Up to 55 Injured Skiers and Snowboarders Arrive at Colorado Emergency Rooms Each Day, Analysis Shows
More than 4,100 skiers and snowboarders were transported to emergency rooms in ambulances or helicopters across 2018, 2019 and the first part of 2020, which is about 10 patients every day of the season.
Chris Arnis was with his crew, carving spring snow on his home hill. It was a good Sunday for the lifelong skier.
It was a little shy of 4 p.m., March 15, 2015, when it happened. Arnis, a ski coach in Steamboat Springs, hit some deep ruts where a speed-controlling fence had just been pulled to prepare for snow grooming that evening. He lost a ski and flew face first into the flats on a run called Rainbow.
He’s been in a motorized wheelchair ever since.
“They pulled the fencing and left these trenches. If they had left those up, I would not be sitting here in this chair playing computer games right now,” the quadriplegic husband and father of two said from his home in Steamboat. “It could have easily been avoided.”
There are many stories like Arnis’ — the tragic recounting of falls and crashes that changed lives in an instant. But they provide little insight into the severity and frequency of injuries at the nation’s 460 ski areas.
Skier safety laws that require skiers to recognize inherent risks in the sport and be responsible for their own behavior have for decades protected the resort industry from large legal settlements and kept the public from understanding how often people are seriously hurt on the slopes.
But new statistics provided by the Colorado Department of Public Health and Environment offer a peek behind the resort industry’s curtain. A study of ski-season hospital admissions in 20 mountain ZIP codes shows as many as 55 skiers and snowboarders a day arriving at emergency departments.
Another report shows 4,151 skiers and snowboarders transported to emergency rooms in ambulances or helicopters in 2018, 2019 and the first part of 2020, which is about 10 patients every day of the season.
And a review of CDPHE statistics showed more than a third of the 1,426 skiers and snowboarders admitted to Colorado’s trauma centers in the 2017-18 season required immediate surgery.
“These numbers indicate a significant public health and safety risk that is not being addressed at all in Colorado,” said Dan Gregorie, a retired physician whose Snowsports Safety Foundation has spent 14 years working with lawmakers to push ski resorts to provide more detailed information about safety plans, accidents and injuries. “I can’t think of another recreational activity that generates these kinds of numbers.”
The National Ski Areas Association gathers reports from the country’s ski areas and tracks “catastrophic injuries,” which it defines as “significant neurological trauma, major head injuries, spinal cord injuries resulting in full or partial paralysis and injuries resulting in the loss of a limb.”
Over the past decade, the association has counted an average of 45 catastrophic injuries a season nationwide. The U.S. sees about 55 million to 60 million skier visits a year, so the rate of catastrophic injury is less than one for every 1 million skier visits. That does not include skiers suffering from underlying health issues or resort employee injuries.
Dave Byrd, the director of risk and regulatory affairs for the National Ski Areas Association, declined to comment about the statistics, which he said he was unable to review in depth. Many in the ski industry are reluctant to discuss injuries and steer clear of studies that are not peer-reviewed. But many of the peer-reviewed studies involve injury data available to only a select few researchers.
At least one Colorado lawmaker would like resorts to share injury statistics publicly. Only ski resorts can share numbers that differentiate between injuries resulting from a fall or collision and emergency room trips involving skiers and snowboarders suffering from underlying health issues associated with exercise at altitude.
“I think resorts stand to gain more out of a transparent process than keeping data hidden and out of sight,” said state Sen. Tammy Story, a Democrat from Conifer. “If the industry was more clear about all the things they do to ensure the safety of the public, that could assure the public that when they are on the mountain, that resort is doing everything to protect them. But if resorts are not doing all the things that can be done and it’s jeopardizing public safety, I think that also needs to be known.”
Colorado’s public health data on emergency room visits, emergency transport and admissions to trauma centers show a much higher rate of injury than the industry’s “less-than-one-in-a-million” reports. But those trauma center admissions do not necessarily fall under the resort industry’s definition of “catastrophic.”
