The document discusses the epidemiology and management of severe snow sports injuries in Andorra. It notes that Andorra sees over 2 million skier-days per season. For severe injuries, ski patrols provide initial care and transport patients to on-mountain medical centers. From there, some patients are fully treated while others requiring advanced care or monitoring are sent to the main hospital. There is coordination between ski patrols, medical centers, and hospitals to efficiently manage transport and care for severe injuries.

1. SNOW SPORTS INJURIES IN ANDORRASNOW SPORTS INJURIES IN ANDORRA
EPIDEMIOLOGY AND MANAGEMENT OFEPIDEMIOLOGY AND MANAGEMENT OF
SEVERE INJURIESSEVERE INJURIES
Dr Bernat Escoda AlegretDr Bernat Escoda Alegret, Dr Josep Escoda Sales, Dr Josep Escoda Sales
Centre Medic Pas de la Casa-Grau RoigCentre Medic Pas de la Casa-Grau Roig
GRANDVALIRA SKI AREA ANDORRAGRANDVALIRA SKI AREA ANDORRA
www.cmpas.comwww.cmpas.com
info@cmpas.cominfo@cmpas.com

3. ANDORRAANDORRA
-462 square km462 square km
-80000 inhabitants80000 inhabitants
- 2,000,000 skier-days/season2,000,000 skier-days/season

4. Medical centers in the andorran ski areasMedical centers in the andorran ski areas
TWO MAIN SKINGTWO MAIN SKING
AREAS:AREAS:
GRANDVALIRA:GRANDVALIRA:
2 MEDICAL2 MEDICAL
CENTERS:CENTERS:
- Pas de la Casa-Pas de la Casa-
Grau Roig (2 sites)Grau Roig (2 sites)
- Soldeu-El Tarter (3Soldeu-El Tarter (3
sites)sites)
VALLNORD:VALLNORD:
3 MEDICAL3 MEDICAL
CENTERSCENTERS
- Pal (1 site)Pal (1 site)
- Arinsal (1 site)Arinsal (1 site)
- Ordino-Arcalis (1Ordino-Arcalis (1
site)site)

5. 1 hospital:1 hospital:
HOSPITAL NOSTRA SENYORA DEHOSPITAL NOSTRA SENYORA DE
MERITXELLMERITXELL
- 30 to 50 mn from the ski resorts medical centers30 to 50 mn from the ski resorts medical centers
- equiped to attend the most common medical and surgicalequiped to attend the most common medical and surgical
problems (general and orthopedic surgery, critical cares...)problems (general and orthopedic surgery, critical cares...)
- Cardiocirculatory surgery and neurosurgery is not available,Cardiocirculatory surgery and neurosurgery is not available,
in this cases pacients must be transfered to Barcelona (200in this cases pacients must be transfered to Barcelona (200
km) or Toulouse (180 km) by road (>2 hours) or helicopterkm) or Toulouse (180 km) by road (>2 hours) or helicopter
(45 mn) , depending on weather conditions(45 mn) , depending on weather conditions

6. SNOW SPORTS INJURIES INSNOW SPORTS INJURIES IN
ANDORRAANDORRA
- we have old registers beginingwe have old registers begining
in the seventies by their are notin the seventies by their are not
standardized, in paper forms,standardized, in paper forms,
with no control groupswith no control groups
- efforts have been made toefforts have been made to
improve the data collectionimprove the data collection
- for the last 5 seasons theres is- for the last 5 seasons theres is
a unique database resultinga unique database resulting
from the work of the ski patrols,from the work of the ski patrols,
the resorts medical centers andthe resorts medical centers and
the hospitalthe hospital
in the last seasonsin the last seasons
14,000 injuries/season14,000 injuries/season
incidence: 5,86 per 1,000 skier-incidence: 5,86 per 1,000 skier-
daysdays

7. TOTAL INJURIES IN PAS DE LA CASA-GRAU ROIGTOTAL INJURIES IN PAS DE LA CASA-GRAU ROIG
AREAAREA
during 2006-2007 seasonduring 2006-2007 season
3452 people3452 people
of witch:of witch:
- 3320 were attended in3320 were attended in
the resort medicalthe resort medical
centercenter
- 23 went by their own23 went by their own
to Andorra hospitalto Andorra hospital

8. 3320 INJURIES attended in PAS DE LA CASA-GRAU3320 INJURIES attended in PAS DE LA CASA-GRAU
ROIG MEDICAL CENTER (season 2006-2007)ROIG MEDICAL CENTER (season 2006-2007)
TYPE OF INJURYTYPE OF INJURY
TENDONS & MUSCLES
INJ.
5%
DISLOCATIONS
2%
FRACTURES
13%
SPRAINS
29%
CONTUSIONS
22%
WOUNDS
5%
CONCUSSIONS
3%
OTHER INJURIES
10%
UNKNOWN
11%

