I was skiing last year when a friend of mine, another physician, tried to stop next to me - but instead stopped ON me. In fact, he stopped on my ungloved hand, and I sustained a laceration from his ski edge. It cut the skin on my hand and was bleeding pretty briskly.  Luckily I had a first aid kit,so we were able to irrigate the wound and staple the wound edges back together with only some mild discomfort.

An appropriate first aid kit should be designed to treat conditions likely to be encountered while backcountry skiing or riding, and ideally based on group size and individualized medical needs.  One should expect to potentially treat trauma, environmental illnesses, and general medical conditions based on participant’s medical histories. Because space and weight are a concern, each item considered for inclusion should be assessed for its potential benefit, cost, and weight.  No item should be included if no one knows how to appropriately use it. Skiers should plan to improvise some items making use of other gear that they routinely carry on a tour. The best practice would be to prepare a dedicated kit in the preseason and update it yearly with fresh supplies. The first aid kit you elect to carry might differ depending on the length of your trip -- the kit you carry will be different for a single-day day trip  versus a multi-day hut/yurt trip. Likewise, if you are traveling with a group, perhaps only one member needs to carry a first aid kit, while someone else in the party might carry extra layers or a bivy sack.

Skiers in Tahoe should anticipate needing to treat the following conditions in the backcountry: wounds, blisters, fractures, dislocations, head injury, spinal injury, asphyxiation, sunburn, hypothermia and frostbite. If a party member suffers from severe allergy, anaphylaxis would be an example of a general medical condition that would also be a concern.

The goal of wound care in the backcountry should be to clean and bandage wounds, providing bleeding control instead of definitive treatment. Small blisters less than 5mm should be covered with a moleskin donut. Larger blisters, which are prone to rupture, can be drained with a sterile needle, but this is likely to cause more pain. Either way the intact skin can be bandaged with antibiotic ointment and moleskin. Duct tape can substitute for medical tape and clean clothing can function as bandaging material, but the following items should still be carried: medical gloves, antibiotic ointment, 4X4 gauze or 2 inch roll gauze that can be cut into smaller sizes, steri strips, sterile needle, non adherent pads and limited preformed bandages. Tincture of benzoin and steristrips may come in handy, and they are an effective way to close a wound.  Wound glue or staples provides a definitive treatment that may be worth carrying if a member of the party knows how to use those tools. 

Fracture and dislocation care will require splinting, analgesics, and a possibly a sling. Sam splints are lightweight versatile splints commercially available - but skiers can improvise effective splints from many items already in their possession. Ski poles, ice axes, shovels, probes, skins, backpack stays, inflatable pads and entire backpacks can be fashioned into splints using ski straps or duct tape to bind them. One party even fashioned a wrist splint from a Power Bar after an injury on Mt. Dana!  A shirt or jacket can be converted into a sling with the help of a safety pin.  Ibuprofen and acetaminophen should be included in the kit for analgesia.  Narcotic analgesia may be a priceless addition to a first aid kit. And surely a six pack of percocet might give you the best “power to weight” ratio I can think of!

Little can be done in the backcountry for a head injury other than to evacuate the patient. Spinal injuries should be immobilized on a flat surface (skis) and an improvised cervical collar placed if neck injury is suspected. Victims rescued from an avalanche may require rescue breathing or CPR and in this instance a Laerdal pocket mask and a large nasal airway cut to size are worth their weight since CPR patients usually vomit.  

Hypothermia can be both prevented and treated with extra clothes, a sleeping bag, insulating pad, adequate hydration, and lightweight shelter or an improvised snow cave. A lighter or matches may be necessary to light a fire. Frostbite is also best prevented not treated. Facial coverings, spare gloves, extra socks and improvised vapor barriers made from plastic bags are lightweight and easy to carry. Chemical heat packs and warming cold extremities with skin to skin contact can also avoid impending frostbite. If frostbite does occur the injury should be protected with clothing from further harm and warming should be delayed until the hospital is reached. Sunburn should be prevented with sunscreen, lip balm, and sufficient clothing to cover skin.  Spare paper or duct tape sunglasses could save a skier from snow blindness.

Known medical conditions within one’s party such as anaphylaxis or diabetes should be planned for with epinephrine and quick acting forms of oral glucose. The only way to anticipate these conditions is to be familiar with the potentially serious medical histories of your skiing partners. Vomiting and diarrhea are also very disruptive to outdoor sports and a few milligrams of Zofran and Imodium can be very helpful in treatment.  

Below are a list of sample contents for a first aid kit and a list of gear that is useful for improvisation.

First Aid Supplies

Medical gloves: #1 pair
Antiseptic towelettes: #2 packets
Tincture of benzoin: #2 dispensers
Antibiotic ointment: #2 packets
Gauze (4X4): #3 (or one 2 inch roll gauze)
Telfa pads: #2
Steri strips: #1
Moleskin (4X4): #1
Sterile needle: #1
Band aids: #4
Wound glue/Crazy Glue: #2
Laerdal pocket mask: #1
Large nasal airway: #1
Ibuprofen: 2400 mg
Acetaminophen: 2000 mg
Ondansetron: 8mg
Imodium: 8 mg
Percocet: 6 mg
Sunscreen: #1 tube
Lip balm: #1
Paper sunglasses (from optometrist): #1
Epipen: #2
Lighter: #1
Safety pin: #2

Improvised Supplies

Duct tape
Utility knife
Ski straps
Ski poles
Inflatable pad
Sleeping bag

Backcountry skiing is a gear intensive sport and, although an adequate first aid kit is far less glamorous than the best performing skis, the lightest bindings, and the newest high tech boots, it is necessary safety equipment much like an avalanche beacon.  Invest some time and relatively little money in assembling a kit and you and your skiing partners may one day live to appreciate it.  For a day ski I go lightweight and small - for a longer tour I recommend divvying up gear to share the load.

~ Tahoe Wilderness Medicine