The CDPHE statistics defined the severity of injuries using international standards that identified 96 of the 1,426 trauma admissions as “severe” or “profound.” The 2017-18 ski season in Colorado saw about 12.2 million skier visits, so 96 major injuries equates to about one for every 127,000 skier visits. And the trauma center report showed 1,131 skiers and snowboarders admitted into hospitals following an on-slope accident in 2017-18, which is about one hospital admission for every 10,800 skier visits. At the state’s most trafficked ski areas, that means two, maybe even three skiers a day are spending a night in the hospital.
A study presented at the 23rd International Congress on Snowsports Trauma and Safety last year at Squaw Valley in California reported there were about 96,000 “medically significant” ski and snowboard injuries every winter in the U.S., which is about 1,600 for every 1 million skier visits. In Switzerland, which has 25 million to 30 million annual skier visits, research presented at the same safety conference last year shows about 76,000 skiers and snowboarders sustain injuries that require medical attention, which is about 2,500 injuries for every 1 million skier visits.
A review of ski area databases by Jasper Shealy, a researcher who has published more than 100 peer-reviewed articles on ski safety in the past 40 years and has access to nonpublic ski resort injury statistics, shows a declining trend in ski and snowboard injuries over the past several decades. Shealy last year presented his study of emergency room visits in California between 2006 and 2017, based on the same cause-of-injury codes used in the Colorado public health department analysis. Shealy’s review showed the number of ski and snowboard injuries in California dropping from around 9,000 per season in 2006 to around 4,500 by 2014 and staying at that level in following seasons.
Gregorie also presented a report at the snowsports safety meeting last year, but it did not include any injury reports. Instead, his presentation, “Assessing and Assuring Effective Safety Management at California Ski Resorts,” noted that not one of the state’s 26 ski areas responded to his surveys or requests for safety plans.
“We conclude that the volume of annual injuries serious enough to require hospital care and the absence of the documentation of effective safety management constitute a significant unaddressed personal injury and public safety concern that the resorts do not appear motivated to address,” Gregorie wrote in his abstract of the report provided to conference attendees.
Shealy’s research in California, where 26 ski hills log about 7 million skier visits a year, shows about 640 emergency room visits for every 1 million skier visits. The CDPHE used the same emergency room codes as Shealy in California to count about 8,000 skiers and snowboarders visiting emergency rooms every season in Colorado. In a state with about 13 million annual skier visits, that’s about 615 injuries for every 1 million skier visits.
Shealy said the raw data from the CDPHE is “really insufficient” to reach sweeping conclusions and “no one in the scientific community would publish this or cite it.” Shealy said the lack of demographic information showing the skill levels, locations, conditions, ages and other details detracts from the weight of the hospital admissions data.
“With this incomplete data from a handful of Colorado hospitals, you simply cannot draw any conclusions at all,” said Shealy in an email to The Colorado Sun. “And for decades, epidemiologists and engineers like myself have analyzed truly comprehensive audited data sets with scientific controls and with statistical validity, and those analyses have undergone and withstood the rigor of objective, peer-reviewed scientific journals. My peers internationally in Canada, Europe, and Asia have all generally found that using similar methodologies as we use in the U.S., national, peer-reviewed injury rates around the world are largely similar and comparable, remarkably comparable. We have also observed that over long periods of time, injury rates have declined significantly.”
The Colorado report of 1,426 skiers and snowboarders admitted to trauma centers in the 2017-18 season also ranked the severity of their injuries using two standardized systems.
The trauma center admissions data show seven of the 1,426 patients suffered moderate or severe head injuries while 501 were ranked with “mild closed-head injury.” Another 900 were not scored. But the Colorado Hospital Association statistics detailing the injuries of the 4,151 skiers and snowboarders needing transport from slopes to the hospital over three seasons showed 50 patients with severe to moderate brain injuries.
Another standard for measuring trauma is the Injury Severity Score, which ranks trauma as minor, moderate, severe and profound. In the trauma admissions report detailing 1,426 injured skiers and snowboarders, 96 patients — roughly 7% of the total — suffered “severe” or “profound” injuries.
Dr. Marc Doucette has worked in the emergency department at St. Anthony Summit Medical Center in Frisco since it opened in 2005. The emergency medical team at the hospital — which serves skiers from Arapahoe Basin, Breckenridge, Copper Mountain, Keystone and Loveland — has seen traffic steadily increasing in the last decade. The patients come in surges, closely aligned with weekends and holidays.
