Subject: “Group Offers Reward to Counter Skiers’ Deadly Road Rage” L.A. Times – (2/14/99)
Answer: This article, republished in dozens of newspapers around the country, follows in the footsteps of the WSJ piece of 1/8/99 (FAQ #1). Although the WSJ blamed the ski areas for an increase in injuries and the Times blames out-of-control skiers and snowboard riders, both perpetuate many of the same errors of fact concerning the risk of injury in alpine skiing and snowboarding.

The Times article, however, takes the subject of rageful and inconsiderate skiers, a valid issue, and then pads the discussion with a confusing and utterly disorganized array of myths and misconceptions. Even when the statement has a kernel of truth, it is often unrelated to the discussion. This article is not just shoddy journalism but really bad writing.

For the researcher it is vexing when the results of years of effort are misrepresented in the interest of sensationalism or in support of a myth which has been debunked for decades. All the more vexing when the reporter has missed a genuine opportunity to provide factual information of substantial value to the reader. By today’s standards of journalism fact and opinion, peer reviewed journals, newspaper editorials, scientific data, and third hand anecdotes are all thrown into the same pot. From this stew a story is assembled using whichever sources best support the author’s premise. In the process, information is often separated from its context or vaguely attributed to the generic “expert” without further qualification.

Science is always at a disadvantage when reporters are looking for fresh “facts.” The development of an established fact on any subject is time consuming, involving peer review of the entire process, often in multiple forums. While some researchers have been accused of peer review by press release (example – Cold Fusion), competent researchers will qualify preliminary findings and opinions very carefully.

A research colleague, Dr. Jasper Shealy of Rochester Institute of Technology, was quoted incorrectly and out of context in both the WSJ and Times articles. Dr. Shealy and I have worked together with Dr. Robert Johnson of the University of Vermont Dept. of Orthopedic on the largest and longest-running study of snow sport injuries to date, logging more than 16,000 injuries at a northern Vermont ski area over the past twenty-seven years. Separately Dr. Shealy has researched deaths and catastrophic injuries using a national data base including information collected by the Consumer Product Safety Commission (CPSC). These studies led him to the question of helmet use in skiing and snowboarding. Shealy has presented his research on these issues to numerous professional and scientific groups over the past fifteen years. His most recent findings will be the subject of a keynote address to a congress of the International Society for Skiing Safety later this year.

In order to encourage informed discussion of these issues and to facilitate factual reporting by competent journalists, I have summarized below, from past publications and several of Dr. Shealy’s most recent position papers, points which bear on the Times article, along with our comments on injury trends overall.

According to the National Ski Areas Association, the number of snow sport participants has remained relatively constant at around 55 million skier/snowboarder visits in recent years, although the percentage of skiers has fallen as snowboarding has increased in popularity.

To determine injury trends it is necessary to analyze the change in the injury rate (not the injury count). Two methods in common usage today are mean days between injury and injuries per thousand skier visits. Over the past twenty-seven years, skiing injury rates have declined by half. The rate today is low, about one medically significant injury in every 400 skier visits. However, there has been no significant change in the past dozen years.

The most common definition used for “medically significant” is: the injury required medical treatment or the injury kept the person from skiing for at least one day. Although at least some minor injuries go unreported, most serious injuries are, and there is no indication that the rate of unreported injuries in general is changing. So there is no reason to believe that unreported injuries have skewed trends cited by researchers.

At present, there is no credible evidence that catastrophic injuries are increasing at a statistically significant rate according to Shealy. Catastrophic injury is a nebulous term that has yet to be clearly defined and is therefore not a reliable statistic over time. But even if it could be defined, the general category is a difficult statistic for a small ski area to report accurately. Small areas are unlikely to have a medical clinic and staff which can accurately diagnose a potential catastrophic injury and follow up to confirm the long term prognosis. Over the past twenty years the number of ski areas has declined by 50% with most of the attrition among small areas. As the number of ski areas decreases, leaving fewer but larger and better managed facilities, we can expect the reporting to improve. However, these improvements skew the raw data and can create the false impression of a trend, if changes in the quality of the reporting over time are not taken into consideration.

Deaths in skiing are not increasing at a statistically significant rate. But even death is not a certain statistic. Shealy believes a snow sport fatality should meet the following criteria for inclusion: a) the accident occurred within the ski area’s boundaries, b) death occurred within 30 days of the accident, c) the coroner determined the skiing accident to be the primary precipitating cause of death. But, as reasonable as this definition may seem, it is not everyone’s definition, and it is not always the criteria used by the Consumer Product Safety Committee.

Shape ski use by beginners through intermediate skiers, who have gone through some form of shape ski orientation, results in fewer than expected injuries according to our studies. However, we have found shape ski use by experts, who are not experienced or trained in shape ski technique, results in a higher than expected injury rate.

