In November 2015, a 17-year-old student died in a skiing accident, after losing control on a slope while on a family holiday in the French Alps. Louis Ross was wearing a helmet when he lost his balance and crashed, fatally injuring himself at the same resort where F1 world champion Michael Schumacher suffered a brain injury in 2013.

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Winter sports are great for fun and fitness, but they entail risks.

In another high-profile tragedy, British-born actress and wife of Liam Neeson, Natasha Richardson, died in 2008, after a seemingly minor fall on a Quebec ski slope apparently led to bleeding in her brain.

In a so-called talk-and-die case, Richardson did not show any signs of injury after a minor fall but continued talking, apparently unharmed.

Ski patrol transported her to the bottom of the hill in accordance with safety policies, but when an ambulance arrived, Richardson reportedly refused medical care and returned to her room.

An hour later, she began to experience a severe headache. She was rushed to the hospital, where her injuries were confirmed to be critical. Three days later, she died.

How dangerous are winter sports?

Statistics show that while skiing and snowboarding are less dangerous than many high-participation sports, the speed and thrill that provide their attraction carry inherent risks.

Fast facts about winter sports injuries in 2014
  • 114,000 people were treated for snow-skiing injuries in US emergency rooms
  • 79,000 were treated for snowboarding injuries
  • 47,000 were treated for injuries from ice skating
  • 52,000 were treated for injuries from sledding, tobogganing and snow tubing.

The American Academy of Orthopedic Surgeons (AAOS) quote US Consumer Product Safety Commission figures stating that over 290,000 visits were made to emergency rooms for winter sports injuries in 2014.

The National Ski Areas Association (NSAA), which collect data from all the ski areas in the US, report that an average of 53.7 million ski visits were made in 2012-2013, and there were 25 fatalities.

Of these, 20 were male and five were aged under 10 years. When fatalities occur, it is usually due to severe head or neck injury, and/or major thoracoabdominal injury, often as a result of excessive speed and loss of control.

Annually, an average of 49 serious injuries have occurred over the last decade. They include paralysis, broken neck or spine and traumatic brain injuries.

For comparison, the NSAA highlight US National Safety Council statistics showing that in 2013, 34,600 Americans died in motor vehicle accidents and 31,758 died from unintentional public poisoning, while in 2012, 28 died due to lightning strikes.

As the winter sports season gets under way, how can participants ensure maximum safety while not missing out on the fun?

This article will look at some of the most common injuries and how to prevent or deal with them.

Head injury

Head injuries are statistically not the most common problem, but they are potentially the most dangerous. Even a minor blow to the head can cause bleeding that can result in stroke, brain tissue damage and death. A person without symptoms may have potentially fatal internal bleeding, as in Richardson's case.

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Falls and collisions increase the risk of serious head injury.

Neurosurgeon Keith Black, chairman of the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles, CA, explains that bleeding can be fatal if it occurs between the skull and the brain stem.

This is the area at the top of the spinal cord where consciousness, breathing and heart function are regulated. It also connects the brain to many of the body's sensory and motor nerves.

An arterial dissection, or tear in the inner lining of the arteries of the neck, can lead to delayed symptoms such as blood clots. These can cause a stroke and possibly death, although symptoms of fatal bleeding may not be evident for 24 hours or more.

While an immediate CT scan can show up a bleed, Black points out that most patients are not normally scanned following a minor trauma, so that careful monitoring is needed.

Blurred vision, dizziness, confusion, swelling at the site of the injury and vomiting are some of the warning signs.

Commenting on Richardson's case, Black adds that patients with delayed bleeds do not normally deteriorate so quickly; there is usually time to stabilize the patient, control swelling and operate to relieve the blood clot if necessary.

Medical News Today previously reported on concussion in winter sports.

Wear a helmet

In all three cases mentioned above, the patients were wearing helmets. Helmets do not prevent every injury: 14 of the fatalities recorded in 2012-2013 were wearing helmets; 11 were not. But a helmet will decrease the seriousness of a blow to the head.

