Mountains of casualties Whistler’s health care centre can resemble a MASH unit By Don Anderson Easter Sunday, April 7, 2 p.m. Whistler Health Care Centre, Emergency Ward Boy, is it quiet. Extremely quiet. So, this is what they call "the MASH Unit?" The unit, as it appears on this day, is not living up to its billing. On this particular Easter weekend business is rather slow. There have been a few minor incidents — a couple of broken wrists, a shoulder injury or two, a guy with some broken ribs — but nothing out of the ordinary. I'm told by Francesca Cole, the E.R.'s head nurse, that the ward's nine beds are full. Outside the rain falls hard and the skiers, says Cole, just aren't doing the same. Poor weather = very little action in emerg. The same cannot be said about sunny days, notably a string of brilliant ski days through this year's spring break at the resort. At the height of March madness the centre drew more than 120 patients in a single day. According to Cole, entering her second year at the centre, the place was something not far removed from what television viewers are presented with each week on the medical drama ER. That is, of course, minus the bullet wounds, misguided love affairs and internal strife that commonly fills out that show's hour of insanity. Here in Whistler it's a different kind of carnage — mountain carnage. You'd think there was a war being fought on them thar hills to judge by the stream of casualties that roll through the centre's hallways on a good ski day. "Here you never know how your day is going to go," says Cole. "There is a certain element of uncertainty with this job." A busy day during the winter season will bring in between 80 and 100 patients. More than 60 per cent of those patients will arrive from the mountains, either by ambulance, car or foot. It can get so busy at times in emerg that only the seriously injured will be provided a bed, and sometimes that bed is in the hall. If you have a wrist or shoulder injury you'll likely be sitting in the hallway or waiting room. If you're enquiring about the morning after pill on a good ski day, be prepared to wait. And wait. And wait. Sometimes up to four hours, if you're that desperate. "What people don't see in the waiting room is what is coming through the ambulance doors," says Cole. Additional beds wouldn't solve the problem, she says, nor would it be economical. As the volume of skiers, snowboarders, in-line skaters and mountain bikers rises so do the casualties. The staff of the emergency ward, numbering five full-time and five part-time nurses plus Cole, three doctors and a myriad of volunteers, have seen everything and anything you could ever imagine. On an almost daily basis Whistler's ER treats broken wrists, broken ribs, shoulder injuries, spinal cord injuries, neck injuries, lacerations, ripped ears, head injuries and more instances of trauma (i.e. partial paralysis) per capita than any other ER ward in the province, staff boast. A single Saturday or Sunday may produce as many as five traumas. "There are some days that you are going from one bed to the next... it's like you are on auto-pilot moving them through the assembly line," says Cole. Sheer volume makes it nearly impossible for patient follow-up. Once you're out of emerg, you're either sent upstairs or on your own. Between April 1, 1995 and March 31, 1996 emergency ward staff treated 3,357 people for injuries incurred on Whistler and Blackcomb Mountains. Of that number, 2,274 came from Blackcomb Mountain while 1,083 came from Whistler Mountain. March was particularly gruesome. The ward contended with 1,022 injured recreationalists from the mountains, compared to 396 in December. Some days five or six people are air-evaced by helicopter or transferred by ambulance to Lower Mainland hospitals for further treatment. The volume of ski and snowboard injuries outweighs all other sports injuries — in-line skating, cycling, skateboarding, hockey, baseball — seven to one. For the period between April 1, 1995 and March 31, 1996, 249 cyclists were treated for injuries relating to their hobby. In-line skating was a distant second at 82 casualties. In the last year sports injuries have climbed 23 per cent. As a comparison, motor vehicle accidents have fallen five per cent over the same period. RN Anne Fenwick has become a much different skier since joining the centre. After listening to her describe the number of spinal cord traumas she's seen and how many people she's told they won't walk again, it's easy to comprehend why. "I certainly ski different, and I watch my kids and other people," says Fenwick, ironically an avid ER (the TV show) viewer. "I ski a lot more defensively than I used to. And I'm not interested in snowboarding." Sunday, April 14, 4 p.m. The first thing that strikes you about the centre, beside it being so clean and spanking brand new, is the demeanour of the staff. They are one cheery ensemble. Someone's always cracking a joke. Staff turnover is nil. It seems there's no getting this tightly knit crew down, regardless of the situation. Take, for instance, Saturday, Dec. 23, 1995. Tragedy strikes Whistler Mountain's Quicksilver lift when a chair carrying three passengers detaches above Coaches Corner and slides down the line into the chair in front, setting off a catastrophic chain reaction. The first chair and three passengers fell about 10 metres to the ground. Three other chairs collide with a sheave assembly at one of the towers and fall to the ground, taking their passengers with them. Hundreds of skiers are left stranded on the lift. At the Whistler Health Care Centre the