Advanced Life Support Pain Management Program
Now about to conclude its second season, the advanced life support (ALS) pain management program at Stratton Mountain in the Southern Vermont Region has already helped numerous patients with moderate to severe pain while still on the mountain with injuries.
The program, known internally as “Code 90,” was started during the 2024-25 ski season at Stratton Mountain Ski Patrol (SMSP). We saw a need to help our patients with painful injuries while still on the mountain utilizing advanced life-support-level care and pain medications. This was made feasible as SMSP also operates Stratton Mountain Rescue (SMR), a Vermont-licensed ALS ambulance service which serves the Stratton Mountain community and surrounding areas during operating hours throughout the year. Essentially, SMSP/SMR extends the scope of practice and capabilities of the ambulance service onto the mountain to be able to provide ALS-level pain management to injured guests.
The Code 90 Team consists of four paramedic ski patrollers as well as one licensed physician anesthesiologist who is also a ski patroller. The paramedic ski patrollers operate under standing orders of the Vermont Statewide EMS Protocols and work in coordination with the Carlos Otis Stratton Mountain Clinic; an urgent care center located in the base village staffed by emergency medicine physicians and orthopedic surgeons during the ski season. Patients are transported off the mountain by sled and then transferred to the Otis Clinic for further care.
If patients require transfer to higher level facilities, this is accomplished by Stratton Mountain Rescue Ambulance (staffed by ski patrollers). When necessary and weather permitting, our dispatch will request a medivac helicopter for critical care interventions and rapid transport to a Level 1 Trauma Center. Stratton Mountain has a designated Landing Zone that is easily accessible nearby to the clinic throughout the year and secured through Stratton Security or local fire/rescue personnel.
For all reported incidents on the mountain, ski patrol dispatch (located at Patrol Headquarters at the Summit) will initially send one ski patroller to respond directly to the scene. The first responding patroller will assess the patient and request additional resources, patrollers, and equipment as the situation requires. This also may include requesting a “Code 90” for patients with moderate to severe pain if they may need pain management. Ski patrol dispatch will then locate and send a member of the Code 90 Team, if available, to the scene.
The Code 90 Team member will assess the patient further and, if appropriate, administer Fentanyl, a synthetic opiate, to reduce the patient’s pain during splinting, extrication, and sled transport to the clinic. This can be accomplished via multiple routes including intravenous, intramuscular, and intranasal routes. If the intravenous route is preferred, an IV is established on scene on the mountain.
To ensure readiness, ALS patrollers sign out a narcotic kit from a designated safe each morning and, if not used, return the kits after sweep. Restocking of medications is accomplished at the Otis Clinic. Data are tracked for each patient. SMSP is observing significant improvement in patients’ reported pain averaging a five 5-point reduction in pain scores (utilizing the numeric “1-10” pain scale). Every call is reviewed by the team with participation of the Otis Clinic Medical Director, Ricky Kue, MD. Call data are also entered into the Vermont EMS Data System (“SIREN”).
ALS kits also contain naloxone (NARCAN®) as well as ondansetron (Zofran®, an anti-nausea medication) to manage any side effects. As a precaution, an oxygen pack containing additional equipment including airway management, suction, and epinephrine kit and bag-valve mask is also sent to all Code 90 calls. The Code 90 Program is also available at times during the summer season at the Stratton Mountain Bike Park depending on staffing. Currently, this SMSP makes an effort to have Code 90 Team Members on the mountain and available as many days as possible, but is not guaranteed due to staffing. The program is considered “Best Effort” in terms of availability.
Next season, through a generous equipment donation, SMSP is working toward approval to add the capability to also administer nitrous oxide to patients on the mountain as a part of the program. This option will also be available to not only the paramedics and physicians but also Advanced Emergency Medical Technicians (AEMTs) on ski patrol, increasing the availability of the program.
Our goal is to be able to treat as many appropriate patients as possible. While quite common in the west, as was found at my previous ski patrol at Vail, this type of program is somewhat unique in the east and SMSP is happy to offer this service to our guests when needed to make their unfortunate situation a little better.
Marc Burdick has been ski patrolling for 40 years and is currently a paramedic ski patroller at Stratton Mountain Resort. He is a critical care paramedic with Northern Berkshire EMS in North Adams, Massachusetts where he manages special projects.
