Acute Trauma Response

Stop and Size up the scene: Take a deep breath and stay calm. Someone needs to take charge. It may be you! Be quick but not hasty. With trauma it is necessary to act fast but go slow.

• 1. Make sure all others are off the road (we don't need more victims).

  2. Depending on the situation, yell out for someone to CALL 911.

  3. If there are enough bystanders and the patient is lying in the road, locate people up and down the road, ON THE SIDES of the road, to halt or direct traffic around the accident.

  4. Approach the injured patient and quickly survey the situation. DO NOT MOVE THE PATIENT!

     1. 1. Are they bleeding, breathing or moving.

        2. The “walking wounded” (those sitting and holding their arm or with minor injuries) should be asked if they can move, on their own, off the road).

        3. What appears to have happened (could they have lose control or could they have been hit by a car). All the above can be observed in seconds.

Initial Assessment: *The Conscious Patient*:

• 1. Identify yourself. Ask if they need help: "Hi, I'm Tony, Can I help you?" Do they respond? If not proceed as below (The Unconscious Patient).

  2. Tell them: "Please do not move until I know more about your injuries." If the patient does not identify a complaint, ask them what hurts.

  3. Does the patient respond to verbally? Are they oriented? WHO "What's your name?" WHEN "Do you know what day it is?" WERE "Do you know where you are?", HOW "Do you know what happened?" Lack of orientation may suggest head trauma, could be associated with neck or spine injuries, or shock.

  4. Exam for injuries and treat if necessary until the EMTs arrive.

Initial Assessment: *The Unconscious Patient*:

• 1. Is the patient breathing: Rub their chest and call out to them to see if they respond. Only if the patient is not breathing or if the area of severe bleeding in under the patient, a spinal roll (shown below) may be necessary so you can apply CPR (see below) or apply pressure to a wound to stop bleeding.

  2. Can you control bleeding: If you find a major bleed, expose it and apply direct pressure with whatever you have on hand (even if you have to take off your shirt and use it).

  3. DO NOT MOVE THE PATIENT in such cases. Always assume there may be spinal injury.

CPR: A life saving technique which has been modified and simplified for the average non-medical individual.1

For certified individuals: More on CPR New 2014-2015 guidelines2,3

(Be sure to keep your elbows straight) 

Treatment of Bleeding:

• 1. Apply pressure using whatever is available, even a bike shirt is better than letting the patient bleed out. (Use Celox powder for large or persistent bleeds, but be sure to tell the EMTs when they arrive so they don't under estimate the damage)

  2. Call 911 unless cut is minor requiring only superficial dressing

1. Elevate limb only if you're SURE there are no broken bones or spinal injuries.

   1. Persistent severe bleeding may require pressure on an arterial pressure point until help arrives (see below).

Treatment of Shock:

Symptoms:

1. Light headed

2. Pale, gray or deadly white

   1. Cool to touch and may be sweaty ("clammy skin")'

3. Shortness of breath

• 1. Increased heart rate

4. Fainting or Coma

Treatment:

1. Call 911

   1. Keep patient still.

   2. Control bleeding if indicated.

   3. Give protection from the environment.

   4. Unless you have a "walking wounded", lying the patient on their back and raising their legs is NOT advised in cases with multiple injuries.

Broken Bones:

Only for small injuries in "walking wounded" which you suspect a broken bone, one can stabilize the limb by holding the hand or arm in a comfortable position to decrease pain. Otherwise DO NOT MOVE THE PATIENT.

Summary:

Initial Steps

• 1. Stop and Size up the scene

  2. Move bystanders off the road

  3. Call 911 unless injury appears minor

  4. Locate people (on edge of road) to direct traffic

  5. Do not move the patient

  6. Conscious Patient:

     1. Assess patient orientation (who, where, when, how)

     2. Exam for bleeding, broken bones, other injures and treat as needed! Use compression for bleeding.

     3. Are they in Shock. If so treat as above under shock.

     4. Stabilizing broken limbs but only if there's no evidence of spinal injury

  7. Unconscious Patient:

• • 1. Are they Breathing. If not breathing, initiate CPR. They may need a "one person spinal roll" or "multiple person spinal roll" but do so only as a last resort.