The Christmas holiday is the busiest, with the week before New Year’s typically seeing 100 patients every day. Presidents Day weekend, spring break and Martin Luther King Jr. weekend typically see 50 to 70 patients a day. About half of the patients coming to the Level III trauma center are injured skiers or snowboarders, Doucette said.
And most of those skiers and snowboarders have passed through clinics at ski area bases. Centura Health has St. Anthony clinics at Breckenridge, Copper Mountain and Keystone. Those clinics send less severely injured patients home, but some are forwarded to Doucette at St. Anthony in Frisco. Those patients have injuries like a broken femur, a head injury, a collapsed lung or an injury that requires surgery.
“On a typical busy ski season day, our orthopedic surgeons start receiving patients from the (ski area) clinics and they will start operating midday and often go late into the night with cases,” Doucette said.
The more serious patients with multiple traumas will go to Level 1 trauma centers in Denver.
Doucette is not seeing the severity of injuries on the slopes increasing. “Often the type of injury we see correlates with the ski conditions on the given day,” he said.
If there’s a lot of new snow, the injuries tend to involve knees and twisted joints. When conditions are firm and fast, the injuries worsen.
“The really bad injuries typically are most commonly seen on groomed terrain on intermediate and beginner runs where skiers are going excessively fast and strike the snow surface or strike a fixed object, like a tree,” Doucette said.
St. Anthony Summit Medical Center and Centura Health are part of the national Think First Injury Prevention program, which focuses on education and prevention of spinal cord and head injuries. The hospital’s trauma team works with local schools and ski resorts and gives out more than 200 helmets every year during the annual Skier Safety Week.
“We want the public to be aware. It’s a great sport but it’s also potentially dangerous and it’s so important to pay attention and ski in control and wear your helmet and have good slope awareness,” Doucette said. “We don’t want to see horrible injuries, but we always do.”
The Colorado Hospital Association provided CDPHE with emergency room admission statistics from its statewide payment database based on the codes that hospitals use for billing for treatment of injuries. Those statistics showed more than 8,000 skiers and snowboarders visiting the state’s emergency rooms in 2019. That’s up from 6,876 in 2018.
But those codes are third, even fourth hand, trickling through health care and payment systems. And that’s only one problem with the data. The CDPHE statistics were harvested from 20 mountain ZIP codes, but the identity of the ZIP codes has been masked.
CDPHE spokesman Peter Myers said state law prohibits the department from identifying the exact locations of emergency medical service transports and injury locations of patients admitted to trauma centers. That law protects patient and provider confidentiality and prohibits the release of any Emergency Medical Services data that could potentially identify patients. The law also requires the health department to only present data in bulk.
While the statistics were gleaned from 20 different ZIP codes across the state, more than 82% of the injuries that required admission to a trauma center came from only six. It’s likely those include Summit, Pitkin and Eagle counties, home to 10 ski areas that account for about 8 million of the state’s annual skier visits.
Gregorie has been searching for these kinds of numbers for nearly 15 years. His group has conducted smaller snapshot studies at individual resorts that indicate injuries could be as high as two to three for every 1,000 skier visits.
“Although not life-threatening, an unknown but significant number of these injuries result in considerable short-term disability, or even long-term and in some cases lifelong chronic pain or disability,” he said.
The physician’s daughter, 24-year-old Jessica, died in a fall at California’s Alpine Meadows in 2006 while hiking on a traverse above cliffs. He sued the ski area for wrongful death. The resort pointed to a waiver signed by Jessica for her season pass and the case was dismissed. An appeals court upheld the decision, ruling Jessica’s fall was among the inherent risks of snowboarding and the ski area “only owed her a duty not to increase the risks she encountered beyond those which are inherent in snowboarding.”
After losing the legal challenge, he started fighting for ski areas to reveal safety procedures. In 2008 Gregorie founded the California Ski and Snowboard Safety Organization, which has morphed into the more national Snowsports Safety Foundation. He started lobbying lawmakers to enact legislation that required resorts to offer detailed safety plans to all visitors and file monthly reports on injuries and deaths. California lawmakers approved the legislation, but then-Gov. Arnold Schwarzenegger vetoed the bill in 2010, saying the law would have placed an “unnecessary burden on resorts” without assuring it would reduce injuries.
