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Thread: First aid question on a scenario

  1. #1

    First aid question on a scenario

    OK, i know what i would do, but what would you do?
    Here is the scenario, you are the first person to come across an incident involving a motor bike on a main road.
    The biker is face down on the road, in full leathers and crash helmet with full face visor, clearly from the angle of his leg and blood he has a serious leg injury, he is also non responsive and unconscious, in addition he is not breathing, so what would you do?
    Thought provoking isn't it.
    Cheers
    ​Richard

  2. #2
    Top of my head?
    First person to arrive so you are working alone,
    Situation assessed and called in as you approach
    Helmet stays on
    Full leathers on so leg is secondary
    Main problem is lack of breathing

    Commence artificial respiration as for a drowned man- compression of the chest by pushing down on his back type action
    10 compressions/squeezes then check for spontaneous breathing
    Full set of leathers will minimize extra lung damage from compressions
    Basically any biker who comes off and has these injuries in need of professional care and anything I do is better than nothing
    Last edited by Archer; 28-10-2013 at 11:23.

  3. #3
    Check immediate area for any other dangers.

    Call for help or get someone in vicinity to do so.

    Obviously without knowing the full extent of the injuries moving the casualty is a very sore subject but get enough people to support the head/neck/back and i would consider rolling casualty onto back.

    I am not a biker but i assume a full face visor can be lifted up so reveal the full face.

    Lift Visor gently while ensuring someone is completely supporting head/neck.

    Commence Airway check (looking in mouth for any obstructions ie broken teeth/vomit etc)

    Check for breathing (Feel for breath on cheek, look for chest movement) (OP States Not breathing)

    Check Pulse for circulation.

    Start BLS and dont stop until Emergency Services arrive or you physical cant do it anymore or he begins breathing again.

    Depending on severity of leg injury i would be getting someone to either apply pressure to affected area or fashion a torniquet to stem the bleeding.


    Obviously every situation is different and each persons perception of what to do is different so before you slate my opinions.


    Adam

  4. #4
    Depending on how much the leg is bleeding, i'd try to stem it, either by using a dressing, clothing, or a make shift tourniquet. Whilst he's on his back, have a quick look for any other big bleeds. We're talking about pools of blood forming. The blood loss could kill him.
    If he's unconscious and not breathing, then that could be because of a blocked airway, which you cant tell with his lid on. The helmet needs to come off.people are extremely wary of c spine injury and are totally against taking a helmet off. If theres two of you, you can remove it carefully enough to protect the spine. If not, then it needs t be removed. If you leave it on, you'll take a corpse to hospital, safe in the knowledge that you didn't damage his spine. When you remove the helmet have a good look for damage too. To roll him over, try to position his body into the normal anatomical line, ie straight, with hands by sides. With you kneeling by his hips, roll him over, trying to control his head- quite a challenge with only two hands!
    once the helmet is off, check his airway is clear, if it isn't, try to clear if, but only as far as you can see- don't stick your fingers down his throat... To maintain the airway, you could perform a head tilt, or a chin lift/jaw thrust manoeuvre, but the jaw thrust needs to be manned constantly. No good if you're alone.
    if he isn't breathing (a 30 second check) then commence cpr. 30 compressions, to 2 breaths, at a rate of 80-120 compressions a minute, roughly one third the depth of his chest.
    Another thing to check is whether or not the leg is still bleeding. He could have stopped breathing due to cardiac arrest, caused by hypovolaemia (low circulating volume). Cpr needs to continue until an ambulance arrives and takes over. They'll be giving him fluids, some cardiac drugs possibly, and defibrillation. Bottom line is that he need defib, but your good quality CPR is allowing the brain in particular to be perfused and remain alive, long enou for the ambulance to get there.
    there are differing opinions on when to phone for help. Id probably give 2 breaths and 30 compressions before phoning. You can always pause the call periodically to continue cpr- the operator isn't going anywhere. Failing that, talk clearly and fast before hanging up- they can replay the call to get the info.
    if a fire crew arrives first, dont neccessarily expect them to take over from you. If it looks like youre doing a good job, they may leave you to it, unless you ask for help!
    i think posts like this are very useful. I regularly run through "what ifs" and I think it better prepares you for the day something actually happens.
    ​hope this helps

  5. #5
    Just throw something in the mix (and this is a judgment call).

