, is chief of Sports Medicine and an orthopedic surgeon with , and an assistant professor at the . A former football player and athlete himself, he specializes in sports injuries, and says it’s not uncommon for weekend or holiday warriors to end up in the emergency room after a fall on the slopes. But that doesn’t mean it can’t be safe, and there are ways to minimize your risk.

He said the biggest thing is to be realistic about your abilities, and not get overconfident. “People try to ski above their level. They get brave on the bunny slopes, then they think they can head for the Black Diamond,” he said.

For the uninitiated, Black Diamond slopes are difficult with steep gradients, and they are often full of bumps. A Double Black Diamond is the most difficult rating and should be skied by experts only. If you get on one of these and you’re not an expert — well, you were warned.

According to a review article published in a January 2018 issue of the Journal of the , the number of skier and snowboarder injuries continues to rise. The U.S. Consumer Product Safety Commission estimates more than 140,000 people were treated in hospitals, doctors’ offices and emergency rooms in 2015 for skiing and snowboarding-related injuries.

“It might seem like common sense, but don’t ski above your level of comfort, and wear proper safety equipment, such as a helmet, gloves and goggles,” Douglas said. “Always the helmet.”

A broken wrist or twisted knee can most likely be fixed, but a brain injury is much more serious.

The American Academy of Orthopaedic Surgeons says taking lessons is especially important for new skiers, and learning how to fall correctly can reduce the risk of injury.

Douglas said it’s also best to pick a time of day to ski when it’s less crowded, if you can. “It has happened on crowded slopes where a skier has been struck by someone else moving much faster than them.”

Common injuries

A wide range of injuries can occur, with injuries to ligaments more common than fractures. Douglas said the majority fall into two groups: Knee injuries, particularly to the anterior cruciate ligament due to twisting; and because skiers and snowboarders often put their arms out to break a fall, a broken wrist or shoulder injury such as a fracture, separation or dislocation. A separated shoulder is an injury to the ligaments that hold your collarbone to your shoulder blade.

Douglas said injuries to the upper body can be worse as that part “has an extra second to accelerate before hitting the ground.”

Skiers who fall on an outstretched hand while holding a ski pole can get “skier’s thumb,” an injury to the ligament that connects the bones of the thumb together.

Snowboarding injures tend to be more common and severe than skiing injures, Douglas said, as ski bindings are designed to come loose in the event of a fall, with the skis flying away, while a snowboard remains attached. With the snowboard strapped on, those who fall often suffer twisting or rotational injuries to the knees, as well as a broken wrist or separated shoulder. He said snowboarding injuries are more likely to require surgery or hospitalization.

Injuries to novice skiers also tend to be less severe than for those who are more advanced, Douglas said. “More experienced skiers are also less likely to take a doctor’s advice.”

Whether novice or experienced, the American Academy of Orthopaedic Surgeons recommends the following to stay safe on the slopes:

Proper preparation

• Maintain fitness. Be in good physical condition when you set out. If you are out of shape, select runs carefully and gradually build your way up to more challenging trails. Many ski injuries happen at the end of the day, when people are tired and try to get in one last run.
• Warm up. Research has shown cold muscles are more prone to injury. Warm up with jumping jacks or running or walking in place for 3 to 5 minutes. Take a couple of slow ski runs before moving on to something more difficult.
• Drink water. Even mild levels of dehydration can affect physical ability and endurance. Drink plenty of water before, during and after.
• Know safety rules. Understand and abide by rules of the ski resort. Know general safety rules of skiing, such as how to safely stop, merge and yield to other skiers.
• Learn ski lift safety. Before your outing, learn how to properly get on and off a lift.

Ensure Appropriate Equipment

• Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Layering allows you to accommodate your body’s constantly changing temperature.
• Boots and bindings. Buy or rent boots and bindings that have been set, adjusted, maintained and tested by a ski shop that follows American Society of Testing and Materials (ASTM) standards.
• Check the binding of each ski before skiing. Bindings must be properly adjusted to your height, weight and skiing ability.
• Safety gear. Wear appropriate protective gear such as a helmet and goggles. Helmets are sport-specific, so do not wear a bike helmet on the slopes. Ski helmets should be worn.

Ensure a Safe Environment

• Stay on marked trails and avoid potential avalanche areas.
• Watch out for rocks and patches of ice on trails.
• Pay attention to warnings about upcoming storms and severe drops in temperature. Make adjustments for icy conditions, deep snow, powder and wet snow.

