On skis, on call

WHEN Dr Mike Langran says he’s "by no means the world’s best skier", logic tells me he is probably hiding his light under a bushel. For one thing, as the volunteer ski patrol doctor at CairnGorm Mountain in the Scottish Highlands, he spends more time on the slopes than most snow sports enthusiasts.

In the winter months, when not in his GP’s surgery at the nearby Aviemore Medical Practice, Mike will often swap his white coat for a ski jacket and head up the mountain where he provides medical cover for visitors out and about on the ski resort.

It’s a service he’s been offering on a volunteer basis for well over a decade, having got involved somewhat by accident in 1999. At the time he was already a partner at the Aviemore practice and had been collecting data on injury patterns from snow sports, a long-term research project in collaboration with the Centre for Rural Health in Inverness that is still ongoing.

"Inevitably I got to meet the ski patrol and I started getting involved in some of the accidents on the mountain when I was skiing myself. And then, in 1999, I sort of formally became the ski patrol doctor and part of the team. I’ve been with them ever since."

Snow patrol

In general, throughout the season, he will be at the resort most weekends, and one or two days a week at the height of the season. And even when not on the mountain, if the ski patrol needs help, he and his medical partners are always at the end of the line. "Just yesterday I had a call looking for advice on someone who was injured and asking if they were doing the right thing. We have a very good working relationship."

The full-time members of the ski patrol are extremely professional and experienced in terms of stabilising casualties and getting them off the mountain, says Mike. But where his expertise comes into its own is in the more serious emergencies, such as a head injury or a potential spinal injury.

"They don’t need me for every injury and every illness, but I have a particular advantage when people are in a lot of pain," he says. "I can give people stronger pain relief that works more quickly."

Among the many challenges of working outside in winter is actually getting to the patient, particularly as the more serious injuries often occur when a skier has left the beaten track. "I’ve been involved in some rescues in some very hairy situations on the mountain where we’ve been on sheet ice and amongst rocks. But we’ll use ropes and anchors and whatever we need to keep safe."

Only the previous week, Mike says, he was part of an attempt to rescue three walkers who had been buried by an avalanche under four metres of snow. "Sadly the outcome wasn’t as we had hoped." Although they managed to get them to hospital in Aberdeen, they later died.

Sub-zero emergency care

Administering care in sub-zero temperatures and amid gale-force winds adds further to the challenge: "We are often dealing with casualties in very cold, windy conditions and you can’t assess them as you would do in a clinical setting. It’s a balancing act between being able to assess them properly while not overexposing them or yourself. So we have to adapt the casualty management accordingly."

One such adaptation involves using 'intranasal diamorphine', where diamorphine solution is dripped into the nose or via an atomiser. All the patient has to do to get reasonably effective pain relief is sniff. "It’s particularly good in children, because they are usually frightened and if you come along with a big needle and hurt them you tend to lose their confidence."

Another adaptation is a bluetooth electronic stethoscope, developed by an Inverness company, which can even be placed over clothing. This means that as the person is being transported Mike can still listen to their heart and breath sounds. "It enables me to monitor them without having to constantly stop and lift up their clothing, delaying the transfer."

In addition to the training and resources, much of the effectiveness of the ski patrol’s work lies in the teamwork, says Mike. "We’re all pals, we all socialise together. That really does help when you’re in stressful situations – to be with people you know and whom you trust."

Ski-injury.com

While the ski patrol team is trained, ready and kitted out for all types of emergencies, Mike is very keen to emphasise that snow sports are, in general, a relatively safe pastime, with only around three skiers or snowboarders per day, for every 1,000 on the slopes, getting an injury of any kind. It is a message he has long been passionate about spreading, and it led him, over a decade ago, to launch a website (www.ski-injury.com) on the subject.

"I realised there wasn’t very good information for people who were skiing or snowboarding about how to keep safe on the slopes. Also, there were lots of myths out there about how dangerous these sports were and what the risk of injury was, whereas in fact that didn’t correlate with the actual data that was being collected. So I decided that was a gap that could be filled."

Over time the site has grown into something of an Aladdin’s Cave of statistics and information on all aspects of snow sports safety and research into associated injuries. It is the top site on Google for searches on ski injury and, since its inception, has had millions of hits.

As a result, Mike gets plenty of email enquiries, ranging from people who want advice on starting their children skiing and snowboarding, on how to prevent re-injury and on what to do to keep skiing despite the wear and tear of advancing age. "I get emails from GPs and other doctors who have got injured patients, from lawyers who are looking for information and technical advice, and, of course, from journalists."

Indeed, four years ago, Mike felt the full force of the international media after actress Natasha Richardson died at a Canadian ski resort following what seemed an innocuous injury. With his site appearing at the top of Google, his opinions on matters such as the compulsory wearing of helmets (he is against, despite wearing one himself) were furiously sought. "I had enquiries from all over the world. It was quite surreal for a couple of days."

Research opportunities

Mike’s profile in the area of ski safety doesn’t stop at the website or with media enquiries. He is also currently UK national secretary for the International Society for Skiing Traumatology and Winter Sports Medicine (SITEMSH) and was elected president of the International Society for Skiing Safety (ISSS) in 2011. Both organisations hold regular international conferences bringing together leading experts in the fields.

"My particular interest is in epidemiology, what’s happening on the slopes, but others of my colleagues are interested in equipment design, binding function, the design of slopes and the design of jumps."

As ISSS president, Mike is also keen to facilitate access to the field of ski medicine for medical students and junior doctors. To that end the ISSS has put together a package of support for young researchers who want to come and present at their conferences. They are also setting up a portal to match young medics with clinics in ski areas that can offer placements for electives or research projects. "Hopefully, that’s something we’ll be able to offer next season," he says.

Through the ISSS and SITEMSH, Mike has managed to combine his love of medicine and snow sports into an international role, but his day-to-day contribution in this respect remains very much on the ground in the Highlands, whether it is in his practice in Aviemore or out providing care on the mountain at what he fondly refers to as his "branch surgery".

"It’s all about keeping people skiing and snowboarding," he says. "When you like these sports there’s nothing worse than seeing someone injured, who can’t do what you enjoy yourself."

Adam Campbell is a freelance journalist and regular contributor to MDDUS publications