Gregorie’s group has expanded to other states and helped the nascent coalition Safe Slopes Colorado with funding to work with the CDPHE to comb its database for injury reports involving skiers and snowboarders. Safe Slopes Colorado hopes the data bring together skiers, parents, lawmakers and resort leaders “to encourage transparency and leadership,” said Russ Rizzo, with the fledgling group.
“With better data, we can better focus our safety prevention efforts,” Rizzo said.
Colorado’s trauma center admissions and ambulance rides are only a peek, Gregorie said. More information is needed. He’d like to see more statistics on the cost of treatment for ski injuries. His rough math — calculating 8,000 emergency room visits at $5,000 each and 96 major trauma center admissions at $100,000 each — puts the annual cost of ski injuries around $50 million.
“We need to know more about the problem if we want to address this. We don’t really know what resorts are doing to prevent accidents and reduce the severity of injuries. And they have successfully convinced the public and legislators that an inherent risk means it is not preventable,” said Gregorie, citing skier safety laws across the country that protect ski areas from inherent risks like weather, changes in snow conditions and varying terrain. “Inherent does not mean ‘not preventable.’”
The 72-year-old Gregorie fancies himself the Ralph Nader of the ski industry. Nader’s landmark bestseller, “Unsafe at Any Speed: The Designed-In Dangers of the American Automobile,” criticized car makers for resisting safety designs like seatbelts. The auto industry dismissed Nader while shifting the blame for most accidents to drivers, much like the resort industry asks skiers to shoulder responsibility for potential hazards and injuries.
“Once the information about injuries and deaths in automobiles was finally put out there, look at what has happened,” Gregorie said. “Safety in automobiles has become a competitive attribute, not a threat. Public focus on safety creates improvements. If we can get good data out there about safety and drag it out in the sunshine, it will generate all kinds of improvements and the resort industry will thrive.”
The grassroots group Parents for Safe Skiing started last year after Boulder mom Larisa Wilder started looking into chairlift accidents involving young skiers. Her young son had watched a 6-year-old fall more than 30 feet from a chairlift at Eldora and she was shocked to learn that resorts only have to report chairlift injuries outside of the loading and unloading zones. (The Colorado Tramway Safety Board only reviews very uncommon accidents involving skiers during the ascent, not when they are getting on and off the lift.) She asked Colorado lawmakers to require resorts to report injuries while loading and unloading to the Colorado Passenger Tramway Board.
When Colorado lawmakers balked at requiring more transparency in injury reporting at ski areas, Wilder’s group expanded into advocating for more protections for children at resorts. Wilder has spoken with dozens of Colorado lawmakers over concerns with waivers signed by parents that protect resorts and put the onus for protection on skiers, including children.
“When I leave my 4-year-old at ski school, that 4-year-old is legally on their own. A child that young cannot be responsible for themselves at any other place but ski resorts. I tell that to legislators and the first response is I must be crazy,” Wilder said. “This is an uncomfortable conversation for everyone on all sides here. But really, we need to talk about waivers. It’s hard to understand how far ski area waivers go to protect ski areas. You really have to go to a place of nonbelieving to go skiing once you are informed.”
“This is an uncomfortable conversation for everyone on all sides here. But really, we need to talk about waivers. It’s hard to understand how far ski area waivers go to protect ski areas.”
Ski resorts also have some of the highest rates of injury among employees. The Occupational Safety and Health Administration’s latest reports show 8.5 ski resort workers out of every 100 suffered non-fatal injuries in 2019, ranking as the industry with the sixth highest rates of injury, behind armored car guards, delivery drivers, steelworkers, veterinarian workers and prefabricated wood construction builders. That is down from 10 injured workers per 100 in 2018 and 10.7 in 2017.
The National Ski Patrol this season is rolling out a new Outdoor Risk Management Program for ski patrollers, which will help with identifying and mitigating risks.
Story, the state senator from Conifer, has been skiing in Colorado for more than 30 years. She raised her kids skiing and they still all visit ski resorts together. Ski safety has always been something she thought about, but her focus grew more acute when she became a lawmaker in 2019.