9. 3320 INJURIES attended in PAS DE LA CASA-GRAU3320 INJURIES attended in PAS DE LA CASA-GRAU
ROIG MEDICAL CENTER (season 2006-2007)ROIG MEDICAL CENTER (season 2006-2007)
INJURIED REGIONINJURIED REGION
CONCUSSION 3%
OTHER HEAD & NECK 15%
FEMUR & PELVIS FRACT.
DISLOC. 0%
SHOULDER DISLOC. 1%
OTHER SHOULDER 9%
THUMB SPRAIN 4%
OTHER HAND 3%
WRIST FOREARM ARM
FRACT. 6%
OTHER WRIST FOREARM
ARM 10%
ACL INJURY 5%
OTHER KNEE SPRAINS
12%
OTHER KNEE 10%
LEG ANKLE FOOT FRACT.
2%
OTHER LEG ANKLE FOOT
8%
OTHER DIAGNOSTICS 1%
UNKNOWN 11%

10. 3320 INJURIES attended in PAS DE3320 INJURIES attended in PAS DE
LA CASA-GRAU ROIG MEDICALLA CASA-GRAU ROIG MEDICAL
CENTERCENTER
- 3188 fully attended …- 3188 fully attended …
- 122 sent to Andorra hospital for :- 122 sent to Andorra hospital for :
-monitoring (mainly concussions …)-monitoring (mainly concussions …)
-complementary exams-complementary exams
-surgical treatment-surgical treatment

11. 3320 INJURIES attended in PAS DE LA CASA-3320 INJURIES attended in PAS DE LA CASA-
GRAU ROIG MEDICAL CENTER (season 2006-GRAU ROIG MEDICAL CENTER (season 2006-
2007)2007)
FULLY
ATTENDED
96%
SENT TO
HOSPITAL
4%

12. 122 sent to Andorra hospital122 sent to Andorra hospital
(4% of all the pacients seen in the(4% of all the pacients seen in the
resort medical center)resort medical center)
CONCUS.
32%
SPINE INJ.
8%
UPER LIMB
FRACT.
18%LEG FRACT.
5%
PELV FEMUR
FRACT.
10%
THORAX
5%
ABDOMEN
10%
SPRAINS …
12%
SPINE INJ.
8%
UPER LIMB
FRACT.
18%
LEG FRACT.
5%
THORAX
5%
ABDOMEN
10%
SPRAINS …
12%
CONCUSSION
32%
PELV FEMUR
FRACT.
10%

13. SEVERE INJURIESSEVERE INJURIES Fractures or dislocations withFractures or dislocations with
risk of vascular/nervous compromiserisk of vascular/nervous compromise
Quick reduction isQuick reduction is
performed in ourperformed in our
medical center inmedical center in
most of the cases,most of the cases,
and then controlledand then controlled
by their ownby their own
traumatologist, a fewtraumatologist, a few
are transfered to theare transfered to the
hospitalhospital

14. SEVERE INJURIESSEVERE INJURIES possibility of complicationspossibility of complications
and / orand / or
need for further investigations (scan, blood analysis…)need for further investigations (scan, blood analysis…)
HEAD TRAUMA, ABDOMINAL TRAUMAHEAD TRAUMA, ABDOMINAL TRAUMA
DISEASEDISEASE
 HOSPITALHOSPITAL

15. SEVERE INJURIESSEVERE INJURIES need for surgical treatmentneed for surgical treatment

16. SEVERE INJURIES MANAGEMENTSEVERE INJURIES MANAGEMENT
ski patrolsski patrols
They are the first to attend theThey are the first to attend the
injuried skier /snowboarder,injuried skier /snowboarder,
Their initial evaluation is essentialTheir initial evaluation is essential
for the correct management offor the correct management of
each caseeach case
If necessary they are able toIf necessary they are able to
assume ressucitationassume ressucitation
manoeuvres, oxygenotherapy,manoeuvres, oxygenotherapy,
automatitzed DF ( devices inautomatitzed DF ( devices in
the higher points of the resortthe higher points of the resort
so they can be transported in 3so they can be transported in 3
to 5 minutes to all the points ofto 5 minutes to all the points of
the ski area)the ski area)
- permanent radio communication- permanent radio communication
with the medical center inwith the medical center in
order to transmit theorder to transmit the
informationinformation

