ALPINE INFIRMARIES : TAHOE HOSPITALS PREPARE FOR SKI SEASON.

Byline: Barbara Barte Osborn Scripps-McClatchy Western Service

As Lake Tahoe ski resorts prepare for the winter, nearby hospitals are getting ready as well.

Stacks of crutches line a wall in the emergency room at Tahoe Forest Hospital in Truckee, which puts gurneys in the hallways and doubles its emergency room staff as it braces for the onslaught of injuries from the slopes of nine nearby ski resorts.

``The waiting rooms overflow on a ski weekend,'' said Dr. Jay Foley, an orthopedic surgeon.

``When the holiday season comes, it hits,'' said nurse Judy Newland, who is head of emergency services. ``The volume easily triples. Dislocated shoulders, knee and back injuries, fractures of extremities - it's on a daily basis.''

During the quieter fall, the department readies for ski season, bringing in the crutches and other orthopedic equipment, restocking supplies, readying the X-ray rooms and practicing the newest splinting and boot-removal techniques.

By Thanksgiving, the emergency room staffing doubles, five beds are added, and gurneys and chairs are kept ready for the hallway when needed.

Of 7,098 patients treated at the emergency room last November through April, almost 40 percent had snow-sport-related injuries, said Dr. Ed Heneveld, an emergency physician. Among the injured, he said, ``about 65 percent were downhill skiers, 25 percent snowboarders and about 2 to 5 percent each sledders or cross-country skiers.''

As the day goes on, especially on weekends, the emergency room staff prepares for an increasing onslaught, because more injuries occur later in the day when skiers - especially weekend skiers - are tired.

``All of a sudden 4 p.m. hits,'' Newland said. ``It's not unusual to have four or five ambulances at once. . . . It's a shuffle. . . . We go up to 20 beds and the rest have to be in the hall. We have no other place to put them.''

Most ski injuries don't require surgery, so the emergency room nurses train in splinting and stay updated on new techniques.

``Our ER staff here is so good that the specialists are only called in for the acute fractures that need surgeries,'' Foley said.

And some of the care they deliver may not be in standard medical manuals.

``Boot removal, believe it or not, is a specialty,'' Newland said. ``It's a two-person job and, every year, when they redesign the boots from back-entry or front-entry, the physicians and nurses relearn.''

The emergency room staff, most of them skiers themselves, can even tell snow conditions by the injuries coming in. When the snow's soft, there are more twisted knees - the most common injury - and ankles; when it's hard, more fractured wrists and thumbs, Newland said. And, when the snow's icy, more serious accidents occur, as people fall and slide into rocks, trees or chairlift poles, or sled onto the street.

But however the injuries occur, patients waiting for X-rays on a frantic ski weekend are never left wet, cold or in pain, Newland said. Blanket warmers and ``bear huggers,'' blankets with hot circulating air, are kept on hand. Bags of warm IV solution are often given to cold skiers to hold in their hands or place on their feet.

Injured skiers from the five Donner Summit ski resorts - Boreal, Sugar Bowl, Donner Ski Ranch, Soda Springs and Royal Gorge - as well as those in Squaw Valley, Alpine Meadows, Northstar and Tahoe Donner, generally are brought to Tahoe Forest Hospital. Many also are treated at on-site clinics at some resorts.

Witnessing the annual parade of injuries doesn't keep Tahoe Forest doctors and nurses off the slopes, they say, but it does make them more cautious.

Newland offered an impromptu winter ``don't list,'' based on common injuries she's seen: ``From the perspective of an emergency room nurse,'' she said, ``don't snowboard alone. Don't put your chains on in the middle of the road. Don't sled on icy hills, near streams or cliffs, on streets or on hills that open into streets. Don't go out of bounds when skiing. Don't do it.''