Ask Jack Taunton what leads to the most serious injuries among elite winter athletes, including the recent catastrophic accidents that took the lives of two Canadian skiers, and he is quick to reply.
"Air and speed," says the doctor, who was responsible for overseeing the care of more than 2,000 athletes as chief medical officer at the 2010 Winter Olympics in Vancouver.
When the Olympic motto – "faster, higher, stronger" – urges athletes to push the limits in two of those envelopes, the stage seems to be set for serious injuries and, in rare instances, fatalities.
But keeping competitors safe and reducing injury risk has become an increasingly important goal for the International Olympic Committee, the International Ski Federation (FIS) and other sporting bodies.
Every sport has a distinctive injury pattern. Olympic skiers mostly blow out their knees, but along with snowboarders also have a high number of concussions, compared to hockey players, who primarily suffer thigh, knee, pelvis and facial injuries.
Medical experts, who have started to get daily injury reports at the Olympics, World Cup and other big events, hope the data, when collected over several years, will clarify who gets hurt and why. The goal is to help prevent injuries through changes to course design, equipment, game rules and training regimes – without losing the edge that gives sports drama.
"Number one for everybody … is to make it, sure, fast, but safe," Taunton said.
It was speed, and a subsequent loss of control, that led to the death of Georgian luger Nodar Kumaritashvili, whose sled left the track on a training run just hours before the Olympic opening ceremonies in 2010. That accident led to immediate course changes and a greater awareness about the vulnerabilities of inexperienced athletes.
Air was the common factor in the recent deaths of freestyle skier Sarah Burke, who died in January, following a training accident in Utah, and ski-cross competitor Nik Zoricic, who crashed in a World Cup race in Grindelwald, Switzerland.
There are obviously other factors (body contact and getting hit by the puck are is the prime causes of hockey injuries for example) but athletes who go fast, and high, are at greatest risk. A case in point: Olympic alpine skiers and snowboarders have four times as many concussions as hockey players.
"Any time you take air you have got to hit the ground and if you've lost balance control, that is where we see injuries. And so the more air that occurs is often where there is grief," said Taunton, a professor at the University of British Columbia.
Taunton is not studying the tragic accidents that took the lives of Burke and Zoricic, but he said those accidents are under intense scrutiny, and research into the "trigger event" will almost certainly lead to future safety improvements.
That research will fit into a much larger matrix being assembled by sport medicine experts from around the world who are now using a standardized injury surveillance system (ISS) designed to illuminate statistical patterns. They are not asking who won? But who got hurt, how, when and where?
In Vancouver, researchers got daily, standardized ISS reports from the team doctors for 2,567 athletes. Drawing on that data a study published last year in the British Journal of Sports Medicine identified the high-risk sports, and catalogued the most common and severe injuries. In total, 287 athletes were injured and "the risk of sustaining an injury was highest for bobsleigh, ice hockey, short track, alpine freestyle and snowboard cross."
Those sports, which might be characterized as high, fast and dangerous because they all feature speed and air, have been of particular concern to FIS.
Last year the organization called for alpine equipment changes, requiring longer skis among other things, in an attempt to reduce knee injuries by limiting speed in turns.
Under a future equipment change, alpine skiers in the 2014 Sochi Olympics will wear air bags under their race suits. The devices inflate in 40 milliseconds to protect back, chest, shoulder and collar bones in crashes.
The Ski Racing Supplier Association initially objected, saying that "several thousand pairs of skis have to be changed." But in an e-mail from Salzburg, Austria, SRSA chairman Michael Schineis said the objection was because some of the proposed changes wouldn't make racing safer. He said a dialogue with FIS has led to "more moderate" adjustments that industry supports, and that hopefully will pay off with fewer accidents.
Peter Judge, chief executive officer of the Canadian Freestyle Ski Association, said research into accidents has helped reveal injury patterns and raise awareness about risks.
"Hopefully now what we can do is try and find ways to create prevention mechanisms out of this as opposed to just being able to monitor what's happened. … That's really the next step," he said.
In an e-mail, Kathrin Steffen of the Oslo Sports Trauma Research Center said the deaths of Burke and Zoricic were "extremely sad" and would lead to "many discussions in the next days and months."
"Though the athletes know that they are competing in a high-risk sport, we have a responsibility to continue our work making skiing more safe," she said.
Her research colleagues were in Grindewald last week, where Zoricic died, engaged in their own race to find answers before the next catastrophic accident occurs.