snow sports injuries in andorra, epidemilogy and management of severe injuries
TRANSCRIPT
SNOW SPORTS INJURIES IN ANDORRASNOW SPORTS INJURIES IN ANDORRAEPIDEMIOLOGY AND MANAGEMENT OF EPIDEMIOLOGY AND MANAGEMENT OF
SEVERE INJURIESSEVERE INJURIES
Dr Bernat Escoda AlegretDr Bernat Escoda Alegret, Dr Josep Escoda Sales, Dr Josep Escoda SalesCentre Medic Pas de la Casa-Grau RoigCentre Medic Pas de la Casa-Grau RoigGRANDVALIRA SKI AREA ANDORRAGRANDVALIRA SKI AREA [email protected]@cmpas.com
ANDORRA ANDORRA -462 square km462 square km
-80000 inhabitants80000 inhabitants- 2,000,000 skier-days/season2,000,000 skier-days/season
Medical centers in the andorran ski areasMedical centers in the andorran ski areas
TWO MAIN SKING TWO MAIN SKING AREAS:AREAS:
GRANDVALIRA:GRANDVALIRA:2 MEDICAL 2 MEDICAL
CENTERS:CENTERS:- Pas de la Casa-Pas de la Casa-
Grau Roig (2 sites)Grau Roig (2 sites)- Soldeu-El Tarter (3 Soldeu-El Tarter (3
sites)sites)VALLNORD:VALLNORD:3 MEDICAL 3 MEDICAL
CENTERSCENTERS- Pal (1 site)Pal (1 site)- Arinsal (1 site)Arinsal (1 site)- Ordino-Arcalis (1 Ordino-Arcalis (1
site)site)
1 hospital:1 hospital:
HOSPITAL NOSTRA SENYORA DE HOSPITAL NOSTRA SENYORA DE MERITXELLMERITXELL
- 30 to 50 mn from the ski resorts medical centers30 to 50 mn from the ski resorts medical centers- equiped to attend the most common medical and surgical equiped to attend the most common medical and surgical
problems (general and orthopedic surgery, critical cares...)problems (general and orthopedic surgery, critical cares...)- Cardiocirculatory surgery and neurosurgery is not available, Cardiocirculatory surgery and neurosurgery is not available,
in this cases pacients must be transfered to Barcelona (200 in this cases pacients must be transfered to Barcelona (200 km) or Toulouse (180 km) by road (>2 hours) or helicopter km) or Toulouse (180 km) by road (>2 hours) or helicopter (45 mn) , depending on weather conditions(45 mn) , depending on weather conditions
SNOW SPORTS INJURIES IN SNOW SPORTS INJURIES IN ANDORRAANDORRA
- we have old registers begining we have old registers begining in the seventies by their are not in the seventies by their are not standardized, in paper forms, standardized, in paper forms, with no control groupswith no control groups
- efforts have been made to efforts have been made to improve the data collectionimprove the data collection
- for the last 5 seasons theres is - for the last 5 seasons theres is a unique database resulting a unique database resulting from the work of the ski patrols, from the work of the ski patrols, the resorts medical centers and the resorts medical centers and the hospitalthe hospital
in the last seasons in the last seasons 14,000 injuries/season14,000 injuries/seasonincidence: 5,86 per 1,000 skier-incidence: 5,86 per 1,000 skier-daysdays
TOTAL INJURIES IN PAS DE LA CASA-GRAU ROIG TOTAL INJURIES IN PAS DE LA CASA-GRAU ROIG AREAAREA
during 2006-2007 seasonduring 2006-2007 season
3452 people3452 peopleof witch:of witch:- 3320 were attended in 3320 were attended in the resort medical the resort medical centercenter- 23 went by their own 23 went by their own
to Andorra hospitalto Andorra hospital
3320 INJURIES attended in PAS DE LA CASA-GRAU 3320 INJURIES attended in PAS DE LA CASA-GRAU ROIG MEDICAL CENTER (season 2006-2007)ROIG MEDICAL CENTER (season 2006-2007)
TYPE OF INJURY TYPE OF INJURY
TENDONS & MUSCLES INJ.5%
DISLOCATIONS2%
FRACTURES13%
SPRAINS29%
CONTUSIONS22%
WOUNDS5%
CONCUSSIONS3%
OTHER INJURIES10%
UNKNOWN11%
