The Scars of Summer

In-line skating, or Rollerblading, reached its peak in 1995 with more than 22.5 million participants. The number has now dropped to around 13 million in the U.S.,¹ with California having the most skaters at 3.6 million.²

In-line skating grew out of roller skating, which emerged in Belgium in 1735 due to the lack of ice for skating in the summer. What we now see as the skate or blade for in-line skating emerged in Minneapolis, MN, in the 1970s as a way for hockey players to skate in the summer. It exploded across the U.S. when Rollerblade was launched and strategically marketed in the early 1980s.³

Protective Equipment and Injuries

As the popularity of in-line skating grew, so did the development of safety equipment for participants. Though protective equipment continues to evolve and improve, its use has not. Knee pads are worn 45% of the time and are the most commonly worn protective equipment, yet only 6.8% of in-line skating injuries involve the knee.^1,4 Wrist guards, followed by elbow pads, are worn about one-third and one-quarter of the time, respectively, yet wrist injuries (fractures, sprains, etc.) are the No. 1 reported injury and account for over 24% of all injuries sustained.^1,4 Interestingly, head injuries only account for slightly more than 4% of injuries reported, though only some 20% of individuals use head protection.⁴ Only 7% of individuals report using all recommended safety equipment, and a staggering 46% use no protective equipment whatsoever.⁴

Overall, in-line skating injuries occur in only 3.4 out of 1,000 participants, which places them behind basketball, soccer, softball and bicycling injuries.⁴ No deaths were reported by the National Electronic Injury Surveillance System (NEISS) in 2010.⁵ The leading cause of injury was described as a spontaneous loss of balance. Basically, the skater fell and sustained wrist or lower arm injuries while trying to break his fall with an outstretched hand. The next most common cause of injury was striking a stationary object, which resulted in wrist and arm injuries, as well as lower extremity fractures and lacerations. These two causes make up 80% of Rollerblading injuries that EMS will encounter.⁴

Assessment and Management

When responding to an injured in-line skater/Rollerblader, scene safety and situational awareness cannot be stressed enough, since roughly 50% of incidents occur on streets, sidewalks or trails where you will likely encounter other skaters, cyclists and even motor vehicles.⁴ Scan the scene as you approach the patient, assessing airway status, whether or not the patient is breathing and how well he is oxygenating, and doing a rough assessment of circulatory status based on skin color and level of consciousness. Once you obtain an adequate history of the incident, you can determine if the patient requires a rapid trauma assessment and management of possible life-threatening injuries, or if there is time for a focused exam and treatment of specific injuries.

Focused Management of the Three Most Common Injuries

Wrist fractures, sprains and lower arm injuries are the most commonly encountered injuries, followed by lacerations and lower leg injuries. Most extremity injuries can be predicted by mechanism of injury and the patient's chief complaint(s).⁶

With potential upper or lower extremity injuries, complete a focused physical examination for obvious signs of injury to the extremity. These could include abrasions, contusions, penetrations, lacerations, deformity or swelling.

Once your inspection is completed, palpate the injured extremity to assess for pain, tenderness, instability or crepitus (crackling, crinkly or grating feeling).⁷

Finally, assess circulation, motor function and sensory function (CMS) in the injured extremity. Circulation can be assessed by evaluating the presence and strength of the distal pulse, skin color, temperature, condition and capillary refill. Motor (muscle) function should be assessed against resistance.

For an upper extremity, have the patient squeeze two of your fingers on each hand with each of his hands and compare the strength.

For the lower extremities, have the patient push against your hands with the balls of his feet (plantar flexion), then place your hands on top of his feet and have him pull up (dorsiflexion) against them. If any deficit is found, assess the extremity further for the cause.⁷

Assess sensory function using the blunt end of a pen or bandage scissors and ask the patient to describe if he can feel it or what he feels. A more comprehensive sensory exam can be conducted at a later time.

If splinting is required, conduct the CMS exam before and after the splint is applied⁷ following your system's guidelines. Splinting of both upper and lower extremity injuries can be accomplished with soft, hard or vacuum splints.

Lacerations are another common injury to in-line skaters/Rollerbladers and most commonly occur to the face.⁴ Since the face is extremely vascular and the depth of a laceration can vary greatly, there is a possibility of significant bleeding and blood loss if the laceration is large or arteries are involved. Clean-cut lacerations tend to bleed less than jagged-edged, since the muscles tend to contract and help limit the amount of bleeding. A dressing may be all that is needed to manage them. More aggressive management may be needed for jagged-edged lacerations, since they tend to bleed more and may require a dressing with direct pressure and application of a clotting agent to control the bleeding.^6,7

Summary

In-line skating/Rollerblading kicks into high gear with the arrival of summer and warm weather. Skaters take to the streets, sidewalks and park trails to compete with motor vehicles, pedestrians, runners, bicyclists, other skaters and the unpredictability of the surfaces they skate on. Life-threatening injuries are uncommon, and deaths, although they do occur, are rare. Injuries to the upper and lower extremities, along with lacerations, will be the most often encountered scars of summer.

References

1. Schieber RA, Branch-Dorsey CM, Ryan GW, et al. Risk factors for injuries from in-line skating and the effectiveness of safety gear. N Engl J Med 335:1630-1635, 1996.

2. Centers for Disease Control. In-Line Skating Activity Card.

3. In-Line Skating Resource Center. History of in-line skating.

4. In-Line Skating Resource Center In-line skating statistics.

5. National Electronic Injury Safety Surveillance. Deaths from in-line skating.

6. Hubble MW, Hubble JP. Principles of Advanced Trauma Care. Albany, NY: Delmar, 2002.

7. Bledsoe BE, Porter RS, Cherry RA. Paramedic Care: Principles & Practice, v4. Upper Saddle River, NJ: Pearson, 2009.

Scott Tomek, MA, EMT-P, has been a paramedic for 25 years, 23 with Lakeview Hospital EMS in Stillwater, MN. He is a faculty member with the Century College paramedic program, and a curriculum development specialist.