Assess, Intervene, Monitor, Repeat

By Gayle Brady.


A change of seasons is often a time of reflection, and as I pack away my skis and winter gear, ready for spring and all it promises, I find my thoughts still wandering in the mountains. Our lives, like most, are particularly busy during the week when work, home, and our kids’ activities keep us on the go. Weekends are a sacred time to relax and reconnect, and we often escape the coastal winter rains and head to drier, sunnier days in the snowy mountains. This past winter we rejoined the Canadian Ski Patrol after a 12-year hiatus and spent weekends with friends old and new at our favourite provincial park located a 3-hour drive from home. It was a wonderful winter in spite of some extreme weather situations and their challenges.


In the fall we experienced unprecedented flooding here in the Pacific Northwest that wiped out major highways and infrastructure. Families were stranded, and businesses and farms were devastated. It took some time, as these things do, but communities and families bonded together, as we do, and we managed to weather the storms and their aftermath. Support and kindness from neighbours and strangers alike energized recovery, and although efforts and work are ongoing and will take months and years to achieve completion, there is a sense of resilience and determination to see things through. Our favourite ski resort and its proximal highways sustained damage as well, but although opening day was delayed, the season started more or less on schedule with a renewed sense of teamwork and camaraderie. So, there in the mountains, on most weekends throughout the winter, we filled our cups, feeding our passions for skiing and the outdoors while also providing first-aid with a team of skilled and dedicated volunteers. It was, all told, a wonderful winter.


Now, outside of the patrol we don’t talk much about calls we attend, but there was one accident in particular this season that resonated on many levels, and I sometimes revisit it in my mind. In the late morning toward the end of a shift, my youngest daughter and I were traversing at the top of a collector run, my husband not too far behind us, when bright orange ski pants suddenly caught my eye. In a split second I turned to look uphill and witnessed a skier become airborne, perhaps 100 feet from us, out of control, landing hard on the groomed run below. The pitch and bank of the hill blocked my view of the skier’s landing, but I paused nonetheless, concerned for a possible injury. I glanced back at my husband to find out if he had seen what had happened and saw that he was already removing his skis and hiking up to the accident site. I quickly did the same, and we arrived on scene within minutes to find an adult male skier sprawled supine on the run but still conscious.


We began to assess both the scene and skier as we approached, and our youngest daughter marked the accident site with our skis, giving us room to do a proper assessment. The fellow was shaken, having hit the ground hard, but told us he was okay. His primary concern was injury to his thumbs, and his wife encouraged him to stand up, get going, and continue the run; both insisting they were fine. My husband did a primary assessment and took baseline vitals. Everything looked good, but that drop, though -- he had fallen hard (mechanism of injury.) I asked the injured man if he had been planning to jump the ledge, and he said that he knew the drop was there but that in the flat light it had come up sooner than he had anticipated. He and his wife remained determined to continue their run and get on with their day, but I asked them to humour us while we continued our conversation, repeating questions already asked, wanting to complete a more thorough assessment. I wasn’t terribly surprised when the skier began to provide entirely different answers than the ones given just minutes earlier. (You know those moments when you get a feeling in your gut and time seems to pause? We called for backup, a toboggan, and activated EMS.) We urged the gentleman to be still while we carefully removed his helmet. It was broken and revealed a significant bump at the back of his head. Additional patrollers arrived while we carefully applied a c-collar and immobilized our patient onto a backboard before loading him into a toboggan for transport. By the time we arrived at base, there was a significant decline in his condition and amnesia was persistent – he didn’t remember what had happened, didn’t remember how he got there, and didn’t remember his date of birth. Fortunately, his wife was available to provide helpful information, but when we donned facemasks as per COVID protocols and he didn’t know what COVID was, the seriousness of the situation became evermore apparent.


Let’s think about that for a minute. He didn’t remember COVID. COVID. We’ve been in this pandemic for over two years, and yet he had no recollection of it whatsoever. What would the last two years have been like for you if not for COVID? How have the last two years been for you because of COVID? Are there moments or details you’d like to forget? Some of you may know that as a clinical counsellor I work in both the public school system and private practice. I can tell you without hesitation that there are many moments from this pandemic that I would love to forget. It has been hard. Maybe not hard like unexpectedly skiing off a 5-foot drop and landing supine sprawled on an icy surface with a serious concussion hard, but yeah, it has been hard. I’m often asked to provide an opinion with regard to a child’s social, emotional, and academic needs, and I can tell you that this pandemic has been hard on everyone, particularly our gifted children and youth. Behaviour is often a driving force behind a referral, and I’ve received an exponential increase in demand since COVID began. Behaviour is communication, so what are our kids telling us? Truth be told, one of the reasons my husband and I rejoined the Ski Patrol was a desire to focus on our own family’s self-care, to spend more time together outdoors, and to find ways to completely detach from the added stresses of the pandemic. COVID has been hard.


