Feature

Mon 27 Sep 2010, 5:00 pm BST

Health: First aid treatment on the trail

By Michael Jones, Mountain Biking UK

The death of a mountain biker on Snowdonia's Marin Trail earlier this month has brought home the inherent risks associated with the sport, especially when riding in isolated areas that are hard for the emergency services to reach.

While it still isn't clear exactly what happened in this incident, it's really important to have some basic knowledge of first aid, wherever you ride. We'd recommend doing a proper course. In the meantime, here are some basic pointers.

You'll be much safer if you follow three simple rules: always tell someone where you’re going and how long you’ll be gone, try to ride in a group or at least in pairs, and always carry a first aid kit and fully charged mobile phone.

Get the kit

Making up a lightweight first aid kit is cheap and easy. You can buy the essentials in most chemists or from websites such as www.firstaidwarehouse.co.uk.

“Most off-road mountain bike accidents we see result in soft tissue injuries, with the occasional broken arm or collar bone,” says Dave Craddock, paramedic with South East Coast Ambulance Service. As a keen mountain biker and trauma management specialist, he recommends taking the following with you:

  • 1 x size 1 ambulance dressing
  • 1 x size 2 ambulance dressing
  • 2 x sodium chloride (sterile solution for cleaning wounds)
  • 1 x emergency aluminium blanket
  • 2 x triangular bandages

Trail treatment

If the worst happens and one of your friends is injured out on the trail, follow the six steps below:

1 Stay in control: Never put yourself in danger – if in doubt dial 999 (112 in the EU, 911 in the US). Stay calm – if an injured mate sees you going all quivery, it won’t do anything to help them. Take a deep breath and think what you’re going to do.

2 Key signs: Check whether the person is breathing (first priority!), unconscious, complaining of neck, back, abdominal or pelvic pain, or has an altered level of consciousness (unequal pupils, sleepy, slurred speech and so on). If any of these problems crop up, go straight to step 6.

3 Keep them laid still: Injuries and pain can speed up the heart. Get the person to lie down and help support their body. Stemming any bleeding is a priority – if they’re bleeding from an arm or a leg, get the limb elevated into the air. With very heavy bleeding, raise the person’s legs a foot or so off the ground to return blood to the heart, and call 999.

4 Dress any wounds: “Never apply a dry dressing to a wound,” says Mr Craddock. Use a sodium chloride solution to wet the inside of a bandage and squirt it onto the wound to wash away any dirt, then press the bandage directly onto the injury and apply firm pressure. If applying to someone’s limbs, leave their fingers and toes exposed so you can check blood flow beyond the dressing. Do this by pinching the fingernail or toenail for five seconds – if it takes more than two seconds to return to pink, the dressing is probably too tight, so loosen it slightly. See below for more details.

5 Don’t let them move: Injuries any more serious than minor cuts or grazes need to be immobilised to prevent any further damage. The person will instinctively protect an injury by keeping it still. If they can’t do this themselves, an arm sling or leg splint are good basic ways of achieving this (see below for details). Again, wash and dress any wounds. Call 999 for help.

6 Dial 999: If it appears to be a serious injury, don’t move the person unless they’re unconscious, in which case, gently lie them on their side in the recovery position (see below) and check that they’re breathing. “Get someone to hold their head in neutral alignment (its natural position), using Manual In Line Stabilisation [see below]. It’s what we do until back-up arrives,” Dave advises. If it’s cold, wrap them in the emergency blanket. Call 999 and ask for help. The operator will talk you through what to do if it’s serious or life threatening.

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How to put someone in the recovery position

1 Kneel next to the person and straighten both their legs.

2 Open their airway by lifting their chin.

3 Place the arm next to you at 90 degrees to their body, with the elbow bent with palm facing up, as if they’re waving.

4 Bring their other arm across their chest and hold the back of the hand against the cheek nearest to you.

5 With your other hand, take hold of the leg furthest and bend it at the knee, keeping the foot on the ground.

6 Making sure that their hand is still on their cheek, pull on the leg towards you, this will roll them over onto their side.

