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Injured Boarder Refusing Care

jcjpdx

Getting on the lift
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Yesterday was my first day skiing at Timberline Lodge in 2022 and it was a glorious day. Unfortunately, it was marred a little by an incident I encountered and I would like some patroller's input.

I was skiing towards Molly's Run when I encountered two boarders who had both crashed. Not into each other, but in the same area. They seemed to be together and it didn't look too serious. However, when I came back up the chair, they hadn't moved, the man was tending to the woman, and she was sitting up, alternately holding her wrist, arm and head. I skied over and asked them if she was okay. She was clearly not okay, she was dazed and in pain, but both of them insisted that she did not need any help, did not want ski patrol contacted and that she would be fine. I stood there several minutes, they made it clear they did not want help, so I reluctantly skied away, but decided to report to the first patroller I saw.

I found a patroller at the top of Pucci lift, and told him of the incident. The woman was wearing a distinctive outfit, which I described. He said he would check things out. I went by the crash area again, and the couple was not there, but another crash had occurred in the exact same location, someone was injured, and these people were responding appropriately to the injury. So I skied down the trail again, and found the young woman about 150 yards away, sitting on the ground, her friend nearby. I got to the bottom of the run, found three more patrollers, and again described the situation. They said they were aware of the woman and had sent for medics.

The last time I saw the couple, they were moving, very slowly, towards the bottom of Pucci lift, with no patrollers or medics in sight. So I am worried that there was confusion because of the two crashes in the same area, and that a possibly head-injured boarder left the area without medical attention.

So, I have several questions:

Should I have done more, specifically should I have not left the area the first time?

In a ski area, does an injured person have the right to not report the injury to ski Patrol?

Ethically, does a head-injured person have the right to refuse care, especially if they may not be thinking clearly?

Was there a way to be more clear with the patrollers?

I did find a phone number for ski patrol printed on my lift ticket, which is now programmed into my phone. But I did not know about this number at the time of the incident.

Thanks, James
 

pchewn

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Should I have done more, specifically should I have not left the area the first time?

In a ski area, does an injured person have the right to not report the injury to ski Patrol?

Ethically, does a head-injured person have the right to refuse care, especially if they may not be thinking clearly?

That cross-traffic area near the top of Molly's lift is very accident prone. I use extra care there.

An injured rider is required to report the accident to the ski area. Failure to do so allows the ski area to revoke lift use. See law for Oregon here: https://oregon.public.law/statutes/ors_30.985

The law says the skier is the sole judge of their skill and ability. So yes, they can refuse treatment.

You did more than required to try to get the person treated. You can lead a horse to water, but you can't make him drink.
 

coskigirl

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Unfortunately, this sounds like either a situation where she doesn't have medical insurance or an domestic abuse situation and they were afraid of what would happen if patrol got involved. Not that the crash was abuse but that in evaluating for that they would find evidence of other injuries. I don't think there is much else you could do, unless you could get them separated and have an individual conversation with the woman to find out if she needed help. Kudos to you for trying.
 

Jwrags

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If the injured was alone then I think you have an obligation to stay with them until patrol arrives. However, she was with another adult who appeared responsible so I think you went above and beyond your moral duty.
 
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jmeb

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My 2cs as a patroller
Should I have done more, specifically should I have not left the area the first time?

No. Moving along and reporting to a patroller is the appropriate action here. If the person were alone or you were concerned about their company, calling patrol while staying out of the injured party's way may be appropriate. The last thing we want is someone pushing too hard and escalating a situation. Skiing to find a patroller is a-OK.
In a ski area, does an injured person have the right to not report the injury to ski Patrol?
This varies by jurisdiction. I would never tell someone they are required to come to us with an injury, but would encourage them to do so.
Ethically, does a head-injured person have the right to refuse care, especially if they may not be thinking clearly?
Not going to talk ethics, but operationally: suspected concussions or head injuries do not have the same refusal of care rights as other injuries. This may vary by jurisdiction and what medical directives the patrol operates under. For us, suspected concussions or head injuries where a patient is anything besides "A&Ox4" (alert and oriented to person, place, time and event) needs to be cleared by ALS--typically a paramedic at most hills. Most patrollers aren't paramedics, but some are. Some hills do not have ALS on staff and may require ambulance paramedics to clear. Most all will want to clear the patient in an aid room off the mountain.
Was there a way to be more clear with the patrollers?
Sounds like you communicated what we would communicate: specific location last seen, mode of travel (skis, snowboard, walking), clothing, sex, approx age, and number in group.

@coskigirl makes a good point re:insurance. Many folks are concerned about being billed by insurance. Patrols in the States do not charge or bill insurance. (Situation differs across the pound). However, you may be routed into care without a choice of refusal (i.e. you have signs of a concussion and have been drinking == you're going in an ambulance, or you are actively in shock, etc etc) that does incur costs. Patrols do often collect information on whether you have insurance (yes/no) because it is required by their insurance.

And yes, in most jurisdictions patrollers are mandated reporters for any type of suspected abuse or neglect.