    He will die without air. If he has positional asphyxia or an obstructed airway, no amount of compressions are going to bring him back.

    Adam's answer is comprehensive, but being a biker I would physically assess him and make a judgement call as to whether or not to remove the helmet in addition.
    .243 Weatherby Vanguard Synth /.223 BRNO CZ527 Synthetic
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  6. #6
    check his wallet for a doner card whilst lecturing him on the dangers of motorcycles ! (all said very tongue in cheek!)
    Right where's those stones , I'll start !

  7. #7
    + 1
    YOU should never remove the helmet it may be holding a injury from becoming worse keep up comp's and deal with his leg as a 2nd unless its a fem bleed then unless you can reach it his not goner last long anyway

    Quote Originally Posted by Adam_Muirhead View Post
    Check immediate area for any other dangers.

    Call for help or get someone in vicinity to do so.

    Obviously without knowing the full extent of the injuries moving the casualty is a very sore subject but get enough people to support the head/neck/back and i would consider rolling casualty onto back.

    I am not a biker but i assume a full face visor can be lifted up so reveal the full face.

    Lift Visor gently while ensuring someone is completely supporting head/neck.

    Commence Airway check (looking in mouth for any obstructions ie broken teeth/vomit etc)

    Check for breathing (Feel for breath on cheek, look for chest movement) (OP States Not breathing)

    Check Pulse for circulation.

    Start BLS and dont stop until Emergency Services arrive or you physical cant do it anymore or he begins breathing again.

    Depending on severity of leg injury i would be getting someone to either apply pressure to affected area or fashion a torniquet to stem the bleeding.


    Obviously every situation is different and each persons perception of what to do is different so before you slate my opinions.


    Adam

  8. #8
    look around and if no one else is about see how much cash he has in his wallet ?
    or if im feeling kind if he is not breathing so going to die i would probably wrongly move him and give mouth to mouth was my first thought all goes against the advice i have heard but my thinking was he is going to die if i dont and pushing on his back to give cpr would be as bad as moving .mouth to mouth because he may have broken ribs /internal injuries.oh and call an ambulance might be an idea.

  9. #9
    If you don't remove the helmet he will die. If you do remove the helmet, worst case he will die. Either way the odds aren't good, but leaving his helmet on means you cant clear any obstruction and cant administer rescue breaths, which are the only thing that will keep his organs partially perfused.
    the likely issues caused by removing a helmet could be antagonising a cervical spine injury, or possibly worsening a very serious head injury, which the helmet is effectively splinting. Chances are, if the biker has a head injury, the intercranial pressure will be rising. Theres nothing you can do at the roadside for this. If the skull is so badly fractured that his helmet is the only thing splinting it, then it really isn't his day and the helmet would be in bits anyway. The only thing that you can fix at the roadside is his lack of breathing and lack of a pulse. You cant do that with his helmet on, unless you want to try mouth to nose through the front of it.

  10. #10
    Well its a tough one for todays first aiders as when I renewed my ticket earlier this year I was told never to do more than the absolute minimum to keep them alive till the ambulance/ doctor arrives on the scene as anything extra you do which is wrong opens you up for a huge amount of ball ache being dragged through the courts especially if they die and even then getting the basics wrong could land you in court!

    But OT first off is don't move the helmet just yet, check if there are any obstructions in the front of the lid which is stopping him from breathing, second if their are by standers get them to help roll them on to their back by supporting all parts of the body, next if there is still no breathing then the helmet must be removed, life take precedence over spine damage, check pulse again and then start chest compressions, depending on skill and your confidence you either do about 100 (if memory serves me) a minute and no breaths until paramedics arrive or if you know what you are doing 30 compressions to 2 breaths.

    The way CPR is looked at today is there is a few minutes of oxygen stored in your blood so mouth to mouth is kind of a last resort and just the compressions are enough to keep someone alive.

    That being said I'm sure it will change next year!

    Whilst this is going on get someone else to sort the leg out

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