7 With your hand still on their leg, adjust it slightly so that their knee and hip are both at right angles.

8 Tilt their head back to ensure their airway remains open.

9 Check their breathing and pulse regularly and wait for help to arrive.

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Manual In Line Stabilisation (MILS)

1 If the person is complaining of neck pain, or has numbness, pins and needles or unusual sensations anywhere, call 999.

2 Without moving them, kneel or lie at the head end of the person.

3 Place your hands gently on either side of their head, with your elbows resting on the ground.

4 Hold their head in its natural position. What you’re doing here is immobilising the neck to prevent any further damage.

5 Keep talking to the person and reassure them to keep them calm.

MILS:

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How to make a sling

1 Take a triangular bandage, open it right up and lay it flat on the ground.

Sling 1: sling 1

2 Tie a small knot with the tip of the triangle, this is where the person’s elbow will go.

Sling 2: sling 2

3 Have the person hold their arm, they’ll probably be doing this naturally anyway to soothe the pain they’ll be in.

4 Carefully take hold of the point of the sling in one hand and the knot in the other.

5 Gently slide the point of the sling under the person’s arm and the knot behind their elbow.

Sling 3: sling 3

6 Pass the point up behind their neck, it should be on the same side as the person’s hand.

7 Pass the other point over the arm and up across the body towards the shoulder.

8 Tie the two ends of the sling in a bow, either on the left or right of the neck to avoid pressure on the spine.

Sling 3: sling 3

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How to dress a wound

1 Clean the injured area and wet the dressing.

Bandage 1: bandage 1

2 Apply direct pressure with the bandage.

Bandage 2: bandage 2

3 Wind the ends of the bandage around the gauze pad, overlapping each end by 2-3cm and tie together in a bow.

Bandage 3: bandage 3

4 Keep the wound elevated higher than the heart if possible.

Bandage 4: bandage 4

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How to immobilise a wounded leg

1 If you think the person may have a fractured leg, or if they can’t be moved, dial 999 immediately.

2 Then, open up the triangular bandages and pass them under the natural hollows of the knees and ankles.

Legs 1: legs 1

3 Carefully strap the legs together, being sure not to tie the bandages over the injury site or the knees. The idea is to keep the injured leg immobilised, by securing it to the uninjured one.

Legs 2: legs 2

4 Remove shoes and socks and check the blood low to the feet.

Legs 3: legs 3

5 Keep the person warm with the emergency blanket, or they'll soon start to get cold.

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User Comments

There are 18 comments on this post

Showing 1 - 18 of 18 comments

  • ;) good thinking.. with a bleed (i.e chain ring slip) pressure and elevation are 100% neccesary. Im a FA Trainer assesor and regularly find trail riders bumbling around with plasters and even innertubes to stop bleeds....

    Great Article.

  • dailing 112 can be quicker than using 999, particulary if there is no signal.

    i dont no why, but 112 will work with no signal, which is more likely if your in a remote/hilly area

  • 112 is a real emergency number and will link GSM mobile phone network users to emergency services in some parts of the world. In the European Union, 112 is the standard emergency telephone number. In some other areas, dialling 112 will automatically divert the call to a local emergency number. However, as with any other mobile phone call, a signal must be available before the call can succeed.

    If you receive this email please do not forward it to others. Perpetrating the false information the message contains could ultimately lead to confusion and dangerous diversion during a real emergency situation. The message should be deleted.

    If you receive this email please do not forward it to others. Perpetrating the false information the message contains could ultimately lead to confusion and dangerous diversion during a real emergency situation. The message should be deleted.

  • -you can use things like seat posts to provide support for possibly broken bits too.

    -don't take any helmet off, even for CPR, if you can avoid it.

    -keep them warm, no drinks though.

    -not sure about removing the shoes though. What if they have sustained ankle damage?

