The ski doctor
Mike Langran is a GP at the only UK practice that treats substantial numbers of snow sports injuries
Mike Langran is a full time GP partner at Aviemore Medical Practice in the Scottish Highlands. He is a leading authority on snow sports injury and prevention, and he has a special interest in prehospital care. He volunteers as the ski patrol doctor at the nearby CairnGorm Mountain. He is also president of the International Society for Skiing Safety and has been active in the field of snow sports injury research and management for almost 20 years. He runs the website www.ski-injury.com, which aims to disseminate information from snows sports research to the general public.
You work at the only general practice in the UK that treats a large number of skiers and snowboarders. How much of your practice time does this take up?
The season can last anything from mid October through to the end of May and into June. In between, we have periods when we don’t have much skiing on because the snow has disappeared or weather conditions are such that you can’t ski, but it is a fairly substantial amount of our workload in our winter period. The doctor on call in the afternoon can be dealing with skiers and snowboarders coming in on a fairly regular basis with a variety of injuries.
We all enjoy snow season. But we don’t like seeing people injured who are enjoying sports that we enjoy.
Are there typical injuries that you see in snow sports accidents?
Snow sports tend to have a fairly defined pattern of injuries. For people skiing, for example, the knee is the commonest area that gets injured. This accounts for about a third of all injuries. With snowboarding, people tend to put out their arms to break their fall, so injuries to the wrist are the commonest we see.
You also volunteer as a ski patrol doctor, what does that involve?
I mainly go up for weekends and occasional days in the week. I help the ski patrol and I’m there if they need me to aid with casualty management. The ski patrol is professionally trained but there are occasions when, particularly if a patient’s in a lot of pain, having a doctor available to give analgesia is a big help. If it’s a day when I’m not on the mountain, the ski patrol will ring me if they’re concerned or need advice. If the assessment is such that one of us [from my practice] needs to go to the mountain then we will do so. The difficulty we always have in ski patrol medicine is that the environment in which we work can be challenging. If it’s minus 15 and there’s a 40/50 mile an hour wind it’s a different environment to assess a patient in compared with having them in the surgery.
Does the mountain environment present a lot of challenges?
It certainly does because you can’t expose people as you do in the surgery to examine them. If somebody is in a lot of pain it can be quite difficult to give intravenous drugs because it’s difficult to find a vein on them. You’ve got to be careful about how much you expose them because you’re going to make them cold so we’ve developed techniques to get round that. We use intranasal diamorphine a lot to give pain relief and that works well. We have problems as well with even simple things. Using a stethoscope, for example, out on the mountainside in a gale is difficult. It’s hard to be sure that what you’re hearing is accurate. We’ve been involved in a few projects to improve the way we manage casualties. We worked with a company looking at the development of an electronic stethoscope, which connects via Bluetooth to a pair of headphones so I can listen to the person’s heartbeat without having to have a stethoscope connected directly to my ears. This means when we move a patient I can keep monitoring them without having to interfere with the transfer.
Are you in danger when you respond to these emergencies?
One [situation] we always have to be aware of is the risk of avalanche. Increasingly, people go into the off piste environment. When something goes wrong it’s often the ski patrol that is called on to help them, and it’s important that we do a proper assessment of what we’re going into and make sure that we’re safe. It can be difficult to navigate on the mountains as well; we don’t have trees and we don’t have a lot of obvious features so when the cloud rolls in it’s easy to become suddenly disorientated and to become cold quickly. You’ve got to have respect for the mountain because you never know when the weather’s going to change and you never know when something might happen that suddenly changes the environment.
It sounds action packed. Is that the reality of the role?
It’s unpredictable. You never know what’s going to happen from day to day, and I suppose that’s the best and worst bit of the job. You have to be prepared for everything. There are days when I don’t get a call, and they balance out the busy days when you spend your whole time dealing with one casualty after another.
What skills are important to have in this field?
To have a fairly relaxed demeanour, a good sense of humour, and to be prepared to work as part of a team. The experiences that will help you are things like emergency medicine and some orthopaedic experience, but it’s a very interesting and varied aspect of medicine.
You’ve made a few television appearances through your work in the ski patrol. What was that like?
There’s a huge thirst from the public for these fly on the wall medical shows, and I think that they [the programme makers] ruin it a bit with over-dramatic commentaries. It’s always about drama and critical illnesses, which is not what we normally deal with. We do use these programmes to try and get messages across to people—to wear a helmet, to wear a wrist guard, to take your time getting experience—so there are a lot of positives to it, but it is quite time consuming—and I usually cringe when I hear the commentaries.
What do you think are the benefits of working in a rural general practice?
I think what I do is a good example of the opportunities that you have available in rural practice. You can take on these extra roles because resources are relatively scarce.
Do you have any advice for students interested in doing a medical elective at a ski area?
My main advice is plan ahead. These tend to be popular placements and you need to start thinking about it two, preferably three, years ahead of when you might be doing your elective. You need to decide, depending on the time of year you’re looking to do your elective, whether you’re going to go into the northern or the southern hemisphere. I would say don’t view it just as a free ski holiday—that’s not what clinics are after. Clinics want people who will engage with them and get the most out of the attachment.Kelly Brendel, assistant web editor, BMJ
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2012;20:e8219