By Terry Abrams, Co-ordinator, FIPS Medical Special Interest Group (terryabrams279@gmail.com)

The short answer is yes!

Brillhart et al (1 – first reference in list below) just published a review of three successful cardiac arrest resuscitation cases between January 2024 and April 2025 which occurred at ski resorts in Vermont, USA. The male patients (63, 68 and 72 years old) experienced cardiac arrest while participating in snow sports; one Nordic, two alpine.

All received immediate bystander CPR, AED defibrillation shocks and oxygenation on scene and these treatments continued while transporting by toboggan. Return of spontaneous circulation (ROSC) occurred after arrival at an ambulance or the patrol room. The patients were admitted to hospital where they received either an implanted defibrillator or coronary artery stenting. All three left hospital neurologically intact.

The quality of CPR in a moving toboggan has been researched in Canada (2), Norway (3), Japan (4), and Argentina (5) using mannequins and electronic devices to measure compression depth, compression rate, chest recoil, duration and compression fraction (the percentage of resuscitation duration when compressions were being performed).

All showed that effective CPR can be administered while moving when:

  • The patient’s head is uphill and the compressor is facing backwards in the toboggan.
  • The compressor straddles the patient’s hips.
  • The compressor understands that compressions will tend to be shallower and compensates for that.
  • Compressor knee padding and a strap against the compressor’s boots may help maintain position.
  • Compression rate is 100 to 120 per minute.
  • Slow, steady toboggan driving, maintaining the toboggan in the fall line and picking the easiest route, not necessarily the fastest.

These three Vermont-based cases provide real world support for the earlier mannequin-based research outlined above.

Below is the list of references for those who are interested in doing further reading on the subject:

  1. Brillhart A, Nowak C, Moore N, Silva E. Ski patroller manual cardiopulmonary resuscitation during rescue toboggan transport: three Vermont skier cases of cardiac arrest with neurologically intact survival and practical suggestions for implementation. Wilderness & Environmental Medicine 2025-08-20 | Journal article DOI: 10.1177/10806032251364148.
  2. Abrams T, Torfason L. Evaluation of the quality of manual, compression-only cardiopulmonary resuscitation in a moving ski patrol toboggan. High Alt Med Biol. 2020;21(1):52–61. DOI:10.1089/ham.2019.0047.
  3. Thomassen O, Skaiaa SC, Assmuss J, et al. Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation. Emerg Med J. 2017;34(9):573–77. DOI:10.1136/emermed-2016-206323.
  4. Tanaka S, Nakagawa K, Katsurahara T, et al. Quality of chest compressions performed on mannequins in toboggans on a ski slope: a crossover study. J EMS Med. 2024;3(3):61–67. DOI:10.35616/jemsm.2023.00080.
  5. Morrone AC, Tarico J. et al. CPR Effectiveness Analysis on a Toboggan. AADIDESS (Asociacion Argentina De Instructores De Ski y Snowboard), 2022 not published.
Is Toboggan CPR REALLY a Viable Option?

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