Prepare for Injuries

• Ski or snowboard with partners and stay within sight of each other. If you get ahead of your partner, stop and wait.
• Seek shelter and medical attention immediately if you, or anyone with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help if injuries occur.

“The work of David Gross and the Northeast AHEC exemplifies the incredible work performed by all of our statewide AHEC programs. We are so fortunate to have this effort recognized on a national level as we seek to close the health care gap in our rural areas,” said R. Brent Wright, MD, acting statewide program director for Kentucky AHEC and associate dean for rural health innovation, UofL School of Medicine.

The regional center received the honor for its STEPS program. STEPS, or Successfully Training and Educating Pre-medical Students, was created in 2013 to level the playing field for local students interested in applying to medical school. Appalachian Kentucky, including most of the NE KY AHEC’s service region, has a long-standing shortage of physicians.

Studies have shown shortages are partially attributable to factors including Appalachian students’ inadequate academic preparation, limited exposure to health care occupations, low self-confidence and financial considerations. STEPS helps northeast Kentucky students overcome these barriers by providing participants with Medical College Admission Test (MCAT) preparatory courses as well as mock interviews, application process and personal statement tutorials, physician shadowing and other activities aimed at better preparing them for the process of applying to medical school.

“It’s quite an honor to be chosen by our peers for one of only three Center of Excellence awards among the nation’s nearly 250 regional AHECs,” said David Gross, director of the NE KY AHEC. “The purpose of STEPS is to produce not just more, but more competitive, medical school applicants from our region. In part because of this program, we continue to see meaningful increases in the number of local students applying to and being accepted by in-state medical schools.”

Since its creation, three cohorts of students have completed STEPS and the subsequent medical school application/ interview/matriculation cycle. Of the 25 students who met all program requirements, 22 matriculated to medical school.

The NE KY AHEC recently entered into a two-year contract with the Kentucky Primary Care Office to replicate STEPS among the other seven Kentucky AHECs.

AHEC is a collaborative effort of the University of Louisville Health Sciences Center, the University of Kentucky Medical Center and eight regional centers. The goal of the Kentucky AHEC program is to improve the recruitment, distribution and retention of health care professionals (particularly in primary care) in medically underserved areas throughout the state.

Each regional AHEC center serves a specific geographic area of the state, and is responsible for certain counties in their area. The University of Louisville serves as the central office for all eight regional centers.

Dramatic, yes, but it’s a scene that could happen, and it’s the plot of a new CPR training film developed by a University of Louisville doctor. , physician director for resuscitation at and an assistant professor at the UofL School of Medicine, is hoping the novel approach will improve high school CPR training by helping students remember what they have learned by applying it to a real-life situation they can relate to.

CPR instruction in high school is now required by law in a growing number of states. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed its law in 2016. Similar laws are being considered in the remaining states.

“The goal is to create a real, emotional scenario,” said Brown. “There are so many lives that could be saved if more Americans knew CPR, and we have all of these students coming out of high school with CPR training.”

About 4 million students per year now graduate with CPR training. Brown has studied CPR training in high school, with her work in the . She found CPR skill retention in high school students was poor, with only 30 percent able to perform adequate CPR six months after training. She also found that there was no standard method of implementation.

“We wanted to know, is there a better way to do it?” she said.

That’s where the film comes in. Working with the local and using $10,000 in grant money she received from winning the prestigious Stamler award for young researchers at Northwestern University last October, she modeled the film after one done in the United Kingdom, where CPR training also is required.

The interactive film, designed for classroom use in high schools and shot at by a local film company, forces students to make choices along the way about how to respond. It will be rolled out in local high schools this fall, then Brown will determine whether it improves skill retention. If it does – and Brown said she believes it will – the plan is to expand it across Kentucky and the nation.

“This could be a game-changer in the way CPR is taught in the United States,” she said.

The film used six local high school and college actors, and paramedics from , who brought an ambulance for one scene. In the film, the coach (Brown’s real-life husband, who auditioned for the part) suffers cardiac arrest during basketball practice, and staggers out into the lobby, where he becomes unconscious and falls onto the floor. He is found by a player, who, along with the other students at practice, must call an ambulance and perform CPR on the coach together until the paramedics arrive. The coach regains consciousness, and the students are congratulated by paramedics for saving his life.

