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Piste rescue in 3V

 Poster: A snowHead
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Last week I was out with a group of people in the 3V. On the last day one girl in our group had a nasty twisting fall and was stretechered off the mountain with a suspected broken leg. The initial x-rays showed no fracture, but relatively serious ligament/tendon damage.

Anyway - main point of this post is that the pisteurs who took her down the mountain were fantastic & friendly. They arrived within about 15 mins and took her off the mountain in a stretcher, without charge or fuss. However, at the bottom she needed to be transferred to an ambulance to get to the medical centre. Whilst she was screaming in pain in the back of the stationary ambulance, the drivers refused to drive off without payment in cash (€140). The members of our group who were with her at this point didn't have it on them, but offerered credit cards, insurance documentation, European health cards all to no avail. After a heated and prolongued argument they agreed to take her on the basis that immediately afterwards they went to a cash machine. After dropping her off at the hospital, boyfriend was frog-marched to the cash machine by the ambulance driver. The attitudes of the french ambulance driver was then not improved when the cash machine wasn't working, at which point he arranged to come round to our hotel to pick up the cash later that evening.

One of the problems was apparently that our package came with a fairly comprehensive insurance package, but other than the policy document (in English) they provided no further documentation.

I am interested to hear people's views on this, mine is that:

1) Given that she was already off the mountain, shouldn't the ambulance have been free? I can't imagine a french kid being picked up of a British road, and them saying "no - we will not take you to hospital without a hundred pounds in cash", even when it was clear he didn't have it, but he was offering credit cards etc.

2) If people insist on payment upfront, why in this day and age can they not accept credit cards? Could it not be simply charged at the same time as the medical treatment?

3) Is there not something morally wrong about refusing to take someone who is in pain to a medical center without upfront cash payment. One could even potentially argue that it is legally wrong, and tantamount to professional negligience. Delaying people in need of emergency medical treatment whilst squabbling over payment causes extra suffering and may in case medical complications.

Is the only option to always make sure you are skiing with a few hundred pounds of local currency (and multiple local currency if you are in a resort that crosses Swiss border?)

[slight disclaimer: I wasn't there in person, so my account is 2nd hand from those that were]
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Snowbunny (IIRC) had a similar tale of woe from last season. Where in the 3V did this take place? My only direct experience of requiring transport to a local medical centre and subsequent medical care was in Courchevel, and I was impressed with the whole system from initial contact to paying the bill (by card) at the end of the process.
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Just a thought, would a Carre/Carte Neige policy have covered the transfer to the medical centre?
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Did the girl have Carte/Carre Neige insurance? I get the impression it may be worth paying the small amount extra for this as the French are familiar with it. This does sound very like Snowbunny's experience in Val Thorens last season.
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rob@rar.org.uk, You remember correctly. This has real echoes of my experience.kamikaze, I am really sorry to hear about this, it looks as though nothing has changed, and I am not at all surprised, since the private companies involved in rescue, transportation and treatment seem to like the current arrangements. I was held in VT, untreated with a broken collar bone, for 2.5 hours until the "cash" turned up, not even a painkiller. I was carrying c/cards with around £30k limit, plus E111, plus AXA (a French co.) insurance. I believe that the Swiss would not act in such a distateful manner when dealing with pain and suffering, though I have no personal experience of treatment in Switzerland.
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rob@rar.org.uk wrote:
Just a thought, would a Carre/Carte Neige policy have covered the transfer to the medical centre?
Yes. The problem with the proliferation of foreign-sourced insurances policies and companies - with vague and difficult to comprehend cover for the likes of the ambulance companies, - is that they have little comeback if, once back in foreign parts, the insurance fails to cough up.

These guys run a business and costs are immediate - waiting months for payment (or non-payment) of bills can ruin them. They've seen it happen time and time again. I've spoken to a local firm about this.

Not to suggest that the current situation is remotely acceptable, of course not. But the insurance world should get its act together, speak to the resort authorities and others, and work out some means of ensuring that payment to the private ambulance businesses etc is fully guaranteed.
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rob@rar.org.uk, Occured close to Val Thorens. Not sure exactly where.

In terms of Carte Neige. It would have probably helped, but we didn't have them. As background we were booked on a package with Club Med that included their own comprehensive insurance (including mountain rescue) and lift pass etc. So carte neige wasn't necessarily required (in that by default we had a policy that covered it) or presented as an option. So we were not issued with anything beyond a long policy document (in English), that was of little interest to the ambulance drivers.
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kamikaze wrote:

I am interested to hear people's views on this, mine is that:

1) Given that she was already off the mountain, shouldn't the ambulance have been free?