3320 INJURIES attended in PAS DE LA CASA-GRAU 3320 INJURIES attended in PAS DE LA CASA-GRAU ROIG MEDICAL CENTER (season 2006-2007)ROIG MEDICAL CENTER (season 2006-2007)
INJURIED REGION INJURIED REGION
CONCUSSION 3%
OTHER HEAD & NECK 15%
FEMUR & PELVIS FRACT. DISLOC. 0%
SHOULDER DISLOC. 1%
OTHER SHOULDER 9%
THUMB SPRAIN 4%
OTHER HAND 3%
WRIST FOREARM ARM FRACT. 6%
OTHER WRIST FOREARM ARM 10%
ACL INJURY 5%
OTHER KNEE SPRAINS 12%
OTHER KNEE 10%
LEG ANKLE FOOT FRACT. 2%
OTHER LEG ANKLE FOOT 8%
OTHER DIAGNOSTICS 1%
UNKNOWN 11%
3320 INJURIES attended in PAS DE 3320 INJURIES attended in PAS DE LA CASA-GRAU ROIG MEDICAL LA CASA-GRAU ROIG MEDICAL
CENTERCENTER
- 3188 fully attended …- 3188 fully attended …
- 122 sent to Andorra hospital for : - 122 sent to Andorra hospital for :
-monitoring (mainly concussions …)-monitoring (mainly concussions …)
-complementary exams-complementary exams
-surgical treatment -surgical treatment
3320 INJURIES attended in PAS DE LA CASA-3320 INJURIES attended in PAS DE LA CASA-GRAU ROIG MEDICAL CENTER (season 2006-GRAU ROIG MEDICAL CENTER (season 2006-
2007)2007)
FULLY ATTENDED
96%
SENT TO HOSPITAL
4%
122 sent to Andorra hospital122 sent to Andorra hospital(4% of all the pacients seen in the (4% of all the pacients seen in the
resort medical center)resort medical center)
CONCUS.32%
SPINE INJ.8%
UPER LIMB FRACT.
18%LEG FRACT.5%
PELV FEMUR FRACT.
10%
THORAX5%
ABDOMEN10%
SPRAINS …12%
SPINE INJ.8%
UPER LIMB FRACT.
18%
LEG FRACT.5%
THORAX5%
ABDOMEN10%
SPRAINS …12%
CONCUSSION32%
PELV FEMUR FRACT.
10%
SEVERE INJURIESSEVERE INJURIES Fractures or dislocations with Fractures or dislocations with
risk of vascular/nervous compromiserisk of vascular/nervous compromise
Quick reduction is Quick reduction is performed in our performed in our medical center in medical center in most of the cases, most of the cases, and then controlled and then controlled by their own by their own traumatologist, a few traumatologist, a few are transfered to the are transfered to the hospitalhospital
SEVERE INJURIES SEVERE INJURIES possibility of complicationspossibility of complicationsand / or and / or
need for further investigations (scan, blood analysis…)need for further investigations (scan, blood analysis…)
HEAD TRAUMA, ABDOMINAL TRAUMAHEAD TRAUMA, ABDOMINAL TRAUMADISEASE DISEASE
HOSPITALHOSPITAL
SEVERE INJURIES SEVERE INJURIES need for surgical treatmentneed for surgical treatment
SEVERE INJURIES MANAGEMENTSEVERE INJURIES MANAGEMENT
ski patrolsski patrolsThey are the first to attend the They are the first to attend the
injuried skier /snowboarder, injuried skier /snowboarder,
Their initial evaluation is essential Their initial evaluation is essential for the correct management of for the correct management of each caseeach case
If necessary they are able to If necessary they are able to assume ressucitation assume ressucitation manoeuvres, oxygenotherapy, manoeuvres, oxygenotherapy, automatitzed DF ( devices in automatitzed DF ( devices in the higher points of the resort the higher points of the resort so they can be transported in 3 so they can be transported in 3 to 5 minutes to all the points of to 5 minutes to all the points of the ski area)the ski area)
- permanent radio communication - permanent radio communication with the medical center in with the medical center in order to transmit the order to transmit the informationinformation
SEVERE INJURIES MANAGEMENTSEVERE INJURIES MANAGEMENT
medical centermedical center
