Words: Anna Beck
 
Mountain biking is a fabulous pastime with social and health benefits, but ask anyone who has been riding a while and it’s likely they have had a mountain biking injury. While we ride off road to avoid cars and traffic, the pesky trees that jump in our way, jumps that were built larger than we first remembered, and narrow bridges we love to test ourselves on mean that while our safety is largely in our own hands, the very nature of the sport is one of risk mitigation.
 
So what do you do if you come across an injured rider, or a friend has a crash? Let’s explore how to assess the injured rider in the setting of haemorrhage and cardiac arrest, and in following issues we will explore head or spinal injuries, limb fractures, impalements, hyper/hypothermia and stings and envenomation.
 
For simplicity, we are talking about protocols for adult patients, and while we are discussing procedures such as CPR and first aid; nothing beats getting a first aid certificate and practicing in an environment with skilled assessors providing feedback. The protocols for resuscitation change frequently, so keeping a first aid certificate up to date means you know you’re doing the right thing.

Adventures can be fun but can also be isolating
Adventures can be fun but can also be isolating

 

That’s traumatic, man!
 
While the act of CPR is the same for medical and traumatic causes of cardiac arrest, it’s important for the trailside first-aider to know and understand that there are three common cases of cardiac arrest in the situation of trauma that differ from medical causes (ie: heart attacks, or acute myocardial infarction). These include airway obstruction and inadequate ventilation, chest trauma and blood loss (1). In the case of a severe bleed it’s important to know how to stop external bleeding, in fact, stopping bleeding and making sure the airway is clear is more important than CPR in the very early stages of administering first aid (2).
 
Key for successful haemorrhage control is timeliness, and the most effective forms of haemorrhage control trailside are direct pressure, bandages, and in more severe cases, use of a tourniquet (in extremities).
 
Direct pressure is exactly that; pressing down on the wound, with the pressure and time required to stop a bleed corresponding to the size and depth of the wound. If you have a pad to apply pressure, this can be used, and when the bleed stops hold it in place with a bandage. Should the wound be severe and unable to be managed with direct pressure, a tourniquet can be applied using whatever is on hand, proximal to the wound (3).


1 - Australian Resuscitation Council, “Management of Cardiac Arrest Due to Trauma”, (April 2016), https://resus.org.au/wpfb-file/anzcor-guideline-11-10-1-als-traumatic-arrest-27apr16-pdf/

2 - Australian Resuscitation Council, “First Aid for Management of Bleeding” (July 2017), https://resus.org.au/guidelines/

3 -  Day, M.W., “Control of Traumatic Extremity Haemorrhage”, Crit Care NurseFebruary 2016 vol. 36 no. 1 40-51