When It All Goes Downhill on the Slopes

His first run of the day on the half-pipe “didn’t work out,” says Phil Whitman, stating the obvious with a painful smile, a tattered gauze sling supporting his arm.

Still wearing his snow boots and bib overalls, the 14-year-old is walking away from the emergency room at Bear Valley Community Hospital--an early end to the snowboarding weekend he had planned with his San Clemente church group. “They say I may have a broken humerus bone, but there’s a three-hour wait,” he says, figuring he’ll try to find another, shorter-line hospital.

Second only to Catalina Island’s facility as the smallest hospital in California, Bear Valley Community is stretched to the limit as the population of this San Bernardino County resort area soars from 18,000 to 100,000 on a typical winter weekend.

With a single physician and two registered nurses treating as many as 90 patients in a 24-hour period, the seven-bed emergency room becomes a Friday-through-Sunday-long episode of “Downhill ER,” where injury meets the mountain after every run gone bad.

It’s the part everyone prefers not to think about. After all, this is where people come for a taste of the great outdoors--of sunshine and snow, of downhill speed and beautiful vistas.

Big Bear, in the San Bernardino National Forest about 110 miles east of Los Angeles and 90 miles northeast of Orange County, is a popular destination for Southern California skiers and snowboarders. Snow Summit and Bear Mountain resorts are just two miles apart and within the service area of Big Bear City Fire Department and Bear Valley Community Hospital.

“It looks like Beirut in there,” a woman says one Saturday of the hospital lobby, a small room with folding chairs, overflowing before noon with scores of banged-up but surprisingly patient patients.

“They’re doing their best,” says Jane Morris, 26, of Rancho Cucamonga, who hadn’t heard anything since her husband, Robert, was brought in by ambulance an hour earlier from Snow Summit after slamming into a tree on his snowboard. “But this is the only place up here. How do they handle all these people?”

This is not a specialty trauma center but a small-town ER. Those with the mountain’s most common hard knocks--broken wrists, blown-out knees, cuts and contusions--receive emergency treatment here. So do those hurt in traffic accidents and suffering heart attacks brought on by the 7,000-foot altitude. Those with the most serious injuries are typically airlifted from adjacent Big Bear Airport to Loma Linda University Medical Center in Redlands or Arrowhead Regional Hospital in San Bernardino.

Bear Valley Community is only half a mile from Snow Summit, a little more than that from Bear Mountain. So by ambulance, by car or simply limping in on their own, the ailing come here. When the hospital is in a state of injury overload, necessity is the mother of invention.

“We set up army cots in the ER ... we do our job,” says registered nurse Dawn Macey, squinting at the late morning sun before returning to her 12-hour shift. “Sure, a bigger ER would help,” she says. “But for now we’re just here, giving great care with what we have.”

Rick Rolston, Big Bear City Fire Division chief of emergency medical services, says all involved have learned to juggle the available resources. “We always have places to put them, but at certain times it gets very busy and very challenging,” he says.

Meanwhile, he says, a three-year plan is in the works to expand the hospital.

Big Bear is not alone among ski areas seeing increased pressure on medical facilities. Last winter marked a record 57.3 million visits to U.S. ski resorts, according to the Colorado-based National Ski Areas Assn. There are 490 ski areas nationwide, 31 of those in California.

On a recent Sunday at Mammoth Mountain, Mammoth Hospital’s seven-bed emergency room treated about 100 patients, says hospital spokeswoman Lori Ciccarelli. “We don’t have army cots, but on the weekends during the winter, gurneys are lined up in the hallway,” she says. Mountain High in Wrightwood has different challenges delivering emergency medical treatment--the nearest hospital is at least 40 minutes away, and many injuries are treated at the first aid station on site.

While few ski areas release individual injury statistics or the annual number of accidents on their mountains, the national ski association reports that an average of 34 people are critically injured on American slopes each year. The number was higher in the 2000-2001 season, when 33 skiers and 11 snowboarders were seriously hurt.

“Nationally, we had a record season last year,” says Stacy Stoutenberg of the ski association. “There are just more people out there skiing.”

Locally, Snow Summit president Richard Kun says that it is actually getting safer out there--at least on his slopes.

“Injury-wise, we are on a decline in both frequency and severity from, say, three or four years ago,” Kun said. “It is much better now that everybody’s used to the skiers and the snowboarders together on the mountain.”

But as the overall number of people on the slopes has steadily increased in the decade and a half that Rolston has headed the EMS program in Big Bear, so have the number of injuries. “It was a more seasonal call volume back then, with big lags in the spring and fall,” recalls Rolston, who came from Orange County to the rural mountain community 17 years ago to start up the EMS division. “In 1985 we had actual days when we didn’t have a call,” he says. “It’s not that way now.”

The Big Bear City Fire Department works in close cooperation with the hospital. The department employs 45 men and women, including firefighters, paramedics and support personnel, says Rolston. “Everybody works with everybody up here ... that’s just the way it is,” he says.

The department’s five advanced-support ambulances, three paramedic engines and one paramedic squad are in constant use. And on peak days they have a couple of temporary “day cars” to service increased demand.

All this goes on throughout the snow season--which usually takes off starting in mid-November and winds down about mid-April.

Patrolling the mountain at Snow Summit are about 25 rescuers who make about 50 runs a day on weekends, according to one ski patrolman taking a quick break before going back up the mountain. The patrol treats minor injuries at its own overflowing first aid center and transports patients as needed to Bear Valley Community.

