Drew Petersen’s body bounced from rock to rock as he fell down a steep, rugged slope while skiing in Colorado’s High Country. 

As Petersen tumbled out of control, he banged his head at least three times, shattering the goggles he was wearing, denting his helmet and putting a gash through his forehead. 

“My helmet looked like a golf ball,” Petersen said. “… If that was my skull, it would not be good.”

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Growing up in Summit County, Petersen longed to be a professional skier exploring the mountains and the powder-filled backcountry. As he pursued his dream and scratched the itch of his adventurous spirit, Petersen endured quite a few falls.

“I have had a pretty extensive history of concussion,” Petersen said. “It goes all the way back to when I was a little kid. The first major concussion that I got was when I was probably 6 or 8. Looking back, concussions have played a pretty instrumental role in my life track, especially in my mental health journey.”

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While Petersen, a Solomon-sponsored skier, embodies the lifestyle many people live or seek out in Colorado’s mountains, the recreational activities that people like to enjoy in the Alpine all come with risks of head injuries. 

With endless outdoor activities that attract thrill-seekers from around the globe, mountain towns like those in Summit and Grand counties see elevated rates of traumatic brain injuries, also known as TBIs. These injuries are caused by any force to the head or neck that alters the brain’s function or causes a loss of consciousness, according to Ph.D. Catie Johnston-Brooks at the Marcus Institute for Brain Health in Colorado.

A majority of traumatic brain injuries — 47% — are caused by falls, according to the Brain Injury Association of Colorado. Accidents that involve a blunt-force strike were the second leading cause at 15%, followed by motor-vehicle crashes at 14%, unknown causes at 13% and assaults at 11%.

With major highways filled with bikes and vehicles, endless recreation opportunities, and roads and trails that weave in and out of some of the country’s highest peaks, there are myriad ways to sustain a TBI through everyday life in the Rockies. 

How common are TBIs in Colorado’s mountains? 

Many health professionals in the area believe Colorado’s mountains see a high rate of traumatic brain injuries because of the countless outdoor opportunities and persistent winter conditions, where snow is likely eight months out of the year. 

“I would say the majority are falls,” said Melissa Volkert, an occupational therapist and certified brain injury specialist at Vail-Summit Physical Therapy. “Falls include slipping on ice, falling from skiing, mountain biking — all the adventure sports.”

There were 223,135 traumatic brain injury hospitalizations in 2019 and 64,362 traumatic brain injury deaths in 2020 in the United States, according to data from the Centers for Disease Control and Prevention. 

The Brain Injury Association of Colorado says the state ranks ninth in the nation for fatalities related to traumatic brain injuries and 13th in the nation for hospitalizations involving TBIs. Roughly 5,000 people are hospitalized and nearly 1,000 die from TBIs in Colorado each year, according to the association. Annually, roughly 23,500 visits to the emergency room in Colorado involve TBIs. 

At-risk groups for traumatic brain injuries

Ph.D. Gale Whiteneck, a research scientist at Craig Hospital in Englewood, helped study the prevalence of TBIs in Colorado roughly a decade ago, using a random survey that interviewed about 2,700 adults in the state. That survey is the most recent county-level analysis of its kind.

He said while 42.5% of adult Coloradans reported experiencing some degree of a TBI in their lifetime, the rate was higher in the heart of the mountains. Around 43.8% of people surveyed in Region 12 — which includes Summit, Grand, Pitkin, Eagle and Jackson counties — reported experiencing some degree of a TBI in their lifetime, and Whiteneck said Region 12 had “substantially more TBIs with (loss of consciousness) than in Colorado overall, particularly in the (loss of consciousness) under 24 hours categories.”

Volkert estimates that the emergency departments in Summit County see four times as many traumatic brain injuries than the national average — around 1,500 visits annually — making up over one-fifth of the annual rate in the state.

CommonSpirit St. Anthony Summit Hospital Trauma Medical Director Dr. Scott Otto said his hospital admits about one to two traumatic brain injury patients a day during the busy winter season in Summit County, with numbers slowing outside of the peak winter season.

“For us here in Summit County, with the gravity sports involved, we are definitely going to see quite a few traumatic brain injuries,” Otto said. 

Statistics from 2024 at Middle Park Health, which operates two of the three emergency rooms in Grand County, show that around 3.8% of injured patients at its Granby location were diagnosed with a TBI while around 12% of all injured patients at its Kremmling campus were diagnosed with some form of closed head injury or TBI. 

What happens to the brain and body after a traumatic brain injury?

As Petersen tried to carve out a path for himself as a Salomon-sponsored skier, his head injuries became more severe and affected his everyday life. 

With at least two significant traumatic brain injuries and many concussions, Petersen developed a stutter, experienced vision issues and suffered from memory problems.

When to seek medical help after hitting your head

The flurry of common traumatic brain injury symptoms forced Petersen to seek treatment and go through an intensive program.

“When I figured out this was going on and first started getting treatment for it, it was a pretty serious reckoning with my health overall,” Petersen said. 

Often used interchangeably with the word concussion, TBIs are diagnosed using three common categories: mild, moderate and severe, Johnston-Brooks said.

“They are differentiated from each other essentially by the degree of the loss or alteration of consciousness,” she added.

The longer someone is unconscious or without oxygen to the brain, the more severe the brain injury. Mild concussions caused by hitting the head might not cause someone to be knocked out, but they can temporarily disrupt brain function, according to the Mayo Clinic. 

