Saturday, September 4, 2010

My WFR training kept someone from getting paralyzed today

I am not sending this to show off about my skills. Actually, I did just about everything wrong. The one thing I got right was the important one - I remembered that a concussion is an automatic mechanism of injury for a spinal injury. The patient in question has chipped his c6 vertebrae and is spending the night in hospital before being evac'ed to Hong Kong tomorrow. I'm sending this note so that hopefully someone else does better next time.

Here's what happened:

I went mountain biking today with the Chevron bike group. It's something Josh and I just discovered and it makes being stuck in Chengdu much more pleasant. We were doing a 25 km "easy" ride with about 400 m elevation gain on a decrepit old road. The road used to be paved but hasn't been kept up, so it's got lots of potholes and loose gravel and strange brick quasi-paved sections. Well, it's a decrepit Chinese road, what can we expect?

We had ridden up both hills and down one and half. The ride was going slowly because there were 14 of us, including some total newbies. I was riding Josh's rigid singlespeed and doing ok with all the potholes and remembering to manual off stuff and pull up my fork more than usual since there was no suspension. Pretty happy with myself actually as I was the 2nd fastest climber in the group and one of the faster descenders.

So on the last descent I was 4th back. Ahead of me were rider 1 (a new cyclist who is really strong and was riding his old bike as his squishy one was out on loan), rider 2 (former CX racer for Phil's in Seattle), and the patient (new to mountain biking, on rider 1's squishy bike; previously rider 2 had pointed out how comfortable the new rider seemed today, maybe a natural). I came down around a corner and noticed that a rider was face first on the pavement in front of me, later I learned who it was (keeping his name out of this). I slowed down around the edge of a pothole and dismounted (even managed a speedy cx dismount). I promptly forgot everything I ever learned in my WFR class or the 3 subsequent recerts. The rider was tangled in his bike and lying face down in a pool of blood. I tried to untangle him but he moaned so loudly I backed up. Then I was joined by rider 3 (not sure his experience...) who ignored the screams, pulled out the bike and rolled over the rider. It didn't occur to me to check vitals, see if he was conscious, or anything. I started to feel faint (me and blood... it happens). After a few minutes I noticed that the rider wasn't really alert. More like a "P" on the "AVPU" scale (it's a measure of consciousness - Alert, Verbally responsive (i.e., someone calls your name), Pain responsive (i.e., moan if it hurts), Unresponsive; you can be Ax3 (awake, alert, aware) ranging to out cold). He moaned in pain but didn't really seem aware at all. Over the next minute or so he moved up to A-. He was groggy and trying to sit up. Stupid rider 3 kept helping him. I made him lie down. He was angry at me. I tried to get him to lie still but stupid rider 3 kept helping him up. Finally I ordered him to lie down and and sat down behind him and held him spine stable. He was bleeding a lot - glasses cut his forehead and nose and he bit through his upper lip. Blood everywhere.

We then started to wait. Over the entire time we waited I forgot to take any vitals, do a physical exam, or do anything except alternately feel faint and hold his head. My training vanished into thin air. The place patient fell smelled like a pig farm. Ick. Everything smelled. Hours later poor patient still smelled. Someone who speaks Chinese called 120 (ambulance) and got directions. Someone else called the Chevron medical officer. I traded off with someone responsible enough to actually hold patient's head still and explained to rider 2 and the group leader, rider 4, about how I was certain that patient had a concussion and may have injured his spine. We figured out how to fashion a neck brace if the ambulance didn't have one. Patient's driver showed up. I decided I didn't want any more patients and tried to make the 12 healthy people eat. No one eats on these rides! I think they are all trying to lose weight and so they don't eat. Then they might bonk. I did not want more patients. Finally the ambulance arrived and we agreed on making sure Ian was moved properly. Rider 2 also has had some medical training so he directed the procedure.

Turns out that the ambulance carries a neck brace (phew!) but that's about it for spine safety. No backboard. Just a low slung litter without any straps to tie him in. Rider 5 (a Singaporean) and I were sent in the ambulance. I kept the ambulance doc from putting in an IV drip (just salt water anyway and it was making Ian very unhappy). I told the patient that I was there because a) I speak Chinese, b) I have medical training, and c) I am also foreign and can advocate for treatment he wants or doesn't want. We then commenced on my first ever ambulance trip. Lots of traffic. nearly 2 hrs to hospital/clinic. Good thing Patient's car is a Prado Landcruiser. They have pretty much free reign over roads in China and when he put his flashers on he was able to just follow the ambulance. We got to the clinic with an american doctor. The Chevron medical lady met us there along with the american doctor at the clinic. I explained what happened as far as I could tell/put together (hit pothole, lost control, fell over bars, slid on ground, scraped up hands, teeth through lip, glasses cut forehead and nose badly, concussion, unconscious for a long time (minutes), amnesia about accident, squishy bikes make you feel safer than you are). Patient got a CT scan and xrays of wrists and elbows. He ended up having no bleeding or damage to his brain, a fractured radius near his elbow (minor), lots of abrasions, fractured nose, and a chipped c6 vertebrae. Yikes. I left soon after that because more folks, including his boss, had arrived and I hadn't eaten and was still in my kit. The Chevron medical person complemented my attention to vitals and good reporting of them, but I feel like I really messed up. I have so much training and all I could remember was to hold his head still. And that wasn't right away. Fortunately I wasn't too late.

In hindsight I wish I had remembered:
1) Don't move him until you know more about what is going on
2) Keep rider 3 very far away (and anyone else interferring. I needed to have appointed a crowd manager and have delegated better)
3) Move him properly onto his back
4) Keep him spine stable immediately
5) Do a proper physical exam while we were waiting
6) Take vitals regularly
7) Write a soap note (ok, that is impractical, I didn't even have a first aid kit, I was on a mountain bike ride, for heaven's sake! we barely carry anything, only what can fit in jersey pockets)

We also should have had someone riding with him and cautioning him on speed since it was his first time out. Those squishy bikes really can be deceptively stable. I think it was 6 in front and rear travel.

But seriously, there are so many things I forgot in the heat of the moment and I am embarrassed that I have lost that much of my training. I guess this is why we get 3-yearly recerts. I am due up in 6 months.

Be careful out there.


1 comment:

  1. Sounds like you did well.

    It may be excessively cautious, but if I'm riding offroad I'm wearing a boblbee back protector, impact glasses, helmet, and thanks to your story I think I'll be adding a first aid kit to the list. Not that it would have been very useful. Maybe a cold pack, bandages, and some ibuprofen for the secondary injuries.

    And in groups, I tend to ride in the middle and talk to people. It emphasizes the social nature of the ride and reduces the urge to race. On the flats and downhills, anyway. I'll race uphill, but racing downhill practically guarantees somebody's caution center is going to turn off and they'll end up in a ditch.