In Reply to Dr Allen

To the Editor:

Thank you for your interest ¹ in our article, “A Survey of Ski Patrols in the United States Comparing Medical Direction, Patroller Training, and Patient Care.” ²

Medical care is defined by the Dictionary of Public Health as the “care of sickness or injury under the direction of … any qualified professional person in a health-related institution.” ³ This project was designed to serve as an introductory investigation into the patient care provided by ski patrols in the United States.

We believe that the title appropriately applies the term “patient care.” If patrollers are held to the standard of their training, then inquiring into the specifics of that training, along with the presence of medical directors and medically associated administrative tasks, does serve to quantify the patient care provided.

This was not a comprehensive study but a survey and titled as such. Surveys are, by nature, study designs used by researchers to gain a specific piece of information. The piece of information that we intended to gather from this survey was the descriptive statistic of “What” is being done in medical care.

Once descriptive statistics like “Who,” “What,” “Why,” “When,” and “Where” are sufficiently answered, the more complex issue of “So what” (and of what quality) can be addressed. ⁴ As there have not yet been any published nationwide studies addressing the basic questions of medical care provided by ski patrols, this authorship team felt that addressing the “What” was a necessary first step.

In early 2019, the research team did indeed contact the medical director of the National Ski Patrol at the time via email, and he declined to offer any assistance.

As stated in your letter, our research did not find a national standard for medical care at the various ski resorts, which is one of our primary conclusions and concerns. You illuminate the fact that “the vast majority of ski patrols require either OEC or EMT training and that many require both.” ¹ You also state that “the local ski area together with the patrol members and medical advisor develop their own protocols to fit the needs of their particular area,” ¹ yet our study, despite its small sample size, found that not every ski area has a medical director/advisor and that an even smaller contingents develop their own protocols. Furthermore, if ski areas are independently straying from the protocols developed by the “exhaustively peer reviewed” ¹ certifications of the outdoor emergency care or emergency medical technician, with or without a medical director/advisor overseeing the process, how is a standard of care consistent with the industry standard to be guaranteed?

These authors propose that because ski patrollers don uniforms as the designated prehospital medical providers for the public at ski areas, there should be a standardized, supervised system to ensure the quality of care delivered. This is not only to protect the public but also to protect the ski patrollers. These authors, with a combined experienced of 42 y as ski patrollers, have a strong interest in protecting all involved.

This was an initial survey, and the geographical bias and limitation of sample size were noted. Our intention was to initiate a conversation with the data that we obtained. We eagerly await the publication of your larger study.