MNT reported at the time of Richardson's death on the debate about whether helmets should be mandatory for skiers and snowboarders. Until now, they are not compulsory in most of the US.

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Helmets are a cheap and effective means of protection.

Dr. Jasper Sheely, of Rochester Institute of Technology in New York and lead author of the NSAA's injury report, estimates that helmet use reduces the rate of any head injury by 30-50%, noting that fatalities on the slopes have dropped as helmet use has risen.

The NSAA see this as evidence that wearing a helmet does not give a person the go-ahead to increase their level of risk-taking behavior. "We urge skiers and riders to wear a helmet, but to ski or ride as if they are not wearing a helmet," they say.

While 80% of those aged 17 years and under and 81% of those aged 65 and over wear a helmet, only 60% of 18-24-year-olds do so. This is up from only 18% in 2002-2003, but still low, especially in an age group that likes to take risks.

Helmets cannot prevent every serious injury, but they can save lives and should always be worn to reduce the incidence and severity of head injuries.

Sprains and fractures

The most common injuries during winter sports are sprains and fractures, usually sustained during a fall or a collision. In 2012-2013, 63% of all ski injuries and 56% of all snowboarding injuries were sprains or fractures. While damage to the back or neck can have serious consequences, damage to a limb or extremity is more likely.

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Snowboarder's ankle involves a fracture of the talus bone.

For skiers, the knee is the most frequently injured body part; damage to the thigh, ankle and the leg in general are common. In snowboarding, the wrist is most susceptible, but the shoulder, arm and elbow are also prone.

Although snowboarding injuries to the lower body are less likely, "snowboarder's ankle" is particular to the sport. It can happen when the foot bends up toward the leg, while at the same time as the ankle rolls under the foot, causing a fracture of the talus.

Symptoms include pain, bruising and swelling of the ankle, and inability to bear weight or to walk. Treatment can include a cast or, in some cases, surgery. Snowboarder's ankle is sometimes misdiagnosed as a sprain, since ankle sprains and fractures often have the same symptoms.

Sprains and fractures of the wrist, hand and upper body are seen at ice skating rinks as a result of people putting out their hands to break a fall.

Treat sprains with RICE

Treatment for a suspected sprain is RICE: rest, ice, compression and elevation for 48-72 hours. If after this time there is no improvement, medical help should be sought, which will probably involve an X-ray.

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It is tempting to keep practicing with a sprain or fracture, but it is not worth the risk.

Sprains are rated into grades based on the degree of damage to the ligaments, and a correct diagnosis is necessary to prevent long-term problems.

Recovery from sprains and fractures takes time. Rehabilitation and a gradual return to full activity are important to prevent long-term problems. Exercises may be prescribed to strengthen and stretch the joint and a support or brace may be needed.

Appropriate footwear helps to prevent ankle sprains and fractures. Most winter sports require firm boots that limit ankle motion and fit snugly.

Participants can reduce the risk of injuries like sprains, strains, dislocations and fractures by slowing down at the end of the day and avoiding overexertion when they are tired or cold.

They should also prepare for their sport by keeping in good physical condition, warming up before each session, staying alert and stopping if they are in pain.

Lacerations

Lacerations and abrasions are less common but still significant injuries in winter sports, especially in ice hockey, a fast-paced game with a risk of high-speed collisions with other players or with the boards.

Fast facts about injury rates
  • The US Hockey League (aged under 20 years) sees around 96 injuries per 1,000 player hours
  • Snowboarding rates are around three to six injuries per 1,000 days
  • Skiers experience two to three injuries per 1,000 days.

New technology in hockey has led to sharper blades and a greater risk of laceration; meanwhile, better protective equipment is helping to reduce the incidence of such injuries.

Visors and kevlar-infused socks and gloves are improving safety levels among hockey players. Some major Canadian teams insist that their players wear kevlar undergarments, which they say result in fewer laceration injuries.

