pool, as well as emergency childbirth with obstetric manikins.
Not all of these techniques reappear in Outdoor Emergency Care (OEC), which the NSP developed in 1987–88, under the name Winter Emergency Care. Connoisseurs of bandaging, for example, will search in vain for some of the more artistic designs from AFA, such as the 4-tailed bandage for nose or jaw. But OEC still includes far more trauma care practice than emergency medical technician (EMT) courses, and the disparity comes out much more conspicuously in the way the courses are taught and the skills tested than in a comparison of the textbooks and curricula. This author was an AFA instructor and instructor trainer for 20 years, has been an OEC instructor for the NSP since the beginning of the program, and is currently an OEC instructor trainer.
OEC courses are scenario based, which means that after students have learned some basic skills, about 50% of OEC class time is spent on role-playing accident scenarios. Much of the other 50% is spent learning and practicing new skills. OEC students are expected to master the textbook (which includes study guides and self-test questions in every chapter) on their own, so as to minimize the need for lectures in class. Staging scenarios effectively requires many knowledgeable people to act as patients and monitors. This is feasible in OEC because the NSP is a volunteer organization, with many instructors and experienced patrollers willing to help teach the classes. Moreover, both the midterm and final practical examinations for OEC are a series of scenarios.
By contrast, at least 50% of a typical EMT class is spent on lecture and audiovisual presentations, and EMT skills include much less trauma care than OEC skills. Although EMT instructors may choose to do an occasional scenario, the National Registry EMT practical examination requires each student to demonstrate only 7 specific skills (although some EMT instructors may add more skills to the test): 2 patient assessments (trauma and medical), ventilation with a bag valve mask, oxygen administration, cardiopulmonary resuscitation and automated external defibrillator, spinal immobilization for a supine patient; and 1 of 4 skills assigned at random. The random skill may be spinal immobilization of a seated patient, bleeding control and shock management, long bone immobilization, or joint immobilization. 2
EMT students are tested on the ability to demonstrate a set of skills, 1 skill at a time, and only 2 of the required skills involve trauma care. OEC students, on the other hand, are tested in scenario-based examinations in which they must assess the scene and patient, set priorities, request additional equipment and assistance (if needed) in a simulated radio call, and perform all necessary emergency care. The OEC practical examination, therefore, closely simulates what ski patrollers would do when treating a real patient on the snow. Moreover, OEC students go through a variety of scenarios in the examination, which require them to demonstrate many different skills in the context of realistic patient care.
Alpine ski patrollers (volunteer and professional) work at downhill ski resorts, and evacuate patients from the slopes on skis by steering a toboggan downhill to the first aid room or (depending on the severity of the patient's problems) to a waiting ambulance or helicopter. Although medical problems can occur even on the snow, the potential for falls and collisions in downhill skiing on crowded slopes guarantees a daily supply of injuries for alpine patrollers to treat, with hypothermia and altitude illness as possible complications. Patrollers must be able to apply bandages and splints quickly and to backboard patients with suspected spinal injuries on a steep snow slope in all weather conditions. Moreover, OEC students practice aligning and managing spinal precautions for a patient who is found in a bent or twisted position (straightening the pretzel)—a skill that does not appear to be taught in most EMT classes.
Most Nordic and backcountry patrols ski on public land, many of them in partnership with the US Forest Service. So Nordic patrollers are trained to improvise emergency shelters in case they have to bivouac with a patient, and to build sleds for evacuation with a patient's skis and poles, as well as learning all of the OEC skills used by alpine patrollers. The NSP also conducts courses on mountaineering and avalanche rescue that patrollers are encouraged to take. 3 Even alpine patrollers may face difficult evacuations after rescuing out-of-bounds skiers or snowboarders.
Many of the emergencies to which EMTs respond, however, are indoors, and their patients are only exposed to the weather while being rolled on a gurney to the ambulance. Any bandages or splints they apply need only stay on for a short ambulance ride. Moreover, EMTs not only respond to many medical emergencies but also often transfer patients with medical problems (who are likely to be taking multiple medications) from one facility to another. So it is understandable that EMT students spend much more time than OEC students learning about medical problems and medications and much less time practicing trauma care. EMT students also spend more time learning about pediatrics and geriatrics than OEC students because EMTs deal with far more elderly and very young patients than OEC technicians. In fact, a separate chapter on geriatrics is new to the 5th edition of the OEC textbook.
As the authors of the following article explain, much of OEC and EMT course content in the textbooks overlaps. But the differences in how the courses are typically taught, and how student skills are tested, reflect the very different conditions in which OEC and EMT students are trained to operate, and the different proportion of trauma versus medical emergencies that they are likely to encounter. Nevertheless, instructors and developers of both OEC and EMT programs may discover ways to improve their courses and the way they are taught by reviewing the detailed comparison that the article provides.