At this point you may be wondering where I’m going with all of this. What does my role as a weekend ski patroller have to do with my role as a counsellor, parent, and advocate for gifted children? Maybe nothing. Maybe everything. Maybe something in between. What strikes me about my experience as a ski patroller is how intentionally we are trained for dealing with numerous possibilities of both injuries and environmental conditions. Each and every new recruit spends a minimum of 64 hours of in-person advanced first-aid training, in addition to online coursework and practical and written exams. Returning patrollers spend an average of 32 hours each season to recertify in advanced first-aid and are then held to an even higher standard on written and practical exams. For fun throughout the season, new and returning patrollers alike also practice scenarios and hold competitions to improve skills. At the end of each and every shift, we debrief the day and talk about anything we learned, how we felt, and any improvements we might have made in relation to the incidents that occurred. On shift, new recruits are paired with experienced patrollers as much as possible to offer support and mentorship and although every first-aid situation is different – from patient to responder to environment - the principles and priorities we follow in our assessment and treatment are the same. We routinely provide life-saving interventions and care until patients are transported to appropriate medical facilities. We recognize that situations are dynamic; our weather environment on the mountain and the nearby roads is ever-changing as is a patient’s response to interventions, so they are constantly monitored. As you can imagine, although we are each highly skilled, there isn’t much room for ego. Beyond ensuring no further danger to others, it’s about what’s best for the patient.


So how does this compare and relate to our work with gifted children and youth? Unlike Ski Patrol training, not everyone is using the same manual, so let’s start with some questions. For starters, unless they’re in crisis and asking for help, how are gifted children identified and by whom? How is participation in gifted programming determined? What metrics are used? Do all schools or districts perform universal screening? What information is available in regard to a child’s developmental baseline? Do we consult with family to fill in blanks and have a more rounded picture? Have we looked at trauma? (https://www.sengifted.org/post/bachtel-trauma-collaboration) Do we consider performance and behaviour in the context of a child’s developmental level? What happens if that development is asynchronous? Did we miss a diagnosis? Were they misdiagnosed? (https://www.sengifted.org/post/misdiagnosis-and-dual-diagnosis-of-gifted-children) Are they 2E? 3E? Are our support systems culturally responsive? (https://www.sengifted.org/post/3e-learners) What about Individualized Education Plans (IEPs)? Are recommendations and plans being followed? Are we monitoring outcomes and response to interventions? Where do we turn when a child’s needs exceed what is available? Who has a seat at the table when decisions are made? Who is part of our team? These questions are endless but valid and we need to start somewhere.


I understand that not everyone dreams of wearing a red jacket and skiing fresh powder while wearing a first-aid pack, but I believe that we in gifted land can learn something from a volunteer organization some 5000+ members strong. Here are some ideas that come to my mind and I invite you to explore them and share your own ideas that may apply.

  1. Identify the helpers. On the mountain we’re the ones in the red jackets emblazoned with a white cross. Who are the helpers in your gifted child’s life?

  2. Develop protocols. Our ski patrol protocols were developed in consultation with professionals around the world and are reviewed and updated on a regular basis. COVID was a challenge for which new protocols had to be developed. Research, collaboration, consultation, and best practice guidelines are key.

  3. Qualifications count. We train and recertify every year to provide advanced first-aid, but we are not doctors. We know the limits of our training and practice within these confines and professional guidelines. Let’s up our game in whatever role we play in supporting gifted individuals.

  4. Situations and environments are dynamic. Assess, intervene, monitor, repeat.

  5. Ensure no further danger. This is at the top of our protocols as we know we cannot help others if we do not first protect ourselves. It also recognizes that significant interventions are sometimes needed to prevent further harm.

Going back to the situation of the patient who suffered amnesia after sustaining a concussion, there are a lot of little details that also carry meaning for me. For instance, when we were applying the c-collar we had to make sure it was correctly sized. Incorrect fit can be very damaging. Our patient ended up being air-lifted to hospital but first had to be transported by ambulance to a site 10km away because weather made the mountain pad inaccessible. Sometimes we have to improvise and make do. We have no choice but to remain flexible. Once en route, the destination was changed multiple times, and a hospital with a neuro trauma centre was ultimately chosen. Upgrade services and seek specialists as needed. Weeks later we received an email from our patient who was recovering from his injuries which included a concussion and also sprained thumbs. His chief complaint on-scene (sore thumbs) was not the most serious of his injuries, but it was nonetheless an injury. Assess thoroughly and be open to multiple diagnoses, and beware of masking. Communicate outcomes. In our debrief on the day of the accident we talked about what happened, and we returned to the case once more following receipt of the email. Talk about it, and then talk about it some more.


Now, as I write, it’s hailing outside my window. There is still snow in our mountains but our favourite ski resort has closed for the season. My thoughts shift to spring gardening and summer hikes, alpine meadows, and warmer days to be spent at our local beaches. In Canada our K-12 school year lasts into June, and my local school will wrap up June 30th, just 3 weeks before SENG’s annual online conference July 22nd-24th. (https://www.sengifted.org/sengonline2021) I’m looking forward to it. Are you? I invite you all to attend and to bring a friend this year! The pandemic has been hard, and everyone deserves a chance to get together - even virtually - to connect with friends old and new.