Not if it is a private ambulance which is often the case in France. The public ambulance service is provided by the fire brigade. They don't have very good (like non-existant) medical training but will sometimes come with a doctor if things are serious. You could have threatened to call the fire brigade but I expect Courchevel has some kind of agreement with the private firm.

kamikaze wrote:

3) Is there not something morally wrong about refusing to take someone who is in pain to a medical center without upfront cash payment.


It is not just morally wrong but illegal in France where there is a very clear law: Non-assistance à personne en danger

This law [L'article 223-6] says that if someone does't help you with immediate action, without of course putting himself in danger, is committing a crime and risks 5 years in prison and a 75,000 euor fine.

Quote:
[slight disclaimer: I wasn't there in person, so my account is 2nd hand from those that were]


There are too many of these incidents reported on snowheads for them all to be wrong. The ambulance drivers were very seriously out of order and I would suggest you write to the Courchevel mayor (who is responsible for your daugher's rescue) and complain. Do this by international recorded delivery and ask him to investigate.
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PG, Perhaps it should be compulsory that the ambulance operators must have access to a PDQ terminal. We are all told to carry plastic. When we used a doctor in Les Meniures she had a PDQ machine but preferred sterling (was all I had in reasonable quantities) over plastic. One asks why?. Is the black market rife in France.
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The mayor is M Gilbert Blanc-Tailleur, and the Mairie is in St Bon, FYI.
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Frosty the Snowman, No more than anywhere else (black market). Some do carry a terminal. It's just a stupid situation that needs sorting, and responsibility is shared between the French in general and their lackadaisical approach to these things, the resorts themselves (it's in their best interests but that doesn't stop the French from carrying on regardless) and the insurance world. In the meantime the "injured party" is the tourist who suffers unnecessarily.
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The only people I know who have been injured in Switzerland all reported that they were invoiced only after they had been treated and that in virtually all their cases insurance covered everything, as I understand it in Wengen if you are recovered by a pisteur there is no charge for their services, however if your recovery involves a helicopter expect to receive a sizeable bill, likewise in Wengen the local taxi serves as an ambulance but check what you will be paying as it will be much higher (due to something to do with liability insurance or some such nonsense) than a normal taxi fare.
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French private ambulances are often run in conjunction with a taxi business, I believe. Just as you wouldn't expect a cabby to give you tick or a free ride, you can't expect a French ambulance to do so. Similarly, try paying for a minicab here with a credit card.

These stories of people not being properly looked after are shocking, but I daresay the ambulance drivers and medics have plenty of stories of transporting or treating people (especially tourists) on tick and never getting the cash.

davidof, does the law you mention extend to people in pain, as opposed to danger?

PG, davidof, is there anything one can do to avoid the need for cash? PG mentions Carte Neige; we already have insurance, so i suppose that I should ski with EURO 250 just in case.

Anyone know how this sort of thing works in other countries?
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I don't think the taxi analogy is a great one. I might go out with £30 in my pocket to get a taxi home, but people are less likely to be carrying large amounts of cash just in case they fall skiiing, get knocked over by a bus etc.
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When I broke my ankle in Corvara last March, I was given free transport to the local doctor's (literally carried the last 200 metres by two burly policemen!! Blush) apparently all was included in the lift pass. I paid for the treatment (x-rays/plaster/crutches) afterwards, and was able to claim all back on the insurance.

A word of warning however; I chose to return to the UK to have the operation to fix my ankle. Having got me back to the UK, my insurance company advised me that they would not pay for the operation. Had I had it done in Italy, they would have paid for it! Sad
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DavidS, true, but I wasn't making an analogy, exactly. If you take a French private ambulance, you are taking a cab; the cab happens to be white and have curtains. Perhaps the ambulance driver brought the cabby's (perfectly reasonable for a cabby) attitude to payment with him. The problem lies in a system which places ambulances on a par with cabs. I don't know whether it's still the case, but French ambulances were often adapted Citroen estates, rather than 'proper' ambulances. A bit claustrophobic, I'd have thought, lying there looking up at the roof abut 2" above your nose.

It's strange that a health system which is generally regarded as one of the best, if not the best, public health system in the world runs such a bizarre and unsatisfactory ambulance service. What happens if the injured person needs urgent treatment? Does a doc/parmedic come seperately, or would the pompiers automatically come in such cases. I believe that the pompiers have medics working for them, or am I confusing France with USA (for which I shall probably be banned from both countries)?


Last edited by Poster: A snowHead on Mon 6-02-06 10:49; edited 1 time in total
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richmond wrote:
DavidS, true, but I wasn't making an analogy, exactly. If you take a French private ambulance, you are taking a cab; the cab happens to be white and have curtains. Perhaps the ambulance driver brought the cabby's (perfectly reasonable for a cabby) attitude to payment with him. The problem lies in a system which places ambulances on a par with cabs. I don't know whether it's still the case, but French ambulances were often adapted Citroen estates, rather than 'proper' ambulances. A bit claustrophobic, I'd have though, lying there looking up at the roof abut 2" above your nose.


