It’s a clear and sunny, but cold. Temps have been dropping after a period of warmer weather, and the snow surface is firm. A good day for carving skis or a late start. You’re in the patrol shack at the top of the lift when you receive a report from a member of public unloading the lift that there is a solo skier fallen on the piste about 15 meters below tower 10. They were laying face down and unmoving.
Recognizing the potential for a serious situation, you make a quick trip down to tower 11 to investigate. As you approach, you see an adult skier on rental skis laying on the snow, head downhill. As you approach, they pull themselves up to a seated position, and swing their legs downhill.
You ski down to just below the guest and address them from the direction they’re facing, asking if they need help. An approximately 40 year old female looks up at you and says, “Hi young lady, no, I don’t want any help”, waving a gloved hand at you distractedly, “What happened?” they ask you.
You say, “Looks like you took a fall, let’s try to figure out what happened and make sure you’re ok”, you respond, and you kneel on the snow in front of the patient.
You observe that the patient’s goggles have been pushed off the back of their helmet, and there is a large scrape down the right side of the helmet, with snow in the vents. The patient is alert, and oriented to self and year, but avoids answering questions about what mountain they’re on (”of course I know where I am”), and when asked about events says “that’s what I asked you”. Their skin color appears normal, pupils are small and equal. There is no obvious trauma to the face or extremities.
You ask the patient not to move her neck and explain that you’re worried about her because she can’t remember falling. You tell her you’re concerned that she could have an injury to her head, or “something more serious, and I think we should get you checked out at the clinic”. The patient repeatedly says, “What happened? How did I end up here? Tell me again.” They permit you a brief head to toe survey of palpation which is unremarkable. She says again, “What happened? How did I end up here? Tell me again.” Your partner arrives on scene with a toboggan and med pack, and you obtain a finger stick glucose of 124 mg/dl.
You recommend the discussed course of treatment and the patient refuses. “I’m not going to let you take me!” she says, “Leave me alone!”. She still exhibits repetitive questioning, and doesn’t know what mountain she’s on.