While overuse injuries are by far the most common problem among regular figure skaters, lacerations can occur during competitive paired skating, when two pairs of blades work closely together.

Minor cuts and abrasions to hands have been reported in a survey of a temporary winter ice rink in the UK. While not warranting a visit to the local emergency room, such incidents have prompted rink managers to insist that all customers use gloves while skating.

Lacerations accounted for 12% of snowboarding injuries in 2009-2010 in Scotland and 10.3% of all skiing injuries, according to Dr. Mike Langran, director of the Scottish Snow Sports Safety Study and the UK's secretary of International Society for Skiing Traumatology and Winter Sports Medicine (SITEMSH).

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Falling on the ice can cause injuries to wrists and hands.

As in other sports, advances in equipment technology have reduced the incidence of serious laceration. Ski leashes and ski brakes now prevent runaway skis from injuring other people, and carving skis, which are easier to control than traditional skis, have helped improve safety.

If an accident happens

The first person at the scene of an injury should start by calling for professional help. Next, ensure that the casualty is safe and warm, gather as much information as possible about what happened, stay calm and reassure the injured person.

A trained first responder can assess the patient's level of conscious, airway, breathing and circulation (ABC), and immobilize the spine if appropriate.

A bystander should never rush in without first checking that the scene is safe, never move the casualty or remove any neck immobilization, helmet or boot unless the person's life is in danger; never give a casualty alcohol.

How can injuries be prevented?

Common sense, preparedness and responsibility are key. Crucial safety measures include careful planning, keeping fit, warming up before starting, having the right equipment and never participating alone.

Beginners should complete at least a basic training course, and those who have not practiced for some time should attend a refresher. Knowing how to keep control and how to fall properly can minimize injuries.

Treat the winter sports environment with respect: check the weather forecast, and heed any weather warnings.

In sub-zero temperatures, appropriate layers of clothing are essential for keeping warm and dry, as are knowing the signs of hypothermia and frostbite and how to seek shelter in an emergency.

Dr. Langran told MNT:

"Many [participants] overestimate their ability levels and are tempted to follow more experienced friends/family down slopes and in conditions that are beyond their ability levels."

Pushing oneself beyond reasonable limits, ignoring "trail closed" signs and copying stunts seen on TV endanger not only the individual but others' lives, too.

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The NSAA say "No horsing around" on ski lifts.

The NSAA's seven-point Code of Responsibility advises:

  1. Always stay in control
  2. People ahead of you have right of way
  3. Stop in a safe place for you and others
  4. Whenever starting downhill or merging, look up and yield
  5. Use devices to prevent runaway equipment
  6. Observe signs and warnings: keep off closed trails
  7. Know how to use the lifts safely: in 2012-2013, 4% of accidents involved a chair lift.

Snow sports participants in the US who break the code can expect to be stripped of their passes.

Be prepared to have fun

When asked whether most people are really prepared for snow sports, Dr. Langran told MNT:

"I would say that there is huge variation in the degree of preparedness for snow sports. I do not have scientific proof of this, but anecdotally I would say about 70% of people are not as prepared as they should be. By this I mean their equipment is not properly prepared and tested (ski bindings in particular: they should be serviced regularly by a qualified technician) and they themselves have underestimated the physical demands of snow sports."

When asked for one piece of advice for winter sports participants, Dr. Langran told us: "Equipment: ski bindings need to be checked and serviced regularly and protective equipment [such as helmets and wrist guards] needs to be properly sized and sourced."

Winter sports are a great way to stay healthy, to have fun and to develop endurance, leadership and team-building skills. But there are risks to pushing the limits.

Injury rates have fallen dramatically since they were first recorded in the 1970s, thanks to equipment technology, safety awareness and careful management of winter sports centers.

By taking responsibility, individual participants can and must contribute to keeping both themselves and others safe.

So, stay safe and enjoy the season!