    2. If they are Bleeding, apply pressure (use celox if available)

Always observe the trauma patient and treat as necessary while waiting for help to arrives.

If the injuries are very minor and the cyclist wants to continue, tell them to stop if they experience light headiness, dizziness, headache or pain. Never let the individual cycle home alone!

ADDENDUM:---------------------------------------

References:

• 1. American Red Cross Handbook of First Aid and Emergency Treatment , American Medical Association, Random House, 2011. ISBN: 978-1-4000-0712-7.

  2. Harrison's Principles of Internal Medicine (accompanying DVD), 18th edition, McGraw Hill, 2012, ISBN 978-0-07-1748889-6

  3. Wilderness Medicine   by William W. Forgey M.D. (Nov 6, 2012)

  4. First Aid, CPR, and AED Advanced, Emergency Care & Safety Institute, Sixth Edition, Jones and Bartlett Learning, ISBN: 978-1-4496-3505-3

  5. Harrison's Principles of Internal Medicine, 17th Editionby Anthony S. Fauci,  Eugene Braunwald, Dennis L. Kasper, and Stephen L. Hauser, 17th ed., McGraw Hill - A standard advanced medical text book.

  6. Pocket First Aid and Wilderness Medicine  by Duff J. and Gormly P., 10th ed., Cicerone Press, 2007. ISBN: 13: 978-1-85284-500-1

  7. Backcountry First Aid  , Tilton B., Falcon Press, 5th ed., 2007. ISBN: 978-0-7627-4357-5

  8. Merck Manual, Mark Beers, M.D. and Robert Berkow, M.D. (editors), Merck Research Laboratories, 7th ed. ISBN: 0911910-10-7 - Soft bound book addition of the site listed above.

CPR:

• 1. CPR/AED Refresher Course from Trainer is Kuo Rees, who trains individuals for Cardiac Life Products, Inc

  2. How to Perform CPR video from CPRCertified.com.

  3. First Aid Training Video - How To Perform ABC's of CPR (Adult Episode) from OTMT

  4. How To Perform CPR on a Baby with Dr. Jim Sears

  5. American Heart Association Unveils New CPR Guidelines   Video, new 2014 / 2015 CPR for non-trained individual

  6. AHA CPR Guidelines - Updated 2014 / 2015   American Heart Association official guidelines for CPR – Latest 2014/ 2015

  7. *Adult CPR ProCPR: Best guide on 2010 protocol.

  8. *Infant CPR / Baby CPR   From ProCPR

  9. *Child CPR   From ProCPR

  10. Child CPR (Ages 1 to 12 Years)   From the Cincinnati Children's Hospital Medical Center

  11. American Heart CPR   Video showing changes in the new 2010 Guidelines for CPR released on October 18, 2014

AED:

• 1. One Person Adult AED   One Personfrom ProCPR

  2. Two Person Adult AED   from ProCPR

  3. Child AED   From ProCPr

  4. Infant AED   From ProCPr

  5. Learn How to Use an AED—University of Arizona Sarver Heart Center   From Gordon A. Ewy, MD, and Karl B. Kern, MD, the University of Arizona Sarver Heart Center

• • • Visit us at tony10speed.com:     or on:   (Bicycle Emergency Kit)

Visit Tony Marchand at Google +

My name is Anthony Marchand, M.D. Here is my home page: tony10speed,com. I live in Clinton NJ where I am now retired. A graduate of Duke University School of Medicine and former Captain, United States Armed Services. I also have a strong background in bicycle maintenance, repair and safety and am active with the Morris Area Freewheelers, NJ. My friends: William Esposito, M.D. Larry Nastro, M.D. Jon Eiseman, Jim Hunt, John Hinton