In the United States, 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects whether they survive, Brown said. Only 11 percent of the 350,000 receive CPR. Brown has said that if CPR survival improved by just 1 percent, 3,500 more people would live.

Expanding and improving CPR training has been a personal mission for Brown, who has worked for several years on unique approaches.  These days, effective CPR is hands-only, removing a barrier for some from the old mouth-to-mouth method. She also founded and directs a program called “Alive in 5” (), a 5-minute method of teaching CPR she developed.

The wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations.

“It’s important that people be willing to act, and that they remember the skills that they’ve learned,” she said. “As most cardiac arrests that don’t occur in a hospital happen in homes, it is likely they will save the life of someone important to them.”

See the filming

To watch a video on the making of the film, click .

Under the agreement, the Justice Cabinet will contract with the universities for forensic pathology services, combining resources for both autopsies and medical education. The move is expected to boost salaries for doctors, helping improve recruitment and retention, and it will help the cabinet avoid charging counties a fee for autopsies.

“The opioid crisis has placed tremendous strains on our state, and we must take every opportunity to innovate and find efficiencies,” Secretary Tilley said. “By partnering with universities, we can improve the pay and size of our forensics team while also ensuring that families, coroners and police get the answers they need when tragedy strikes.”

The agreement also will help UK and UofL maximize training opportunities for medical students and residents in pathology.

“Our collaboration with the Justice Cabinet and their Medical Examiner’s Office illustrates the University of Kentucky’s desire to take a comprehensive, ‘all hands on deck’ approach to addressing Kentucky’s opioid crisis,” said Dr. Darrell Jennings, chair of the UK Department of Pathology and Laboratory Medicine. “This opportunity will provide our medical students in Lexington, Bowling Green and Northern Kentucky, along with our residents and fellows, with unparalleled training on the front lines, harnessing the power of compassion and commitment to transform the future.”

“Through this strengthened relationship with the state Medical Examiner’s Office, we will broaden the educational and training opportunities for our students, residents and fellows,” said Dr. Eyas Hattab, chair of the Department of Pathology and Laboratory Sciences at UofL. “Our trainees will have access to the number and variety of cases that are invaluable as they prepare for the next steps in their careers.”

UofL will provide up to six pathologists in state medical examiner offices; UK will provide up to four. The cabinet will pay the universities for any services performed by these doctors on a scale similar to current costs. The cabinet and universities will also collaborate on strategies that could possibly lower the overall cost of the program in the long run.

The Medical Examiner’s Office currently employs nine doctors – six in Louisville, two in Frankfort and one in Madisonville. The partnership is expected to provide a net increase of one forensic pathologist immediately with opportunities to add an additional doctor, possibly within two years, thanks to recruitment assistance from the universities.

All doctors have an opportunity to transition into university positions, and those who do are expected to receive a salary increase depending on the individual contracts between doctors and universities. Added salary will compensate for additional responsibilities such as teaching, researching, writing, consulting or other contributions that doctors are interested in pursuing.

While the exact terms of employment will depend on the individual contracts, the higher pay scale is expected to make Kentucky more effective at hiring and keeping new doctors.
Kentucky, like many other states, has struggled to recruit forensic pathologists in recent years due to a national shortage. Only about 500 forensic doctors are currently practicing across the country. At the same time, overdose deaths have continued to climb over the past decade, driving up demand for autopsies and toxicology tests. More than 1,400 Kentuckians died from an overdose in 2016.

In response, enhancing the Medical Examiners’ Office has remained a high priority under the current administration.

In 2016, the office resumed services in Madisonville (following a two-year hiatus), helping coroners and law enforcement agencies across Western Kentucky reduce travel costs and obtain evidence at a faster pace.

Secretary Tilley said he plans to continue looking for ways to improve the office. For instance, the cabinet is aggressively seeking grant funds to expand capacity, reduce caseloads, expand toxicology analysis and enhance data collection.

“We want to consider every option to enhance services while avoiding fees for counties,” he said. “UK and UofL have been excellent partners in this process, and we look forward to continuing our work with coroners to ensure their needs are met.”

The announcement on Friday was made by Gregory Postel, MD, interim president of UofL, and the study’s principal investigator, Roberto Bolli, MD, director of UofL’s Institute of Molecular Cardiology. Bolli also serves as scientific director of the Cardiovascular Innovation Institute at UofL and as a professor and chief of the Division of Cardiovascular Medicine at the School of Medicine.