While there are many ways to get a TBI, Johnston-Brooks says they most commonly occur when an individual’s brain sloshes against the skull. This movement of the brain can often result in a “coup-contrecoup TBI,” which is where the brain sustains damage at the point of impact and at the location where the brain recoils against the skull.

Shortly after taking a blow to the head, symptoms typically begin to appear. The most common symptoms of a TBI include headache, dizziness, confusion, sensitivity to light and sound, slowed reaction time and memory loss. 

“It is pretty much the whole gamut,” Volkert said. “The brain controls it all.”

Depending on the site of the injury, a TBI can also affect a patient’s balance, coordination and speech. They can also lead to sensory issues, such as a sensitivity to sound and light.

Petersen was most likely experiencing trauma to the parts of his brain that control coordination and speech, resulting in him walking into walls and developing a stutter. 

If the brain injury is left untreated or a patient does not allow adequate time for the brain to heal, the symptoms can drastically worsen. While patients may have first been experiencing dizziness and balance issues, new symptoms can appear like trouble sleeping, issues with regulating emotions and fatigue. 

In most mild TBI cases, patients recover and do not have any lingering symptoms. However, if a patient has a more severe TBI — or suffers an additional head injury — the likelihood of having lifelong symptoms generally increases. 

Otto, the trauma medical director at St. Anthony Summit Hospital, said patients who have had one TBI are at risk of getting a second head injury because their brains are much more sensitive. 

“You want to avoid another brain injury,” Otto said. “You basically do not want to have your first brain injury, but if you do have another brain injury — especially the closer it is to the last brain injury — the worse it is going to be.”

Petersen knows that firsthand. Not long before the ski crash, Petersen was on Mount Hood in Oregon when a rock fell and hit his helmet. The rockfall incident resulted in his first significant traumatic brain injury. Petersen believes lingering symptoms caused him to crash while skiing, resulting in a second TBI.

While it is known that higher elevations can slow down the healing process, research has yet to be completed on whether the same is true for the healing of the brain. 

The toll of traumatic brain injuries on mental health 

Once a traumatic brain injury has properly been identified, patients can seek appropriate treatments. 

It was during this time when Petersen faced some of the biggest challenges he has ever overcome. 

“I went through really intensive brain rehab, and that was probably the hardest, scariest time period of my life,” Petersen said. “I don’t want to go through that ever again, and I want as many people as possible to avoid being in that situation.”

Marcie Beroske, a psychiatric nurse practitioner at Middle Park Health, said the things that Petersen was struggling with are common. 

“There are mental health issues that can occur,” Beroske said. “For instance, if a person had a genetic predisposition to a mental health disorder — or had been treated, diagnosed or was experiencing mental health symptoms prior to the traumatic brain injury — that can put them at greater risk for having a recurrence of those symptoms after the TBI and throughout the healing process.”

With TBIs typically preventing patients from engaging in the same activities as before their injuries, Beroske says she has treated several patients who feel anxious, depressed and isolated because of their head injury. 

These feelings can often cause patients to lose their sense of identity. Much like Petersen felt like he might lose his ability to pursue his livelihood and passion as a professional skier, patients can struggle to comprehend what life might look like after their injury.

“It was not clear if I was going to be able to ski again,” Petersen said. “And certainly not clear if I would be able to continue a career as a professional skier. At the time, I had built my whole identity and self-worth around that. That was really terrifying.”

Dr. Lisa Ansell, a licensed professional counselor at A Listening Ear Counseling in Granby, sees similar mental health challenges with her brain-injury patients.

“People often struggle with not being able to get back mentally to where they were before the accident,” Ansell said. “When somebody cannot do that, they lose their sense of identity.” 

When this happens, Ansell said a wide range of mental health issues begin to arise.

According to a 2022 study published in the National Institutes for Health titled “Mental Health Consequences of Traumatic Brain Injury,” moderate and severe TBIs can cause “personality changes including impulsivity, severe irritability, affective instability and apathy.” Even mild TBIs can cause depression, post-traumatic stress disorder and suicidality, according to the study. 

Most concussions can cause anxiety, depression, mood swings and irritability, according to the Mayo Clinic. 

People should seek immediate medical care for suicidal thoughts and headaches that last days or worsen over time. Persistent or severe mood changes are also a sign to seek help. 

Though traumatic brain injuries might cause impairment to daily life, there is hope for patients who are facing both mental and physical health challenges. Whether seeing a therapist like Ansell or being put on medication, patients have several viable options to treat the mental health issues they may be facing.

“Mental health treatment can be very effective,” Beroske said. “We are able to target many of the lingering, ongoing mental health symptoms with medication, which can be very effective, especially when they are being used within a full treatment plan.”

Although Petersen views recovering from his brain injury as one of the scariest things he has ever had to face, he was able to make nearly a full recovery after several months of intensive brain rehab. 

While his stutter and other major symptoms went away, Petersen continues to live with chronic migraines and auditory-processing issues. 

Whether waiting to drop into a couloir or running across a ridge line, Petersen remains mindful at all times about the health of his brain.

“Honestly, I have to take really good care of my brain so that I don’t have more severe migraines every day,” Petersen said. “I wonder what else may be wrong in there, but I am very high functioning. I am super grateful for that.”

Sky-Hi News reporter Emily Gutierrez contributed to this report.