Shoulder Dislocation Infographic

View PDF

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:


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)



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


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


Comments 1

  1. Is Sunshine Village Ski Resort in Banff, Alberta a CSP ( Cdn Ski Patrol ) staffed ski area, or is it patrolled by non-CSP Paid Patrollers ? My understanding is that the CSP AFA manual & policies still do not consider Anterior Shoulder Dislocation Reduction attempts to be within the scope of practice & AFA training of member CSP patrollers, & these CSP patrollers are advised not to perform ASD R , & do not have liability /insurance coverage to do so. I do agree with this study’s conclusion that Non-medical patrollers can be taught to reduce anterior non-high risk shoulder dislocations, & that could be very helpful for prompt pain & suffering alleviation, & probably better quicker achieved positve treatment outcomes. Also, many Ski Patrol nits do have RN’s, Paramedics, EMTs, & retired physicians on staff as volunteer patrollers, so the outcomes likely may be even better than in the study where these medical professionals were excluded. …Joe Gieni – CSP Sault Zone Safety Officer & Volunteer Ski Patroller

Leave a Reply

Your email address will not be published. Required fields are marked *