High speed, high capacity lifts reduce the time skiers spend standing around in the cold or sitting on a cramped lift. In our opinion, if the skier spends the time saved making a few extra runs or taking a little extra time in the mid station lodge over a cup of hot coffee, that is a personal choice. On the other hand, it’s the ski area’s job to make sure that uphill capacity does not exceed the down hill capacity of the trail network.

From our experience, trail grooming reduces the number of falls and, in many types of snow conditions, the number and severity of the injuries that result. However, trail grooming can tempt skiers to ski faster, in our opinion, which can lead to more severe injuries from collision. But areas have many devices at hand for controlling speeders which in the most extreme cases may require aggressive monitoring by ski patrollers.

According to Shealy, 85% of all fatalities are males, although males represent only about 55% of the skiers on the hill. Even though studies in the field of highway safety have shown women to be less crash-worthy than men, women and men sustain different types of skiing injuries, from different causes. Men more likely to sustain certain types of fractures, while women are more likely to sustain soft tissue injuries such as ACL sprains. The raw injury rate for women in skiing is higher then for men. But when ability, experience, and size (weight and height) are taken into consideration, the overall risk of injury for women in skiing is similar to men.

According to Shealy and contrary to popular myth, skiers are more likely to hit a snowboard rider than are riders to hit a skier. In his opinion, this is because skiers are likely to ski faster and spend more time in the fall line. There are also more skiers than snowboarders. Other factors may include the warning sound an approaching snowboard gives skiers and the blind spot snowboard riders have which prevents them from seeing some approaching skiers. Snowboards are also less maneuverable at low speeds than skis, so the snowboard rider has greater difficulty getting out of the way, even if warned of an impending collision. On the bright side, snowboard riders do not slide as far following a fall as skiers and therefore are less likely to collide with stationary obstacles, according to Shealy.

In a typical year there are about 135,000 medically significant snow sport injuries in the US. Shealy has found 2.5% (3400) of the 135,000 are potentially serious head injuries. However, 77% (2600 of the 3400 per year) of all potentially serious head injuries are mild concussions, which do not usually require any treatment, and normally do not result in any long term consequences. In other words, on an annual basis in the US we can expect about 800 head injuries that will have some consequences, in a population of 10 to 15 million participants.

Shealy has found that approximately 60% of all fatal injuries in skiing involve the head. Virtually all of these are the result of a high speed impact, 90% occur on intermediate terrain, and 90% are to intermediate or expert skiers. Helmets are a known and proven effective means of reducing the likelihood of head injury, or in the alternative, of reducing the severity of a head injury, if one is struck in the head, or strikes one’s head against some object or surface. However, helmets are probably more effective at preventing skull fractures than concussions. Yet skull fractures account for only 0.1% of all skiing injuries in comparison to concussions, which are about 2.5% of the total. It is not practical to build enough deceleration time and stopping distance into a helmet to be sufficient to provide a great deal of protection beyond a 12 to 15 miles per hour direct impact with a solid fixed object. Speeds that are routinely encountered in skiing range from 25 to 40 miles per hour on intermediate slopes. Thus, if a skier on the edge of an intermediate trail were to lose control at typical speeds and strike his or her head on a tree, it is unlikely that any commercially available helmet will be of any great assistance in the prevention of a devastating injury. If it were required that everyone wear a helmet while skiing, it would cost 1 to 1.5 billion dollars the first year (10 to 15 million skiers times 100 dollars per helmet) and approximately 50 to 100 million dollars per year to maintain the inventory after that, with no assurance that helmet use would substantially attenuate the severity of the roughly 800 serious head injuries or prevent very many of the 20 head related deaths which occur each year (the Consumer Product Safety Commission estimates 11 would be prevented).

For every death due to a head injury in skiing roughly a thousand times as many Alpine winter sports participants (20 to 25,000 per year) will suffer a devastating knee injury (ACL), each of which will cost ten to twenty thousand dollars in direct medical costs alone. This works out to 200 to 500 million dollars annually. But, there exists a solution that has the promise of cutting the toll of ACL injuries in skiing in half or better (see TIPS). According to our calculations, implementation of a national program, using what we already know can help to reduce the risk of this devastating injury, would not be more than $2.5 million dollars spread over the first five years and about $100,000 a year to maintain the program after that. The savings envisioned through such a program could be 125 million dollars per year.

The core of the knee injury abatement program above is skier education, the same subject at the heart of any program with the potential to reduce fatalities, and the critical factor behind the success of shape skis in reducing the risk of injury to skiers of lower skill levels. So, if you really want to cut your risk of injury in skiing you won’t wait for the multi-million dollar multi-media behavior modification campaign to brainwash you into taking better care of yourself, you’ll act now and check out EIGHT STEPS to Safer Skiing.—CFE