17. SEVERE INJURIES MANAGEMENTSEVERE INJURIES MANAGEMENT
medical centermedical center
2 doctors and 1 nurse in2 doctors and 1 nurse in
each area (trained ineach area (trained in
sports traumatologysports traumatology
and emergencyand emergency
medecine) , can bemedecine) , can be
transported untill thetransported untill the
pacient by skidoo,pacient by skidoo,
transportabletransportable
emergency bagemergency bag
(drugs,perfusion fluids,(drugs,perfusion fluids,
orotracheal intubationorotracheal intubation
set …), cardiacset …), cardiac
monitor / DFmonitor / DF

18. SEVERE INJURIESSEVERE INJURIES
-THE PACIENT IS-THE PACIENT IS
CONDICIONED TO BECONDICIONED TO BE
TRANSPORTEDTRANSPORTED
SAFELY UNTIL THESAFELY UNTIL THE
MEDICAL CENTERMEDICAL CENTER
WHERE A COMPLETEWHERE A COMPLETE
CHECK WILL BE MADECHECK WILL BE MADE
-IF THE PACIENT-IF THE PACIENT
REQUIRESREQUIRES
TRANSPORTATIONTRANSPORTATION
UNTIL THE HOSPITALUNTIL THE HOSPITAL
IT WILL BE DECIDEDIT WILL BE DECIDED
THE BESTTHE BEST
TRANSPORTATIONTRANSPORTATION
MEANMEAN

19. SEVERE INJURIESSEVERE INJURIES
MEDICAL CENTERMEDICAL CENTER
EQUIPEMENT:EQUIPEMENT:
-drugs,perfusion-drugs,perfusion
fluids,fluids,
orotrachealorotracheal
intubation,intubation,
cardiac monitor /cardiac monitor /
DFDF
-OXYGEN-OXYGEN
-X RAY-X RAY

20. SEVERE INJURIESSEVERE INJURIES
transport until the hospitaltransport until the hospital
- USUALLY A- USUALLY A MEDICALIZED AMBULANCEMEDICALIZED AMBULANCE WILL BE USED IN THEWILL BE USED IN THE
MOST SEVERE CASES (PHYSICIAN + NURSE)MOST SEVERE CASES (PHYSICIAN + NURSE)
- AA MEDICAL HELICOPTERMEDICAL HELICOPTER CAN BE USED TOO BUT IT IS NOTCAN BE USED TOO BUT IT IS NOT
PERMANENTLY BASED IN THE HOSPITAL SO IT CAN BE TO LONGPERMANENTLY BASED IN THE HOSPITAL SO IT CAN BE TO LONG
TO ACTIVATETO ACTIVATE
- IN CASES THAT DON’T NEED MEDICATION AND WITH NOIN CASES THAT DON’T NEED MEDICATION AND WITH NO
IMMEDIATE RISK OF COMPLICATION AIMMEDIATE RISK OF COMPLICATION A NON MEDICALNON MEDICAL
AMBULANCEAMBULANCE CAN BE USED (PARAMEDICS)CAN BE USED (PARAMEDICS)

21. SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATIONNEED OF A GOOD COORDINATION
BETWEEN ALL THE INTERVENANTSBETWEEN ALL THE INTERVENANTS
SKI PATROLS-RESORT MEDICALSKI PATROLS-RESORT MEDICAL
CENTERCENTER
We work hand in hand, continous radioWe work hand in hand, continous radio
communication, the medical center iscommunication, the medical center is
involved in the continuous formation of theinvolved in the continuous formation of the
ski patrolsski patrols

22. SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATIONNEED OF A GOOD COORDINATION
BETWEEN ALL THE INTERVENANTSBETWEEN ALL THE INTERVENANTS
RESORT MEDICAL CENTER – HOSPITALRESORT MEDICAL CENTER – HOSPITAL
Phone coordination – exchange ofPhone coordination – exchange of
information / medical reports in order toinformation / medical reports in order to
decide about the proper way to transportdecide about the proper way to transport
the injuriedthe injuried

23. SEVERE INJURIESSEVERE INJURIES
NEED OF A GOOD COORDINATION BETWEENNEED OF A GOOD COORDINATION BETWEEN
ALL THE INTERVENANTSALL THE INTERVENANTS
SKI PATROLS - RESORT MEDICAL CENTER – HOSPITALSKI PATROLS - RESORT MEDICAL CENTER – HOSPITAL
ALL THE DATA ON SNOW SPORT INJURIESALL THE DATA ON SNOW SPORT INJURIES
ARE COLLECTED IN A UNIQUE DATABASEARE COLLECTED IN A UNIQUE DATABASE
Further analysis of witch will probably:Further analysis of witch will probably:
- Help all of us to improve the attention to theHelp all of us to improve the attention to the
injuried peopleinjuried people
- Leed to prevention actionsLeed to prevention actions

24. THANK YOU!!!!!THANK YOU!!!!!
www.cmpas.comwww.cmpas.com
dr.escoda@andornet.addr.escoda@andornet.ad