Good point Richmond and one I think Pete was making. Just to recap, in France there are private ambulances and a public service run by the fire brigade. The problem is organisation in ski areas which are a special case. Normally mountain rescue is the responsibility of the government through its local representative the prefet. But the "law of the mountain" has made rescue the responsibility of local mayors in ski domains. If there is a disfunctionment, as appears to be the case here, he is ultimately responsbible. As Pete says, it is up to Courchevel to get its act together, this is completely unacceptable and I would personally complain.

Regarding the law I mentioned, the private ambulance drivers are not medics and would not be competent to decide if an injured person is in danger or not, they should simply get the person to hospital as quickly as possible. No ifs or buts.

> What happens if the injured person needs urgent treatment? Does a doc/parmedic come seperately, or would the pompiers automatically come in such cases.

Fire crews have very limited first aid skills - but they would take a local doctor with them if the accident was serious. The rescue services are horribly complex in the mountains. It could be the Civil Security (who have nice Eurocopters and always have a specialist doctor with them), Fire Brigade (good for access needing ropes), Piste Patrol, CRS or PGHM (who will also take a doctor) who come to your rescue or maybe all of them depending which day of the week it is. From a rescue viewpoint it works very well but it is extremely expensive to maintain such an overlapping set of services. Still in the UK it could also be a cocktail of local police, volunteer mountain rescue and RAF along with paramedics.
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davidof wrote:
Still in the UK it could also be a cocktail of local police, volunteer mountain rescue and RAF along with paramedics.


That cocktail is invisible to the end-user though, you ring 999 and incident coordination is handled by the emergency services as for, say, a road accident. Mountain rescue (and cave rescue) tends to be volunteer based with the RAF able to assist with helicopters on the rare occasions that would be required. In some area RAF ground teams might be involved as well. The point being it's a managed response with an incident coordinator with clear and well documented roles.
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ise, exactly, and at least in UK, you know that once you get to an ambulance (if not before), you'll get proper medical treatment, and that your ability to cough up on the spot will not be an issue.
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and what if the 'ambulance' was a helicopter? Do you need to keep a couple of thousand € in cash just in case Puzzled
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boredsurfin wrote:
and what if the 'ambulance' was a helicopter? Do you need to keep a couple of thousand € in cash just in case Puzzled


In the UK? No. I've had to call out emergency services for a friend and since the ambuance couldn;t reach us (depsite us saying they should send mountain rescue in a land-rover due to out remote location) they sent a helicopter. money was never mentioned - although the helicopter guys did seem to rather enjoy being called out as it meant tothey got to actually use their skills
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And not in france either right as the helicopter is a central service not a private transfer thingy? I have to say I'd never realised they wouldn't take credit card for an ambulance tho' ...Maybe carte neige not such a bad idea after all... aj xx
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nbt, Sorry, I meant in France Very Happy
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Does anyone know whether the pisteurs get "commission" for passing on injured skiers to specific ambulance companies? With a charge of €140, it sounds like there is a pretty fat margin for sharing between all interested parties. Those working in ski resorts already get commission/benefit in kind for forwarding clients to specific ski hire shops, ski schools and restaurants, so it seems quite plausible that the rescue system operates on the same basis, which if true would partially explain the size of the bill. As for why they prefer cash when there are perfectly good hand held credit card terminals, it's probably the same as with many self-employed trades - i.e. tax & VAT avoidance, plus the processing costs of accepting credit cards
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ajhainey wrote:
And not in france either right as the helicopter is a central service not a private transfer thingy?


Erm unfortunately not. If a company such as SAF (a private French helicopter company) is used you will be asked to pay and there are stories of people haggling with pilots over insurance cover. Somewhere like the Vallée Blanche is where you might be taken by the SAF and also a lot of ski domain rescue work requiring air transport.

Again they have a legal obligation to take you if there is a risk to you - ie you are injured or you risk injury if you are left - this would seem to cover most cases to me.

There is a test case in the French courts over the payment issue at the moment where a private company is used outside of the ski domain.
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I beleive Kamikaze said it was in VT, not Courchevel, which leads me to think it's different in these locations. I disclocated my shoulder in Courchevel last year. Once the piste crew got me to the road, an ambulance was waiting. All I needed to do was to sign a form, no payment was asked up front.

I paid for treatment at the clinic at the time.

The form was from the Regie de Secours, and it covered the ambulance as well (€272 for the piste rescue + €142 for the ambulance). Although they rang my mobile afterwards to tell me to settle the bill before I left the resort, when I got there the office was closed.

When I got back to the UK I immediately made an insurance claim. I received a reminder in the post from the Regie asking to pay, which I forwarded to the insurers. They dragged their heels, and I recevied another reminder threatening legal action, which I also forwarded. A couple of months later I finally received a settlement, with a note that they had paid the other bills.

