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Article Title: 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.

Article Authors: Jamin M Mulvey, Ira N Carson, Kevin A Palmer

Study Link: https://www.wemjournal.org/article/S1080-6032(21)00152-6/fulltext

BOTTOM LINE: This study assessed the efficacy of training nonmedical ski patrollers to reduce anterior shoulder dislocations in settings where physicians were not immediately available to assist. The reduction success rate was 89%, suggesting a way to improve patient care in the absence of more advanced medical practitioners.

Study Design and Methodology: Retrospective Study (Quality Assurance)

Funding: None

Setting: Pre-hospital, remote ski resort environment (Alberta, Canada)

Synopsis:

Anterior shoulder dislocations (ASDs) are common ski hill injuries. In many Canadian ski resorts, the level of medical training for the average ski patroller does not allow them to perform shoulder reductions, leaving on-call physicians to perform this task. However, advanced medical providers are not always readily available. Sunshine Village ski resort in Banff, Canada, developed a protocol for ski patrollers to follow and perform ASD reduction when physicians were not immediately available to assist in treatment. The goal was to reduce patient pain and suffering while also decreasing complications that result from prolonged transport times and/or difficult field extractions. In 2017, 10 patrollers went through an extensive training program to perform either the FARES or the Cunningham reduction technique under the resort’s protocol. Patrollers with more advanced medical training (i.e. EMT, RN, MD) were excluded. After the 2020 season, a retrospective chart review was performed to determine the efficacy of the program. Results showed that out of the 96 ASD reductions performed, 82 were successfully reduced by the trained nonmedical patrollers. The overall reduction success rate was 89% [95% CI 81-95%]. Success rates for those with first-time dislocations was 90% compared to 87% in recurrent dislocations. The Cunningham method was used in 75% of these cases. The authors addressed the known controversy of performing shoulder reductions prior to imaging by screening and excluding patients with high risk of fractures.  The study had limitations of lacking a control group for comparison as well as having inconsistent patient charting. More notably, follow up was not attained and therefore it is unknown whether patients developed complications from their ASDs. The article concludes that training ski patrollers to reduce ASDs can improve patient care by providing earlier treatment. Other Canadian ski resorts may benefit from having a similar protocol.

Reviewed by: Daniel Kliger, St. George’s University School of Medicine

Reference:

Mulvey, Jamin M et al. “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.” Wilderness & environmental medicine vol. 32,4 (2021): 441-449. doi:10.1016/j.wem.2021.07.007