Unstoppable forces and immovable objects
UND’s Emergency Medicine Interest Group takes students to the slopes to learn about emergency care for winter collision injuries.
The idea does sound a bit odd for students attending medical school in an astoundingly flat eastern North Dakota city: emergency medical services (EMS) training for downhill skiers suffering injury.
But there were second-year UND School of Medicine & Health Sciences medical students Mark Raymond and Regan Washist on the slopes in January 2023, practicing patient care in the snow.
Truth be told, they were on less of a mountain than a very impressive hill, laughs Washist. In Minnesota no less. But it worked, she says.
“We got to do a simulation where Mark acted like he’d run into a tree and we had to get him out of there,” says Washist, a Bismarck, N.D., native with an EMS background, of her outdoor training. “I’ve never been on the slopes doing this kind of care. I would definitely say being on the slopes is a lot harder than getting a person out of the ditch from a car accident. There’s no solid ground, so trying to move people on the hill is a challenge.”
‘Getting through winter’
Washist and Raymond are the copresidents of the School’s Emergency Medicine Interest Group (EMIG), one of many student-led groups at the School that give future providers more focused exposure to the medical specialties they might be considering after graduation.
According to Raymond, this latest event’s organizer, such extracurricular hands-on training is exactly the sort of thing many students – even those not considering emergency medicine – are looking for.
“I had the opportunity to work ski patrol for a couple years over in Montana,” explains Raymond. “A number of fellow students here asked me what ski patrol was like and how I got into it, so I thought this would be a cool opportunity to give students a glimpse of that ‘day-in-the-life’ of a ski patroller.”
After reaching out to Mark Lindquist, Director of Ski Patrol at Detroit Mountain Recreation Area who gave an enthusiastic “yes” to the student group’s field day proposal, Raymond connected with Dr. Brian Delage, co-director of the SMHS Department of Family & Community Medicine clerkship for third-year medical students.
“I’ve been [ski] patrolling for about four years at Detroit Mountain – it’s how I get through the winter!” Delage laughs, noting too the benefit students have seen from the School’s relatively new Department of Emergency Medicine, whose Bismarck-based chair Dr. Jon Solberg serves as EMIG faculty advisor. “I’m an [outdoor emergency care] instructor and am ‘alpine’ certified.”
A Bozeman, Mont., native, Raymond says that while not the same as the Big Sky resort in Montana, the more modest local slopes – Detroit Mountain is nestled a few miles east of Detroit Lakes, Minn. – are in some ways better for training less experienced patrollers.
Because Big Sky is such a large mountain, that is, with a sizable guest population and a very large volunteer ski patrol program, it can be trickier to train medical students coming to the EMIG without a formal EMS background. Thus was Detroit Mountain an almost ideal way of introducing future physicians to the type of injuries they’re likely to see on the slopes or in their ERs.
“Most of what you see as a ski patroller is musculoskeletal,” Raymond explains. “We get a lot of long bone injuries, lots of head, neck, and back injuries due to skiers colliding with things at high speed. A lot of bread-and-butter injuries: minor trauma, maybe altitude sickness.”
On the more “extreme” side of winter recreation injury, Raymond says, are severe head and spine injuries – those requiring helicopter evacuation, which are more common than you might think: “You really can injure yourself severely if you hit rocks or trees or buildings going 60 miles per hour.”
“We’ve had kids who get out of control while skiing and go straight into a building at Detroit Mountain,” Delage adds with a wince. “They may break both wrists. Others have had serious facial injuries because they hit their face on a building. Oftentimes, it’s trauma related to speed and hitting an object. Trees aren’t very movable.”
The future ER
Like most medical specialties, emergency medicine is facing a physician shortage – even as visits to emergency rooms across the nation increase. Fortunately, the number of new MDs choosing emergency medicine for their residency training too is increasing, including at UND. Even so, the current provider shortage means that emergency rooms look different today than they did even a decade ago.
All of this is why health systems are not only encouraging patients (more of whom have insurance compared to a decade ago) to use primary care providers rather than the ER for routine care, but are also relying on advanced practice providers in the ER: nurse practitioners, physician assistants, and other specialists. Likewise, “urgent care” facilities are helping ERs triage patients in an effort to reduce ER volumes.
But the ER can still be intense, says Raymond, which is actually what attracts him to the profession.
“My intro to medicine was as an emergency medical technician and working as a ski patroller,” he reflects, admitting that growing up he didn’t exactly love school – too much sitting. “I think patrolling was the first time in my education where I really found something I was excited about learning. I remember just going through my EMT course and loving it. I gobbled it up and I loved working as a ski patroller, especially seeing all of these different injuries and people, and really being able to respond in the moment to these immediate needs and concerns.”
Raymond also admits that the cliché of the adrenaline-junkie-ER-doc fits him.
“I guess I’m a little bit of a stereotype in that I like to play outside: biking, running, rock climbing – things like that. And I know a lot of the ER docs who choose the profession because they do shift work” – 12 hours on, 48 off – “so they’re able to go and work hard and then play hard.”
Washist agrees, adding that for her the choice of emergency medicine is really no choice at all.
“This is my plan, 99% sure,” she says. “I also have an EMS background, and a lot of EMS people who come into medical school tend to go into emergency medicine. I love the variety. I enjoy that my doors are always open to any single patient that would ever come in. And usually insurance isn’t even an issue either because with [EMTALA; the federal Emergency Medical Treatment & Labor Act] I can just treat whoever walks up to me. Work life balance is awesome too. With that shift work and being able to go off on the weekend and do things like ski patrolling or just go hiking and enjoying our time is a draw. It’s a natural transition for us in EMS, and you can’t really do that in any other specialty.”