“There are more and more people talking to me about concerns and issues related to ski safety. Did you know when you buy a lift ticket you are accepting a liability waiver that says the bulk of all liability and responsibility falls on you as a skier?” she said. “I find that extraordinary. And the more I looked into it, it’s astounding to me that there is very little data that is publicly available relative to injuries and user days so you can gauge the frequency of injuries. It just seems that the whole industry has kept really quiet about people getting hurt skiing.”
Story wants to “keep a conversation going” with safety advocates and resorts to see if more information could be studied about injuries at ski areas. With more information, maybe trends could be identified that would better persuade skiers to take more responsibility on the slopes. Maybe information could spotlight ways resorts could improve safety as well, she said.
“But without data, it’s hard to see what needs to be done,” she said.
Story has watched resorts create sweeping new operating plans designed to protect skiers and employees during the pandemic and make sure customers feel comfortable visiting ski areas. All those new plans have been shared publicly, with some details — like capacity limits — removed from public view.
“I think if we can review their new procedures and policies to address COVID, we certainly should be able to look at the overall industry and ski resorts to see what’s going on during their general operations without a pandemic,” Story said.
“Without data, it’s hard to see what needs to be done.”
Story is quick to point out that she does not think resorts are doing anything unsafe. Advocates for better transparency in injury reporting are not raising issues about dangerous activities at ski areas. There are no industry-wide accusations regarding grooming, signage, opening terrain too early or shoddy safety practices.
Skiing and snowboarding are inherently dangerous. The mix of gravity, speed and freedom to roam is both thrilling and rife with danger. Skiers have a large responsibility to be safe and prevent accidents. And the resort industry has a responsibility to protect skiers as well. The legal obligations of both skiers and operators are outlined in ski safety legislation in nearly every ski state. Those statutes often restrict the amount injured skiers can get from resort operators in a lawsuit. In Colorado, for example, the Ski Safety Act limits liability to $250,000.
Melanie Mills with Colorado Ski Country, which represents 22 of the state’s 28 ski areas, said the state’s ski resorts prioritize guest safety “every day without exception.”
“Dan Gregorie’s rush to draw conclusions about an incomplete data set that hasn’t been subjected to the rigors of scientific review is disappointing, but not surprising,” Mills said in a statement emailed to The Colorado Sun. “We’ve seen him operate like this in other states as he promotes a policy agenda untethered to skier safety. Other states’ policymakers haven’t bought his unscientific analysis and we don’t expect Colorado policymakers will either.”
Even with the promises from ski areas, Story wonders if more could be done by resorts.
“It’s impossible to know without more information,” Story said. “I think it’s time for the state and the industry to step up and lead. Why would we not want to look at this and address public safety issues, especially if we could minimize public risks? Resorts have made so many improvements in safety over the years I’ve been skiing, but could there be more that needs to be done? Let’s take a look and see.”
A belt buckle sits on a shelf Dec. 12, 2020, at Chris Arnis’ Steamboat Springs home. A former Division 1 ski racer, Arnis received the buckle in 1999 after winning Steamboat’s Town Challenge ski racing series. He won the series five years in a row. (Matt Stensland, Special to The Colorado Sun)
Arnis, back home in Steamboat with his wife and service Labrador, hasn’t spoken much in the past five years about the accident at Steamboat ski area. He knows many ski patrollers on the mountain. Maybe some of them pulled the bright fencing off the run that Sunday afternoon.
It’s hard to criticize ski patrollers, he said. But he doesn’t see much progress on ski safety. He sees ski resorts hiding behind legislation that protects them. He thought about trying to sue the ski area. He thinks he has a good argument that the resort was negligent in removing the barrier before skiers were off the mountain. But if he lost, the resort could come for legal fees. (Like Alpine Meadows did when Gregorie’s lawsuit was dismissed.)
“I think I could have won, but if I didn’t they could have taken everything,” said Arnis, who grew up at his dad’s Willamette Pass ski area in Oregon and ski raced in upper-level collegiate contests. “It was a hazard and they knew it and they did nothing to fix it. The worse part is just knowing they aren’t doing anything differently. Nothing changed. There are a lot of things they could do differently but they haven’t done anything because they don’t have to. They are the irresponsible kids in the neighborhood, answering to nobody.”