Trackside medicine is intended to provide a general medical guideline and is not intended to replace the clinical judgment of a doctor or take the place of a medical doctor's diagnostic or treatment recommendations. We will always err on the conservative side for safety purposes.
Motocross. I've been involved in just about every sport, and unfortunately, motocross ranks high as an injury-ridden sport. On any given day, you can see someone sprawled out on the track like a cheap yard sale. Stopping trackside and providing medical assistance to a downed rider is what any responsible rider would do. When I've taken a dirt sample, it's nice to know that some guy cares enough to stop and check on me, even if it is just to tell me to get up and stop blocking the track.
It would be great to be able to teach you advanced trauma life support or CPR protocol from trackside medicine, but with my writing skills and your limited reading time, it isn't going to happen in this article. The real truth is we all should know CPR. Nothing can compare with the feeling of helping to save someone's life. CPR online courses such as www.firstaidweb.com can certify you for free and in less time than it takes to put on a new set of tires, with far less sweat and profanity.
For the purpose of this article, we will assume that the downed rider is conscious, possibly alert, oriented and breathing. So what should we do when stopping to help a downed rider? First, always remember that you should never move the rider until his condition has been sufficiently assessed and always send for medical backup. We can all attest that after hitting the ground we are not always aware of our surroundings or all our injuries. Pain from one injury (broken wrist or ankle) can mask the severity of other more important injuries (spinal cord compromise). We must always assess other potentially serious injuries before focusing on the obvious or less serious injuries. Head, neck, back and chest injuries (breathing difficulty) are the first to evaluate once you have determined that CPR is not required.
If the rider isn't alert, determine whether he is having difficulty breathing. If he is, implement CPR training. If the rider is alert, ask him if he is having any problems breathing. If not, obtain the rider's full name and whom he's with; make sure to remember this information in case he passes out. Determine if he is alert and oriented to the time, place and situation. If he is disoriented, assume a worst-case scenario and that he has a head injury and may be unaware of the full extent of his injuries. Ask where his pain is. Less critical, but painful, injuries may distract from potentially serious injuries to the head, back or neck. Ask if he is experiencing any numbness or tingling of the arms and legs (reflects a potential spinal cord injury). If yes, assume neck or back injury and minimize any movement and get an EMT. If there is no numbness or tingling of the extremities, you can rule out a neck or back injury by lightly feeling over the entire spine from the neck to the lowest part of the back for any tenderness. If any tenderness is present, then assume possible fracture and get an EMT. If there is no tenderness over the entire spine and no numbness or tingling of the arms or legs, then it is probably safe to focus on obvious injuries.
Evaluate the rider's body systematically from head to toe. You have already ruled out breathing difficulty, cervical spine and back injury and level of consciousness. Now, evaluate quickly for any major lacerations and apply pressure if the rider is bleeding (this may include a protruding bone fracture). Next, assess chest wall tenderness for rib fractures along with abdominal pain from blunt trauma such as smashing into a handlebar. Abdominal pain may be the result of a liver or spleen laceration, which is potentially life-threatening. Don't write it off when a rider complains of abdominal pain. At this point, the rider is stable, and we can focus on major joints such as shoulders, elbows, wrists, hips, knees and ankles for any fractures.
Remember, triage involves evaluating the possibly life-threatening and most serious injuries first. Triage of the downed rider must be done quickly and efficiently. Don't focus all your attention on the obvious minor injury (it's the injuries you can't see that can kill you)-be systematic.
CPR (airway, breathing, circulation): They say breathing is important.
Brain function: Helps determine level of crisis and if the patient can provide any help with diagnosis.
Spinal cord: Potentially devastating injury, don't make a bad situation worse by moving the rider.
Blunt trauma: Internal injuries, mild to moderate abdominal pain can be a life-threatening sign.
Fractures: If it looks funny, it's probably broken; if the bone is sticking out, it's a no-brainer.