In view of all the wasted administration, I would not be at all surprised if they insisted on up front payment, but it is not acceptable to refuse card payment. If you pay by cash then you need to ensure you get a valid receipt to avoid a future argument, which puts you in a difficult position.
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Julian T wrote:
Does anyone know whether the pisteurs get "commission" for passing on injured skiers to specific ambulance companies?


I doubt it is direct, I expect certain firms get used for a variety of reasons that anyone who has contracted suppliers at a company can imagine.

A rescue from a ski slope probably does cost quite a bit, you are maybe looking at 2 pisteurs for 1 hour for your average rescue (including the paperwork they will have to complete) so 200 euros would seem normal. That said I suspect the piste patrol costs are cross subsidized by the rescue charges and I'm surprised that insurers don't put more pressure to reduce direct costs.

-- edited for word confusion


Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Mon 6-02-06 13:15; edited 1 time in total
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Its £110 for the first hour for the man that service our up n' over doors so the pricing doesn't seem unreasonable.
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My dentist man is £350 an hour!
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I'm £320 an hour!
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richmond, You might want to consider doubling that 250 Euro emergency float for you wallet, I'm basing this on painful experience.
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richmond wrote:
I'm £320 an hour!


I'm priceless!!!
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As davidof and others mention, ambulances in France are usually private and are not at all like the ambulance service in the UK. For emergencies, the Sapeurs-Pompiers (Fire Brigade) are the equivilent, and are trained paramedics. French ambulances are merely taxis with beds Smile
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Would it be true to say that if we carry the Carre/Carte Neige then we wouldn't have this problem? Not because it insures anything extra but just because it would be a document well recognised and understood in a French ski resort.
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Ian Hopkinson, my experience in Val d'Isere of this was that they just took the Carte Neige number and that was the end of it. The pisteur and ambulance driver looked quite relieved to be dealing with it rather than something (for them) more complicated. The pisteur said, "Ahh... c'est bon assurance!" (or something similar). Well worth it for the lack of hassle IMO even if, in theory, you are also covered by your own travel insurance.
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This is another horrid story. I had no such problems when being rescued (however I was wearing a ski school uniform which might have helped). The pisteurs kept my skis until I paid for the helicopter. No problem there. However, it does seem sensible to have an insurance that is understood by the locals, so i would recommend that you don't take the TO insurance, but buy Carte Neige when you get to resort. It also covers repatriation in the event that it's necesary. Our lift company also sell insurance with the lift pass (about €2,30 per day) and that covers all basics as well - no problems there either.

I agree with PG that the insurance industry should get their act together (or at least provide a suitable translation), but that's probably pie in the sky.
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I've got a Carte Neige this season (helpfully arranged via MySnowSports), although by itself I don't think it is sufficient cover so I have annual travel insuarnce as well. For the sake of £35 I'm happy to be slightly over-insured than under-insured.
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Having just been stretchered off the mountain at Sunshine in Canada. I'll add my own observations from a different country. Rescue on the mountain was efficient quick a relatively pain free. I was taken off the mountain in a sledge and then skidoo to the medical centre. They were only concerned with stabilisation of the injury and checking for shock at the medical centre. After completing the required forms we were then asked how we would like to travel to hospital ambulance , taxi or own vehicle we were informed that payment would be required at the destination or arrangements to pay as a minimum. When I arrived at the hospital I was asked immediately for a credit card to cover all costs and this was pre authorised before treatment commenced. There was even a notice tell patients that all treatment must be guaranteed by credit card or prepayment where 'local' health care schemes are not used and would patients please note we do no deal directly with any insurance companies for payment. When i commented on this point the hospital registrar said they haggle too much or people lie about level of cover and then leave the country.

However at no time did I think that the care was anything other that brilliant, I have total admiration for the ski patrol guys and the hospital was a model of efficiency.

My insurance had no quibbles about flying me home either all done without fuss.
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I have twice disclocated my shoulder skiing Skullie Skullie both in France- my wife once in Whistler Skullie oh well.

Me
1. Selva- pisteurs good Very Happy (called by friendly Dutch people- Very Happy is there any other sort?)- put shoulder back in on slope Very Happy - ambulance- Sad took plastic- ditto Dr

2. Val D'Isere- pisteurs took skis to office and kept them Sad til paid by credit card, ambulance took Sad plastic- ditto Dr

Wife

Whistler- ski patrol calls Very Happy skiing Dr equiped with gas& air Very Happy Very Happy and morphine Very Happy Very Happy Very Happy Very Happy Very Happy - ambulance at bottom of piste- all on lift pass...excellent service- wrote afterwards to tell them and say thank you.

NOW

We always take carte/carre neige.
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bindings now set a fair bit higher- pre-releases more likely to cause upper limb injury, failure to release- lower limb
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