You and three companions are on an afternoon cross-country ski of a marked, but un-groomed trail system in the local national forest. The temperature has been hovering in the low teens Fahrenheit, the day made beautiful by a blue sky, the absence of wind, and plenty of fresh snow. Blue wax is gripping well. You’ve been skiing for several hours and reach your planned turn around point 5K from the trailhead.
“Check this guy out!”
A lone skier cuts turns down the steep hillside above the trail. He’s moving smoothly on a course to cut right in front of you until he takes a terrain feature that launches him in the air. His skis go up, his butt goes down, and he lands hard on his back. You’re impressed when he bounces, stands, and glides for a few moments. You’re concerned when he sits awkwardly and rolls onto his side.
“Hey, are you ok?”
There is no answer and the skier seems to be moving awkwardly. In less than a minute, you ski to his side. The skier is gasping for air. One of your companions takes control of his head and asks, “Can you breathe?” The skier gasps in response, “wind….knocked…... out.” “Relax,” you plead as you look at his airway, sweep for obvious injuries and blood, and check for chest injury at the prompting of your companion. All these are negative, which is positive.
Over the next couple of minutes his breathing calms and you make sure he has a clear airway. He knows his name, where he is, the time and date, and what happened. Belatedly you introduce yourselves and ask if you can help. He answers “I’m ok”, tries to move, and cries out in pain. “My back hurts.” He agrees to an assessment. You begin by removing his pack, checking his back, and rolling him onto a couple of short pads extracted from our packs. The NOLS Wilderness Medicine water bottle with the PAS triangle lying on the snow catches your eye. A quick drink allows you to look surreptitiously at the triangle and organize yourself for the assessment.