In short well done. If you want to do anything more -- add the patrol's number to your cell phone in case the next injury you spot isn't responsive or doesn't also have help on the scene.
 

François Pugh

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You did what you could. No more required, nor advised.
I can't advise on the law, but the injured skier has the right to decide if they want treatment or not, and as far as I'm concerned the right to keep quiet about the whole affair or put it on Youtube. Their choice. They call the tune and if required, pay the piper.

Yes, I like freedom and personal responsibility.

Were I in that situation I might keep an eye on the patient, and if they later pass out, then I have implied consent to treat.
 

pais alto

me encanta el país alto
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Retired patroller here.
@jmeb nailed it.
- The OP did exeactly the right things.
- Injured people do not have an obligation to report their injury.
- Injured people can refuse treatment, unless they are obviously unable to make decisions for themselves. To me this meant mentally incapacitated (severe head injury, unconscious, unable to communicate*), which does not sound like the people in the OP. Where I worked we were required to try to get a signed refusal of care form.
- It’s not appropriate for a caregiver (patroller) to force care on a person that is coherently refusing care. In an extreme case, an assault charge is possible for unaccepted/unwanted physical contact.

* Determining a person is drunk or on drugs and therefore not capable of responsibly refusing help is a tricky area. Consider the scenario in court where the person’s attorney asks “What test did you administer to determine the level of incapacitation due to drugs or drink? What training do you have to determine the actual incapability?” Patrollers are not LEO.
 
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fatbob

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I'd bet most likely an insurance issue and perhaps lack of understanding that patrol assistance is free in US.

All the more grist to the Blister/Spot product for outdoor activity enthusiasts.
 

jmeb

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* Determining a person is drunk or on drugs and therefore not capable of responsibly refusing help is a tricky area. Consider the scenario in court where the person’s attorney asks “What test did you administer to determine the level of incapacitation due to drugs or drink? What training do you have to determine the actual incapability?” Patrollers are not LEO.

And patrollers really don't want to be LEO. And we really don't want to call LEO either.
 

kayco53

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As a patroller up here in Canada you did the right thing telling Patrol. When we arrive on scene we need to ask permission to help. If they say no we back off because they have that right. There is also a form to refuse treatment/help that you ask them to sign. We will watch them and may offerhelp again but not bug them. Usually in a case like this we would follow them out and keep a eye on them. However if the person loses consciousness, that would give us implied consent which means we could help. If they wake up they can tell us to go away. The only time that changes if the police would be on a scene and they arrest them and ask you to help. That can happen on a ultra marathon in which runners get delirious. Note we do summer stuff as well.
 

Idris

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As a patroler in France. In this case you would have a duty to report the situation. If people are behaving in a way that is supicious or signs of head trauma. We are not alowed to ignore. If someone has crashed, we turn up and they have no obvious signs of trauma, they can refuse help and we send them on their way once they sign a form saying they don't want help. If it's plain strange or there is something they are not telling us, we call the gendarms (police). In posh resorts there is a lot of what we used to call cataloge wives form certain countries and they know that some things are VERY against french law!
 

pchewn

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Unfortunately, this sounds like either a situation where she doesn't have medical insurance or an domestic abuse situation and they were afraid of what would happen if patrol got involved. Not that the crash was abuse but that in evaluating for that they would find evidence of other injuries. I don't think there is much else you could do, unless you could get them separated and have an individual conversation with the woman to find out if she needed help. Kudos to you for trying.

Those (lack of insurance, abuse) are possibilities I did not consider. From the OP initial description, my thoughts were that here are some beginners who fell without injury and were then slowly working their way down the hill as they were on terrain over their ability.

As a ski instructor, I would sometimes take my best 1st-day skiers down this area (top of Molly's to Pucci). I would allow for 30 minutes or more. A skilled intermediate skier can go down there in 4 minutes.

That's what I was thinking in the OP's description: They fell, not injured enough to need treatment, unskilled for the terrain and moving slowly downhill.
 

firebanex

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Retired patroller here.
@jmeb nailed it.
- The OP did exeactly the right things.
- Injured people do not have an obligation to report their injury.
- Injured people can refuse treatment, unless they are obviously unable to make decisions for themselves. To me this meant mentally incapacitated (severe head injury, unconscious, unable to communicate*), which does not sound like the people in the OP. Where I worked we were required to try to get a signed refusal of care form.
- It’s not appropriate for a caregiver (patroller) to force care on a person that is coherently refusing care. In an extreme case, an assault charge is possible for unaccepted/unwanted physical contact.

* Determining a person is drunk or on drugs and therefore not capable of responsibly refusing help is a tricky area. Consider the scenario in court where the person’s attorney asks “What test did you administer to determine the level of incapacitation due to drugs or drink? What training do you have to determine the actual incapability?” Patrollers are not LEO.
This is pretty much it. I've had multiple guests over the years refuse treatment or transport down the mountain. We typically then back off about 20 yards and shadow them down the mountain to keep an eye on them.
 

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