emergency ward is already in full tilt dealing with that afternoon and morning's stream of injured recreationalists. Dr. Andrew Hamson, a six-year veteran of the centre and its current pediatrician, is there. He is called upon to tend to the first casualty — 25-year-old Trevor MacDonald of Vancouver. Unfortunately, Hamson is one miracle short of preventing a tragedy. MacDonald does not make it. It would be a long night for Hamson and the cast of Whistler's ER, including its many volunteers. Hamson would be on his feet for 23 straight hours before seeing his own bed. The ward was met with a continuous loop of the injured, the cold and the confused. "I think we were a bit worried because if there had been any more (cases) we probably would have gone under," says Hamson. More doctors and volunteers arrived. Food suddenly appeared out of nowhere. "We never knew what was going on," says Hamson. "We never really knew what happened." That evening the centre treated 11 acutely injured skiers and snowboarders involved in the accident. "It was one of those days that you hope you never go through again," says Judi Clark, head of admitting. "You just went, went, went." If anything good came out of all the chaos and calamity of Dec. 23 it was a recognition that Whistler's health care professionals are prepared to meet even the gravest of tasks they are dealt. "It was difficult but impressive how everybody pulled together," concludes Hamson, later admitting he hasn't been bored since the 1960s, just before he decided to take up medicine. POSTCRIPT Sunday, April 21, 6:30 p.m. I'm back at the centre, still waiting to witness first-hand why they call this The MASH Unit. It's been a magnificent day on the slopes. The skies were clear, the slopes weren't overcrowded and the snow wasn't too grabby. But if my projections are right, based on estimates provided by Cole and supported by Fenwick, my time of arrival at the centre couldn't be better. "It's been busy," says receptionist Pat Bader, and I suddenly feel a rush of excitement. Sounds a bit sick when you think about it. But she wasn't kidding about the amount of activity in emerg. I make the sojourn down the hallway where I find every bed and room occupied. One of the nurses wheels a sombre sunburned and bedridden patient to the X-ray lab. "So, were you up skiing today?" asks the nurse. Yes, responds the patient, trying her best to remain positive about her predicament. A second patient, a man in his 30s, explains his crash on the hill to anyone who will listen. It seems he caught a stretch of sticky snow and took a mean crash. He leaves with his shoulder in a sling. In the hallway one man is confined to a stretcher, his neck and head in a brace, a complex web of tubes at his side. He fractured his neck while skiing and is awaiting transfer to Vancouver General for further treatment. He doesn't say much. According to RN Linda Henderson, staff have been going all day tending to the wounded. "I find spring snow can be a little tricky skiing," she says in classic understatement. In the corner of the nurses station Dr. Paul Walden discusses a patient's prognosis with an out-of-town physician. Walden's shift started at 4 p.m. He was no sooner in the ward when all hell broke loose. Within three minutes of his arrival Walden was up to his stethoscope in fractured legs, ruptured knee ligaments, broken wrists and ribs and shoulder injuries. Business as usual, he says. You never know what to expect. A severely injured snowmobiler is expected to arrive any moment by heli-evac. Staff are unsure where he's coming from, what his injuries are or what his name is; all they know is he's coming and they are ready. During a brief exodus from the ward, Walden provides his perspective of a doctor's life in this recreational wonderland. "I like it," he says convincingly. "It's very interesting medicine. There are things that I find more interesting than others, but nothing really surprises me." By now I'm left with the impression that there are going to be a lot of former snowboarders walking around with crooked spines and aching shoulders in the not-too-distant future. And my discussion with Walden doesn't help to allay those fears. As Walden explains, the big air that snowboarders are chasing after with such tenacity is endangering their health big time. "We see a lot of injuries because of jumping," he says. "Air time is one of the worst things you can do as far as injury risk." Getting 40 feet of air, he says, is like jumping out of a two storey building onto the street below. What snowboarders don't realize is their bodies are not built to sustain the force of their landings. And often they are landing on hard packed snow, which is like landing on concrete. Although he's sent more skiers into surgery than boarders, "We are seeing a very high proportion of snowboard injuries," Walden says. His advice to snowboarders and skiers: ease up a bit. "There is no question that jumping off cliffs and getting big air is ridiculous, it's too high risk," he says. "The body just wasn't designed to do it." In the other room, the snowmobiler arrives and his injuries are fairly extreme. According to Walden, the fellow has ripped up his face pretty badly. He'll recover, like most of the injured do. But that's not good enough for Walden. He'd like to see less traffic in emerg, less traumas. Unfortunately, he doesn't envision that happening. "The ante keeps going up. Good skiers don't think they are good skiers if they aren't doing the radical stuff," he says. "But the jumping off cliffs and the big air... it is just pushing the limit too far."