Skiing and snowboarding are not the only winter-sport activities that land folks in the hospital. Other hazards include falling through thin ice at Big Bear Lake, inner-tubing and other “snow play,” says Rolston.

“Some of our most severe injuries ... the worst things we have seen are from snow play in uncontrolled areas, usually behind a house or a big hill somewhere,” says Rolston. “Typically, what we see occurring is that they often underestimate the steepness of the hill and where the inner tube will stop, which is usually into a tree.”

Contributing to some of the distorted judgment calls is alcohol use, which creates the usual problems and more when combined with the mountain altitudes.

All of Southern California’s major ski areas--Mammoth Mountain, Snow Summit, Bear Mountain and Wrightwood’s Mountain High--have special security patrols positioned on the slopes to police reckless skiers and disruptive behavior, including use of alcohol.

“If we see them indulging on the ski area, we remove their booze or take their ticket,” says Kun of Snow Summit.

Snowboarding, skiing and other mountain sports are dangerous enough without pouring alcohol into the mix, says Rolston, who adds that visitors often underestimate the rapid heat loss that occurs when blood vessels dilate after consuming alcohol at high altitudes.

“People should not be mixing alcohol and cold up here,” he says. “We have a lot of problems with hikers doing this. They are very susceptible to hypothermia.”

But liquid courage in bota bags is nothing new to the slopes.

“Yeah, just like every other bar, we have to cut people off,” says one bartender, pouring shots of Red Bull and vodka on the deck at Snow Summit.

“There are at least three people that I would refuse to serve right now if they came back,” she says. “We pop every beer when they leave [to prevent people from hiding unopened cans and taking them up the lifts], and they watch people on the mountain ... you have to be careful.”

By early afternoon the waiting room at Bear Valley Community is a collage of pain-filled faces belonging to those who have been here for hours and those just arrived. A cluster of snowboarders gather outside to have a cigarette, relate injury stories and wait for their names to be called.

A gray-haired volunteer in a pink smock performs her own brand of triage in the cramped waiting room. Grandmotherly yet officious, she logs in patients while scanning the lobby for an available folding chair or unoccupied spot on the bench facing the parking lot.

“I haven’t heard anything yet,” says Jane Morris, who has now waited three hours to hear about her husband’s condition. “It could be a bruised kidney or something. He was just going back for an X-ray.”

Wounded or worried, all eyes are on the volunteer as she rises, clipboard in hand. “Jeff Meyer?” she asks searchingly. “Is there a Jeff Meyer here?” In pain from a visibly broken wrist suffered from “board-sliding on the box” at Snow Summit, 15-year-old Jeff Meyer of Upland manages just enough teen bravado to answer.

“I’m here,” he says, holding his arm as he stands. Unlike most others here seeking treatment, Meyer, unfortunately, is a repeat customer.

“The funny thing is, we were here last Thanksgiving for the same thing,” says Eric Ferguson, 27, Meyer’s uncle, wincing himself from a tailbone bruising suffered on the slopes about 100 feet from his fallen nephew.

“We waited for four hours then,” offers the injured teen’s father, Marshall Meyer. “But they are very good here,” he said. “They followed up on him a few days after and everything to make sure he was OK.”

Outside, an ambulance arrives with a woman on a backboard, followed a few moments later by three more emergency units with patients. An emergency helicopter zooms overhead on its way to the trauma center at Loma Linda.

“I was taking lessons, and they had to come and get me,” says Kim Bowlds, 23, of San Diego, sitting with her husband, Justin, who is holding his arm next to her in silent pain.

“I guess he just toppled and popped something,” she says. “That was two hours ago.”

Fours hours later, Bowlds and her husband leave the hospital. “His collarbone is separated from his shoulder,” she says, helping her husband into their car.

By late afternoon, as scores of weary visitors load skis and snowboards on top of their cars for the slow traffic crawl down Highway 18, Jane Morris remains at Bear Valley Community. After waiting more than five hours, she has just received word that her husband is being transported by ambulance to Kaiser Permanente Hospital in Fontana with a back injury that may need surgery. With all units busy, they are waiting for a transfer ambulance.

“He’s been ready to go for an hour now, but he’s waiting for a ride,” she says, pulling out her cell phone to make plans for the long trip and yet another wait at yet another hospital.

Sitting back down in the folding chair with a sigh, she is composed. “I’m happy it wasn’t worse ... no internal injuries.”

Brushing by Morris and heading to his car, another patient with a broken wrist leaves Bear Valley Community Hospital holding a bag of ice in one hand, his X-rays in the other. He climbs into his SUV--snowboard on top--and heads down the mountain. “I can’t wait around,” he says. “Excellent service, though.”

His upbeat attitude in the face of mishap is peculiar to many who’ve made the detour to this medical way station: They may be in pain, but by and large, they had fun getting that way.

Among those taking the whole experience in stride is Travis Hodges, 28, a Big Bear local, sporting a “what’s the big deal” attitude along with a gash above his right eye.

“What happened? I hit my head on the snow,” says Hodges. “It will probably heal by the time I get in there.”

Hodges, who says his bloody eye is the latest of about half a dozen snowboarding injuries, was wearing goggles that smashed into his face when he fell. “I actually have a piece of my eyelid in my goggles,” he says, wiping blood from his eye with a smile. “I’ll heal.”