    Having been pulled into evacuating someone on a different party from the Brecon Beacons (faceplant on the rocky bit on the way down from Pen y Fach) towards brecon, one of the surprising things is how many bikes you end up having to get out. with two people helping the patient, that's 3 bike needing evacuation, which means 3 more people walking down wheeling two bikes each.

  • If your doing CPR, you'd defo need to remove a full face helmet (access to airway)and a open face helmet would prevent proper airway postioning!!

    You possibly need to remove socks and shoes if concerns for circulation to the lower leg or foot resulting from the injury.

  • latex gloves would not go a miss too!

  • Lucky I have a support convoy when I go out cycling! But good article, good to know :)

  • Latex gloves are best avoided due to increasing numbers who get latex allergies...use other types eg nitrile gloves. A whistle won`t go amiss either as will a map to give a grid reference for emergency services

  • An article from singletrackworld.com that is a warning to anyone about trail safety, helmet use etc etc... Grim reading - but worth a look!

    http://www.singletrackworld.com/2010/09/online-armchair-feature-headcase/

    Happy trails!

  • Hi guys,

    Never remove a fullface helmet unless the casualty is in immediate danger,not breathing or vomiting.In a bad crash always suspect a c-spine injury(top of shoulders up to base of skull).

    The neck needs to be kept in th neutral position to avoid further damage.This is taken from my Brigade first person on sceen training for trauma care at Road Traffic Accidents.Full face helmets for road and MTb are mostly the same.This is how myself and the guys are trained

    Only remove a crash helmet if the casualty has difficulty breathing, is not breathing or is vomiting.

    Two people are needed to remove a full-face crash helmet safely. One is required to support the head and neck at all times, the other to lift and ease off the crash helmet.

    Undo or ideally cut the straps.

    Support the neck with one hand and hold the lower jaw.

    Working from the base of the crash helmet, ease your fingers underneath the rim and pull apart. Ask the person helping you to hold the crash helmet with both hands.

    Ask the helper, working from above to tilt the crash helmet backwards (try not to move the head at all) and gently lift the front clear of the casualty's chin.

    Continue to support the casualty's neck and lower jaw. Ask your helper to tilt the crash helmet forwards slightly so that it will pass over the the base of the skull, and then lift straight off the casualty's head.

    This is as controlled as you can get,in the circumstances.

  • I can only back up what others have said about 112. Although it goes to the same call centre, if you dial 112, they can work out triangulation that the mobile phone is in, therefore, if you are really remote, you can be tracked to a close(ish) proximitary.

    I take my hat off to Bike Radar for publishing this as it can really open a can of worms.

    Two critical pieces of equipment have been missed out here! OS Map and compass.

    Trust me, I think that at least one member of the group should be able to obtain a grid reference. Don't rely on a GPS as you could break it during a fall. Even if you know where you are and even if you know your only a short walk (or run) from a trail centre or road. How would you be able to tell emergency services over the phone where you are? A simple 30 minutes learning to get a grid ref on a map could save you a lot of hassle.

  • as a qualified lifeguard there are some things id like to say.

    Firstly, never move somone who you suspct of spinal injury unless their airway is blocked or their breathing is at risk due to vomitting.

    simple thing to remember guys is this

    DR SAB

    Danger, check around for dangers

    Response, asking if they can hear you, telling them to speak or say their name ect

    Shout, shout for help and get attention

    Airway, check the airway propperly,make sure nothing stopping the airway or blocking.

    Breathing,follows on from airway, checking the breathing tilt head back carfully(dont do if suspected spinal) then count to 10 checking for breaths and chest rise.

    also DO NOT EVEN USE A SLING, PLEASE DO NOT EVER USE THEM ON INJUERED PERSON, i very strongly suggest that they remove the sling information from this posting as it wrong.

    never use sling, by applying the sling you going to cause more PAIN and suffering than is needed and the advantage of sling is therefor lost.

    never apply a sling, you will get punched in the face if you try apply one to a person with broken bone or collar, i not joking.

    triangular bandage are only used for badding for them to hold in their hand to stop the elbow digging into palm as they hold their injured arm ect.

    please remove the sling information from this post as it will cause more problems if people try using it to injured person, suggest only medically trained people who know when the right time to apply one use slings, and even they will not use on in 99.99% of breaks or fractures.