“This is a prestigious grant reflecting the magnitude of the work being conducted here,” Postel said. “Being awarded this grant is a huge, huge accomplishment.”

Bolli thanked the National Heart, Lung and Blood Institute and the NIH for their support. “It is critical that we have this type of support for the important research programs that we carry out, which can help patients around the world,” he said.

Heart failure affects millions of people, and the most common cause is a heart attack. When a person suffers a heart attack, part of the heart muscle dies from lack of oxygen and is replaced with scar tissue, which does not contract. Because of the loss of muscle, the heart becomes weaker and less able to pump.

Until now, conventional treatments for heart failure have consisted of surgery or medications, which can alleviate symptoms but do not cure the disease. In contrast, Bolli’s focus has been on how to repair the heart itself and actually cure heart failure using a patient’s own stem cells. It is an approach that could revolutionize the treatment of heart disease.

The NIH grant is a continuation of a Program Project Grant (PPG) that Bolli and his team were originally awarded in 2005. The overall goal of this PPG is the use of stem cells to repair the damage caused by a heart attack by regenerating heart muscle in the area that died, replacing the scar tissue with new muscle and thereby making the heart stronger and able to pump more blood.

A PPG is a cluster of several projects with a common focus relating to one theme, in this case, the use of adult stem cells to repair the heart. It involves a collaboration among different investigators working as a team, a collaboration that otherwise might not be able to occur without funding.

The latest round of funding comes after Bolli and his colleagues discovered a new population of adult stem cells, called CMCs, in the heart three years ago.

“CMCs seem to be more effective,” Bolli said. “In addition to showing more promise than those we have used in the past, these cells also offer several advantages in that they can be produced more easily, faster, more consistently and in larger numbers than other adult stem cells, which have proven tricky.”

He said this would make them easier to apply for widespread use, as specialized labs to isolate the cells would not be needed as with other types of adult stem cells.

Bolli and his team want to find out what CMCs will do when transplanted into a diseased heart in mice and pigs, ultimately laying the groundwork for clinical trials in patients.

On Friday, Postel noted that the NIH didn’t just approve UofL’s grant application – a long, multistep process involving more than a dozen reviewers who are experts in the field – it funded the project with a perfect score and rare high praise. In fact, the committee reviewing the application concluded Bolli’s program was, “exceptional,” with “significant translational impact, an exceptional leader and investigative team and an exceptional environment.”

“We are continually striving for new and better ways to treat heart disease,” Bolli said. “I’m confident we are not that far from a cure.”

Watch the announcement below: 

An abstract of the study, “Effect of Fireworks Laws on Pediatric Fireworks Related Burn Injuries,” will be presented at the PAS meeting in Baltimore on May 3. Researchers looked at federal and state data from the National Inpatient Sample, with data on 8 million hospital stays each year, and the Nationwide Emergency Department Sample, which annually compiles information on 30 million discharges from emergency medicine facilities.

They determined the number of patients under age 21 treated and released by emergency departments between 2006 and 2012 rose modestly. Significantly larger increases were seen in injuries requiring inpatient hospital admission, which skyrocketed from 29 percent of cases in 2006 to 50 percent in 2012.

“The increase in fireworks-related injuries and the severity of these injuries in children since 2006 are very concerning,” said Charles Woods Jr., MD, one of the study’s authors and associate chair of pediatrics at the University of Louisville. “Although our findings do not prove a direct link to relaxations in state laws governing fireworks sales, it may be time for lawmakers to reassess this issue. Parents and caregivers of children also should be aware of these increasingly serious injuries and the potential dangers involved in allowing young children to handle and play with fireworks.”

Lead author John Myers, PhD, a researcher in the Department of Pediatrics at the University of Louisville, will present the abstract, “Effect of Fireworks Laws on Pediatric Fireworks Related Burn Injuries,” at 7:30 a.m. on Tuesday, May 3 in Exhibit Hall F at the Baltimore Convention Center. The .

“Pediatric fireworks-related burn injuries have increased in incidence, apparent severity of injury, the proportion requiring hospitalization and length-of-stay in the hospital in a time period of relaxed fireworks laws in the United States,” Myers said. “These findings suggest that policy-makers should revisit current fireworks laws for the safety of children.”