Student Blog by Anton Beka (5th year medical student, King’s College London) with Federico Ghio (Chief Executive Officer – I-Help Medical) & Dr Luca Carenzo (IRCCS Humanitas Research Hospital)
During my elective placement with I-Help in Livigno, Italy, I spent two weeks with a ski patrol rescue team working in a busy alpine resort. It was a striking reminder that emergency medicine is not confined to hospitals or road ambulances. On the mountain, good care depended not only on clinical skill, but also on systems, preparation and the ability to adapt decisions to a challenging environment.
Organisation makes clinical care possible
Livigno is a high-altitude resort in the Italian Alps that attracts large numbers of skiers and snowboarders each winter. With that comes a predictable caseload of musculoskeletal injuries, medical emergencies and environmental exposure. What impressed me most was how much of the team’s success depended on preparation long before a patient was assessed.
The ski patrol headquarters was based high on the mountain, allowing the team to respond quickly across the resort. Cover ran continuously from first lifts to last runs, seven days a week. Each day began with a structured briefing covering weather, slope conditions, hazards and staffing. Before the public arrived, the team checked the slopes, placed barriers and closed unsafe areas where needed.
This preventive work often went unseen, but it was central to safety. The team’s effectiveness came from clear communication, shared situational awareness and operational readiness. When incidents occurred, there was already a system in place that allowed staff to focus on the patient rather than the process.
The callout pathway was similarly efficient. Information from emergency calls was relayed through the resort communication network, allowing the ski patrol team to mobilise with essential details on location, timing and the nature of the problem. That early situational picture shaped equipment choice, team deployment and whether helicopter support might be required.
Nurse-led care in a challenging environment
What stood out most was the role of the critical care nurse within the team. Alongside first aiders trained in rescue, patient packaging and snowcat use, the nurse provided clinical leadership in an environment where cold, altitude, terrain and transport delays all influenced decision-making. The growing contribution of nurses in ski patrol teams has also been recognised in recent literature (1), reinforcing the value of nurse-led assessment and decision-making in mountain emergency care.
The response bag reflected this environment well. Equipment was organised logically so it could be accessed rapidly in sub-zero conditions. The analgesia options were particularly well suited to the setting, including intravenous paracetamol, fentanyl lozenges and intranasal ketorolac, offering flexibility when venous access was difficult. The team also carried advanced life support drugs and pre-warmed intravenous fluids for time-critical emergencies and hypothermia risk.
Patient packaging was another important part of care. Vacuum mattresses, box splints and simpler immobilisation techniques were used according to injury severity and terrain. These were not just technical interventions; they were clinical decisions shaped by context. Once patients reached headquarters, assessment could continue with monitoring, ECG, pulse oximetry and blood glucose testing before onward transfer by ambulance or helicopter.
This placement changed how I think about emergency care. I was struck by how much good medicine relied on preparation: morning briefings, equipment checks, rehearsed communication and clear transfer pathways. I also saw how clinical decisions were inseparable from the environment. Analgesia, immobilisation and transport choices all depended not only on the patient, but also on temperature, terrain and distance to definitive care.
Emergency care on the slopes is a strong example of systems and clinical practice working together. My main takeaway was clear: in alpine prehospital care, excellent patient care begins well before the first assessment, with strong organisation underpinning safe and effective practice.
References
- Longobardi M, Ghio FE, Leuci L, et al. Transforming Emergency Care on the Slopes: A Study on the Integration of Nurses in Ski Patrol Teams. Wilderness Environ Med. Published online November 6, 2025. doi:10.1177/10806032251389927