BACKGROUND Heavy ice and snow accumulation combined with record low temperatures in Chattanooga, Tennessee, from February 2-6, 1996, contributed to many sledding injuries. METHODS We retrospectively reviewed medical records of emergency visits to seven area hospitals from February 2-6, 1996. We further reviewed sledding injury records. Sledding was defined as sliding on snow or ice using any device except skis. RESULTS Of 2,134 emergency room visits, 241 patients had 310 sledding injuries. Ages of patients ranged from 3 to 53 years (mean, 18.9; median, 16). One hundred twenty-eight injuries were severe. These included extremity injuries (65), head injuries (28), chest injuries (10), intra-abdominal injuries (10), vertebral column fractures (11), and pelvic fractures (4). Thirty-six patients required inpatient hospitalization; 18 had surgery. The minimum healthcare costs associated with these injuries were estimated at $220,000. CONCLUSIONS Major trauma potential is associated with sledding, especially where significant winter storms are uncommon. Level I trauma centers should seasonally incorporate sledding safety into community-wide injury prevention programs.