Closed Reduction of Anterior Shoulder Dislocations Performed by Ski Patrollers in the Alpine Prehospital Environment: A Retrospective Review Demonstrating Efficacy in a Canadian Ski Resort

Abstract

Introduction-Shoulder dislocations are common ski hill injuries. Rapid reduction is known to improve outcomes; however, advanced providers are not always available to provide care to these patients. In 2017, nonmedical ski patrollers at Sunshine Village ski resort in Alberta, Canada, were trained to perform anterior shoulder dislocation (ASD) reductions. Program success was determined by a chart review after the 2020 ski season.Methods-This study retrospectively reviewed data on patients who presented to Sunshine Village ski patrol with a suspected ASD and who met the study inclusion criteria from November 2017 through March 2020. Data were collected from ski patrol electronic patient care records regarding general demographics, reduction technique used, analgesia administration, and reduction success rates.Results-Ninety-six cases were available for review after exclusions. Trained nonmedical ski patrollers successfully reduced 82 of these cases, resulting in an overall reduction success rate of 89%. Sixty-three (66%) of these patients had experienced first-time dislocations. Eighty-two (87%) patients were male, with a median age of 25 y. The most used technique was the Cunningham method (75%), and analgesia was administered to 70% of patients.Conclusions-This retrospective study documents the results of a quality assurance review of the treatment of ASD at Sunshine Village ski resort. With a success rate of 89%, the evidence supports the conclusion that nonmedical ski patrollers can successfully perform ASD reductions. We believe training ski patrollers to reduce ASD improved patient care in our austere environment by providing early definitive treatment with a high success rate.

Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies

“…However, the need for plain radiographs increases cost, delays reduction, and exposes the patient to ionising radiation [9][10][11] , which is a particular concern for young patients with recurrent dislocations. The perceived need for imaging might also inhibit pre-hospital attempts at closed reduction 12 , which may be particularly important in remote environments such as mountainous ski resorts 13 .…”

Austere Diagnosis and Reduction of Anterior Shoulder Dislocations: 10-Year Review of a Ski Patrol-Based Program with Emergency Medical Technicians

“…26,27 For ASD, mean age and sex characteristics were similar to prior demographic findings. 17,23,25,[28][29][30][31][32] The 2 nearest hospitals are approximately 40 min away in ideal driving conditions. Transport time for ambulance response ranges from 80 to 90 min in ideal conditions.…”

“…It is noteworthy that the only prior study concerning ski patrol-based ASD reduction utilized analgesia not routinely available to prehospital providers in the United States. 17 Further, the WCSP program's intentional avoidance of premedication may highlight a point where patient safety is better served by nonroutine care. Sedation readily achieves its intended purpose of relieving discomfort and promoting muscular relaxation, but it is not without its detractions.…”

“…There is limited available literature on standardized protocols for the assessment and treatment of traumatic shoulder dislocations in austere settings. 16,17 As such, we will provide details of this program. Moreover, there are few studies concerning prehospital shoulder reduction set within the unique healthcare systems of the United States, few studies that explore the diagnostic performance of nonadvanced practice clinicians, and, to our knowledge, no quantitative investigations of established reduction programs utilizing practitioners trained as EMTs.…”

Role of Atropine in Attenuating the Side Effects of Propofol in Procedural Sedation in Anterior Shoulder Dislocation Reduction: A Randomized Controlled Trial

“…condition. Most of these dislocations are caused by trauma, whereas the rest occur spontaneously [1] . Most ASD reductions are done using procedural sedation and analgesia [PSA] [2] .…”