Wilderness Medicine on Ice

For some readers, the headline of today’s blog might spark visions of Disney on Ice, complete with professional figure skaters dressed as emergency medical technicians, gliding, spinning, and soaring through the air as they provide emergency medical care in a winter wilderness setting. 

As they successfully evacuate the injured party from the ice, one skater performs a perfect triple axel in celebration. As for musical accompaniment, I’m thinking we should choreograph the entire scene to Vanilla Ice singing “Ice Ice Baby.”

I only bring this to mind because it was around this time (1990) that Vanilla Ice released his hit video recording, “Ice Ice Baby.” I climbed Mt. Shasta in Northern California’s Cascade Range that winter, and I recall the approach provided intermittent views of the frozen water that would make up the majority of the climb. I came to the realization that providing medical treatment and making potentially life-saving decisions would be much more difficult to achieve in icy conditions and bitter cold than in more temperate conditions. 

In the years since that icy climb, I have continued to enjoy ice and snow activities and have often participating in rescue operations, providing medical care in winter wilderness settings. In this post, I explore the unique challenges of providing wilderness medicine in cold, icy environments and lead you through the standard protocol for responding to injury or illness in these challenging conditions. 

And, for a little fun, I’m going to weave in a few lyrics from “Ice Ice Baby” to reinforce key lessons. So, strap on your crampons and “Let’s Kick It!”

Common Injuries and Illnesses in Icy and Snowy Conditions

Travel and recreation in icy and snowy wilderness conditions is nothing new. They’re not a “brand new invention” like the one mentioned in “Ice Ice Baby.” In fact, Wikipedia reports that archaeological evidence of early skiing dates back to about 5500 years BCE. Since then, human beings have created all sorts of fun ways to get seriously injured and even die in cold, icy environments, including snowboarding, sledding, ice-climbing, and ice-skating. The list of common injuries and illnesses is even longer:

• Sprains
• Broken bones
• Traumatic head injuries
• Spinal injuries
• Heart attacks
• Frostbite
• Hypothermia
• Cuts/lacerations

Responding to a Medical Emergency in the Icy Wilderness

Breaking a leg is never fun, but it’s always heartwarming to see a community rally to help someone who’s fallen and been injured on ice or snow. Assuming they followed proper protocol as taught in our Wilderness Medicine courses, you can learn a lot from such a response.

The first step is to size up the scene: In this phase of the rescue, it’s important to, “stop, collaborate and listen,” as Vanilla Ice advises. The icy environment is apt to change more rapidly than that to which you are accustomed. One of the most compelling aspects of ice climbing versus rock climbing is that the climb varies year to year,  partially due to rapidly changing conditions. Cold can quickly change to dangerously cold, and the shortened days can make matters worse. As you’re sizing up the scene, ask yourself how much daylight is left and how many headlamp batteries remain.

The scene size up can be summarized with the lyric, “If there was a problem, yo, I’ll solve it.” In other words, the first step is to define the problem you’re trying solve and all factors that facilitate and inhibit your ability to solve it. What’s the nature of the illness or injury? Is the ill or injured party mobile and able to help? How much daylight remains? Can you call for assistance? All these factors and others will influence your subsequent treatment and evacuation decisions.

After sizing up the scene, conduct your primary assessment. The purpose of the primary assessment is to identify and address any injuries and illnesses that threaten life or limb. A key factor to consider is the mechanism of injury or illness — how it happened.

Specific mechanisms of injury include falls onto a very hard ice surface — like “falling on the concrete real fast” according to the song. Additionally significant, lacerations can occur from all the sharp items such as ice skates, ice axes and other tools, and crampons used in some winter recreational activities that “slice like a ninja, cut like a razor blade.” Ideally, the sharp ice tool is “somethin’ grabs a hold of me tightly,” but when it slips or is dropped, it can “flow like a harpoon, daily and nightly.”

The final step of a primary assessment is to make an initial evacuation decision. It may be tempting to say, “Yo, man, let’s get out of here,” but you need to consider what’s truly in the best interest of the patient and not be overly hasty. Follow Vanilla Ice’s advice to “keep my composure when it’s time to get loose.”

Information and insight you gather from your scene size up and primary assessment will inform subsequent decisions regarding treatment and evacuation. Protecting the patient from the cold is imperative. With few exceptions being cold makes being sick and injured worse. Packaging the hypothermic patient requires a subtle balance between needing to move out of harm’s way and the potential harm caused by positional changes and incautious jostling.

The decisions you face after your scene size up and primary assessment are numerous and may be daunting. As you sort them out in a way that serves your patient’s best interests, keep in mind that in this context all decisions are impacted by this fact — “Ice, Ice, baby, too cold.” Keep yourself and your patient warm.

Takeaways When Administering Wilderness Medicine on Ice

It is said that a patient is not deceased until they are “warm and dead.” In wilderness medicine, hypothermia can suppress vital signs to the point that death appears likely, yet this condition is reversible. When a patient’s condition is isolated to environmental cold exposure, there is strong reason for optimism because rewarming may restore normal physiological function.

Another EMS adage that applies well when situations get complicated is to make the decisions that we wish another care provider would make for our family. Or, to wrap up with one final lyric from “Ice Ice Baby” — “word to your mother.”

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About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.

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