Re: [ECO] Scenario: Bike v Dog Part One

[Guest guest]

Comments below the text.

Level of training: MRT First Responder/EMT

Equipment available: First Aid with some adjuncts, no drugs no oxygen.

Bystander presumption: the bystanders know no first aid but will follow

instructions.

Ross Boardman wrote:

>

> As usual you are first on scene in the car, with your own skills and

> equipment

> on board.

>

> A bystander informs you that a group of hikers were walking down the country

> lane when one of their dogs slipped his lead. A youth on a motorbike swerved

> to miss the dog, lost the bike and slid across the road and into hedge. The

> bike

> bowled one of the ramblers over before coming to rest in the hedge too.

>

> Patient One: The biker.

> Possibly in twenties. Wearing helmet, leather jacket and jeans. He is lying

> in

> semi foetal position in the base of the hedge. He is unresponsive and

> breathing

> is shallow and fast. Most of the back of his jeans are gone as well as much

> of

> skin and some of the muscle from his buttocks and thighs.

>

> Patient Two: The hiker

> In his forties, lying on the ground unresponsive and no breaths present. He

> a bloody patch on the side of his head that is in contact with the road. His

> wife

> tells you that he is insulin dependant diabetic and has angina (stable at

> present).

>

> No other casualties have been identified.

>

> The police have stopped traffic in both directions and the first ambulance

> has

> an ETA of about 15 mins.

>

> What are your first actions ?

>

With traffic stopped etc. the scene can be assumed safe. The patients

have been assessed so the next step is START (simple triage and rapid

treatment).

Bystanders : clear from immediate area to holding point unless they can

help directly.

Casualty 2: Not breathing:

Check pulse; If no pulse go to second casualty (1), if pulse present

then:

Can breathing be restored by airway manoeuvres, try twice only

If no breathing go the second casualty.

If then breathing, try to get patient on his back with minimal neck

movement. C-spine injury may be possible from the patient hitting the

ground rather than the bike hitting the patient (bloody patch on head).

check for breathing difficulty: possible Tension Pneumothorax; and also

major bleeding.

OP airway in.

Ambulance in 15 minutes - consider needle decompression if required or

wait?

Ask bystander to monitor without moving the patient - preferably this

should not be the wife as she may become emotionally involved and move

patient (trying to cradle the head can lead to c-spine compromise)

Diabetes and angina not urgent if breathing and pulse present.

Go to second casualty.

Casualty 1: Check airway, can OP Airway help if it can be got in under

the helmet. If not assess if the airway compromise is sufficient to

necessitate removing the helmet.

Check breathing, why is it shallow and fast - could be shock but how

long since the accident. check for chest damage (again tension

pneumothorax) when he came off the bike, though seems like most damage

to buttocks, so chest may be OK.

Semi foetal position will give some airway protection but this will need

monitoring - get a bystander to do this. Avoid movement if possible

while awaiting the ambulance.

Cover and bandage buttocks; potential for large blood loss if muscles

damaged also psychologically disturbing to the bystanders - mess will

not encourage them to help out.

Back to casualty 2.

Casualty 2

If originally had no pulse, now is the time to consider CPR. Be

prepared to stop at any time if monitor reports change in casualty 1.

If casualty 2 had breathing and pulse, recheck vital signs, starting

with airway and breathing.

Treat if necessary. On to circulation: check pulse rate and rhythm.

Any indication of rhythm compromise?

Note diabetes condition and also angina. Provision of drugs (assuming

these carried by patient) is problematic. GTN unsafe if blood pressure

low (no or weak radial pulse), or likely to become low. As this

casualty is likely to go into shock from injuries GTN better avoided; it

can compound shock by causing vasodilatation.

Diabetes and shock can be aided, however, by use of glucose: if Hypostop

available try it - will no do any harm if airway is not compromised.

Should be getting close to ambulance time by now. Casualty 1 probably

needs some review at this stage; particularly the airway and breathing

if no cause could be found in the first check.

Awaiting second instalment

Gerry

--

Dr. Gerard CEng MIEE, (EI0CH, WEMT)

TELTEC Radio Systems and Propagation Group,

Trinity College, Dublin Ireland (Ph +353-1-6081743)

Dublin+Wicklow Mountain Rescue Team