  • Understand entirely what you're saying about slings but I do think they have their place, especially when trying to imobilize an arm for a lengthy walk out. Like all first aid situations, if in doubt call for help and let the experts do their thing. If that's not an option then your own training/experience/ingenuity comes into play. A first aid course is definitely a good move for anyone active in the great outdoors, as is a basic map reading course.

  • I wouldn't recommend "having a go" if you are not qualified, however, supporting a fracture in a sling is is very good advice.

    To leave it can cause a lot of pain and could result in a more damage.

    You shouldn't have to move an arm in the event of a broken collar bone or even arm bone. You simply sling it in the same position that they are cradling it.

    If you have ever seen someone with a shoulder/arm bone, they cradle it. Sling it as they cradle it as that's what is most comfortable for them.

    For those (like me) that have recently been on a HSE approved Outdoor First Aid course, that's exactly what you get taught.

    Another good tip, although not strictly applicable, ask your employer about becoming a first aider at work. That way they may put you on a First Aid at the workplace course. The basic course is 8 hours (there are 16 and even 24 courses) and this will at least give you a firm grounding for some of the usual breaks and scrapes that you will encounter.

    Craig Rogers

    www.chaseskills.co.uk

  • blablablacksheep

    You are completly wrong about slings and it appears as if you have no patient skills at all, if the arm needs moving ask the patient to do it themselves, very often they are more then capable. sling the limb in which ever position the present with = no movement. Slings are not just for fractures they are also used to control bleeding.

    And I use them on a regular basis (as part of an ambulance crew) Dont assume when you dont know.

    It may be best to discuss the issue with your trainers as all of this is standard first aid practice.

    Helmet needs to come off if the need for CPR arrises, the patient is already dead at this point in time, CPR is an attempt to keep things going until a defibrillator can be used, (not always successful, mostly not)

  • Sorry rhann but i still stand by what i say about slings, in the real world you never going to use one unless you either in hospital after a OP and they put one on, or maybe you dont like holding your arm in the air and want to rest it.

    in reality you not going to attemp to put a sling on a person with a fracture or injury.

    You will cause them pain and suffering, it better to do the simple pressure and elevation for bleeding then if you have a triangle bandage give it to them and let them put it in their palm of their hand while they hold their injured arm to stop the elbow digging into hand, that about it.

    using slings also is going to be a problem as most people will stick one on somone wrong and cause like i said before more problems.

    i respect that your ambulance crew but i cant see why you would use a sling on anyone , you just going to have to remove it once they at hospital anyhow,

    Also it a natual reaction to hold the injured arm for example, in the most comfortable position anyhow, so le them hold it, it best left alone as they know how much it hurts.

  • Wow......an article written by a paramedic/trauma specialist and also comments from ambulance crew.........but the lifeguard knows best.

    Be very careful about what your saying as you're obviously sure about correcting some very experienced professionals.

    I am also ambulance crew and have used sling for many injuries, but obviously i've not been to the same incidents as you.Thankfully.

    Its one of the basic first aid skills.

    I think you confuse the comments of using a sling/triangular bandage as control for bleeding with elevating an injured limb. I'm sure i'd have something to say if you started elevating a shoulder/clavicle injury that i suffered.

    This is a fantastic article ,with great advice and tips which can make a massive difference,please don't spoil it.

  • blablablacksheep, as a life guard i don't suppose you come across many broken bones, as a member of St John i have treated many people with broken bones, if you can make the casualty more comfotable by supporting the limb with a sling then do so.

    also i have never been smacked in the mouth for trying to put a sling on, you must be doing it wrong.

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