2 doctors and 1 nurse in 2 doctors and 1 nurse in each area (trained in each area (trained in sports traumatology sports traumatology
and emergency and emergency medecine) , can be medecine) , can be transported untill the transported untill the pacient by skidoo, pacient by skidoo,
transportable transportable emergency bag emergency bag
(drugs,perfusion fluids, (drugs,perfusion fluids, orotracheal intubation orotracheal intubation
set …), cardiac set …), cardiac monitor / DFmonitor / DF
SEVERE INJURIESSEVERE INJURIES
-THE PACIENT IS -THE PACIENT IS CONDICIONED TO BE CONDICIONED TO BE TRANSPORTED TRANSPORTED SAFELY UNTIL THE SAFELY UNTIL THE MEDICAL CENTER MEDICAL CENTER WHERE A COMPLETE WHERE A COMPLETE CHECK WILL BE MADE CHECK WILL BE MADE
-IF THE PACIENT -IF THE PACIENT REQUIRES REQUIRES TRANSPORTATION TRANSPORTATION UNTIL THE HOSPITAL UNTIL THE HOSPITAL IT WILL BE DECIDED IT WILL BE DECIDED THE BEST THE BEST TRANSPORTATION TRANSPORTATION MEANMEAN
SEVERE INJURIESSEVERE INJURIES
MEDICAL CENTER MEDICAL CENTER EQUIPEMENT:EQUIPEMENT:
-drugs,perfusion -drugs,perfusion fluids, fluids, orotracheal orotracheal intubation, intubation, cardiac monitor / cardiac monitor / DFDF
-OXYGEN-OXYGEN
-X RAY-X RAY
SEVERE INJURIESSEVERE INJURIEStransport until the hospitaltransport until the hospital
- USUALLY A - USUALLY A MEDICALIZED AMBULANCEMEDICALIZED AMBULANCE WILL BE USED IN THE WILL BE USED IN THE MOST SEVERE CASES (PHYSICIAN + NURSE)MOST SEVERE CASES (PHYSICIAN + NURSE)
- A A MEDICAL HELICOPTERMEDICAL HELICOPTER CAN BE USED TOO BUT IT IS NOT CAN BE USED TOO BUT IT IS NOT PERMANENTLY BASED IN THE HOSPITAL SO IT CAN BE TO LONG PERMANENTLY BASED IN THE HOSPITAL SO IT CAN BE TO LONG TO ACTIVATE TO ACTIVATE
- IN CASES THAT DON’T NEED MEDICATION AND WITH NO IN CASES THAT DON’T NEED MEDICATION AND WITH NO IMMEDIATE RISK OF COMPLICATION A IMMEDIATE RISK OF COMPLICATION A NON MEDICAL NON MEDICAL AMBULANCEAMBULANCE CAN BE USED (PARAMEDICS) CAN BE USED (PARAMEDICS)
SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATION NEED OF A GOOD COORDINATION BETWEEN ALL THE INTERVENANTSBETWEEN ALL THE INTERVENANTS
SKI PATROLS-RESORT MEDICAL SKI PATROLS-RESORT MEDICAL CENTERCENTER
We work hand in hand, continous radio We work hand in hand, continous radio communication, the medical center is communication, the medical center is
involved in the continuous formation of the involved in the continuous formation of the ski patrolsski patrols
SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATION NEED OF A GOOD COORDINATION BETWEEN ALL THE INTERVENANTSBETWEEN ALL THE INTERVENANTS
RESORT MEDICAL CENTER – HOSPITALRESORT MEDICAL CENTER – HOSPITAL
Phone coordination – exchange of Phone coordination – exchange of information / medical reports in order to information / medical reports in order to
decide about the proper way to transport decide about the proper way to transport the injuriedthe injuried
SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATION BETWEEN NEED OF A GOOD COORDINATION BETWEEN ALL THE INTERVENANTSALL THE INTERVENANTS
SKI PATROLS - RESORT MEDICAL CENTER – HOSPITALSKI PATROLS - RESORT MEDICAL CENTER – HOSPITAL
ALL THE DATA ON SNOW SPORT INJURIES ALL THE DATA ON SNOW SPORT INJURIES ARE COLLECTED IN A UNIQUE DATABASEARE COLLECTED IN A UNIQUE DATABASE
Further analysis of witch will probably:Further analysis of witch will probably:- Help all of us to improve the attention to the Help all of us to improve the attention to the
injuried peopleinjuried people- Leed to prevention actionsLeed to prevention actions
