Advocacy & Safety - Unconscious/Immobile on Hot Pavement

This came up in discussion with another desert cyclist over the weekend.

Lets say a cyclist is involved in an incident during the hottest part of day that leaves them unconscious or immobile.

Ideally someone who is non-professional helping should not move the injuried due to possible neck/spinal/head injury. i.e. "Do not move a victim who is seriously injured unless he or she is in imminent danger of death" or "Unless an exposure to greater injury exists at the scene of the accident, no attempt should be made by non-medically trained persons to move an accident victim who appears to have sustained broken limbs or back or head injuries."

But what if it is 115F outside (in the shade), the sun is blasting down and the pavement surface temp is 175F? Add to that the injured has been cycling and their body temp is already elevated.

Would being on the traveled way (even if blocked) and being under great heat and burn exposure would constitute "exposure to greater injury"

Al

But what if it is 115F outside (in the shade), the sun is blasting down and the pavement surface temp is 175F? Add to that the injured has been cycling and their body temp is already elevated.


Probably the same thing as if the vfictim were lying on railroad tracks or in the middle of a busy road and traffic bearing down. Make the best of a difficult situation. In this case provide whatever shade is possible and pour liquid on the victim; if not possible, move him or watch him die.

As a retired fire chief and ex-emt, my advise is to NOT move them (unless you are certain there is no spine injury).

What I mean is, if you come across the person laying next to their bike, you have to assume that they fell, and that there is a spine injury. If you observed them fall and hit the ground hard, you assume there is a spine injury. In both of these cases, the rule is to make sure that someone has called 911 and that help is on the way, check for breathing, and if that's OK, then establish alignment and maintain traction and immobilization on their head.

Note that if they're not breathing, it is essential to establish an airway and get respiration going, and if that takes moving their head and causing further damage to their (assumed) spinal injury, then you have to do that. It's no use to preserve their spine from injury if they die due to respiratory or cardiac arrest. Go to CPR.

If it's really hot (and pavement in direct sunlight on a summer day can get hot enough to burn you) well, they can recover from the burns. Recovering from a damaged spine due to being moved incorrectly is not so easy.

If you are certain there is no spinal injury - lets say your riding buddy started feeling weak, got off the bike and sat down, then keeled over (heart attack, heatstroke, low blood sugar, whatever), and you observed this to be the case - then it would probably be OK to move them either onto grass, or put a blanket under them or something. You observed them go down from a sitting position, and could probably assume that there was no mechanism of injury that would damage their spine.

On a similar subject, I was talking to a bicyclist once who told me that his club recommended that all their members write identification information on the inside of their helmets - the assumption being that the emts would find it there and make notifications, etc. Let me tell you, there isn't any emt worth his badge that's going to remove a bicyclist's helmet if he's been in an accident. He'll just do his patient assessment and treat anything life-threatening, apply a cervical collar, slap you on a backboard with head blocks, and transport. The helmet will come off in the emergency room.

You don't move the patient. YOU DON'T MOVE THE PATIENT!
You're risking a permanent spinal injury for the sake of a burn.
I'm a volunteer ski patroller, sort of an emt for skiing/similar training

You shade the patient if possible. You aren't going to significantly raise body temp under those circumstances in the time before EMS arrives. If you're really concerned you could go get some cold soda cans and put them under the patient's armpits and maybe in the groin area (if you're confident that a) you won't cause the patient to wake up and move and b) you can asure the patient's right to decency and privacy.

Remember EMS shouldn't be more than 10 mins away, less in most cases.

Don't move the patient unless you know the ways to do it and minimize the chances of making a spinal injury something permanent. There are several techniques.


edited to add-> Put your emerg contact info on the outside of your helmet on both sides. One will usually survive and be readable. Include any meds you take, allergies to any meds, med conditions, emerg cont name and phone, and blood type.

....edited to add-> Put your emerg contact info on the outside of your helmet on both sides. One will usually survive and be readable. Include any meds you take, med conditions, emerg cont name and phone, and blood type.Wouldn't it make sense to have all information--I.D., contact & medical-- on a bracelet?

Wouldn't it make sense to have all information--I.D., contact & medical-- on a bracelet?

Nice idea, but there are instances where that bracelet may become disconnected... better it is a Medalert type neck chain. IE dogtag.

except that ppl won't wear a bracelet every time, some not at all. You also have to put the info somewhere ems or the emerg room will find. They will definitely inspect the helmet for damage after they remove it from you.

I disagree about removal of the helmet on scene. A helmet would definitely compromise getting someone on a board cleanly. The head would be elevated and you'd never get the blocks on in such a way as to minimze movement completely like you can with the lid off. We're trained to remove them and I would hope that most ems would be as well and would take it off on scene while maintaining c-spine alignment. The helmet would then get transported to the er with the patient.


If you want to wear a bracelet check these out.
http://www.roadid.com/
You can also get a dogtag at a pet store.

Nice idea, but there are instances where that bracelet may become disconnected... better it is a Medalert type neck chain. IE dogtag.Hoo-ahh!

I think if that were sort of the de facto standard, EMTs could routinely search for those.

I wouldn't touch them unless I needed to administer CPR. Try to find something to cover them if it was really that hot.

This source (Australian) suggests on page 19 that burns from hot pavement is reason to move unconscious:

http://www.ipe.nt.gov.au/whatwedo/mvr/roaduserhandbook/section2.pdf

Al

This source (Australian) suggests on page 19 that burns from hot pavement is reason to move unconscious:

http://www.ipe.nt.gov.au/whatwedo/mvr/roaduserhandbook/section2.pdf

Al Well...in this case they are wrong. Even a full thickness/3rd degree burn pales in comparison to a spinal injury. And so does elevated core temperature. The cyclist would have to be on the pavement a while for the core to be dangerously elevated via conduction. If it's a cyclist and you didn't see it, you have to assume that the mechanism of injury necessary to cause unconsciousness (a crash or collision) would also be sufficient to cause spinal injury. Since you don't have xray eyes you have to assume and treat for the worst.

The most important thing: ABC- Airway, Breathing, Circulation.

Assess and treat any bleeding, assess and treat for shock. Go back to ABC

Unless the situation is life threatening, DO NOT MOVE THE PATIENT. Get someone to call 9-1-1 if you can't do it and have them return. Return to ABC

The most important thing: ABC- Airway, Breathing, Circulation.

Assess and treat any bleeding, assess and treat for shock. Go back to ABC

Unless the situation is life threatening, DO NOT MOVE THE PATIENT. Get someone to call 9-1-1 if you can't do it and have them return. Return to ABCIsn't there a point at which the patient's temperature does become life threatening? And how does somebody just passing by know when it's about to become life threatening?

Isn't there a point at which the patient's temperature does become life threatening? And how does somebody just passing by know when it's about to become life threatening?

They would have to be there for a bit of time before that would become a problem. If you can call 911 the ambulance should be there before that happens.

Even if they have been down for a bit the burn/heat problem can be treated en route to the hospital. A snapped spine can't.

Isn't there a point at which the patient's temperature does become life threatening? And how does somebody just passing by know when it's about to become life threatening?
Yes, but the point here is that you aren't equipped with a rectal thermometer or in a position to know that.
We're assuming in this case that the next level of care (ems introduction) to the scene is a few minutes away. If this is a wilderness setting where the next level of care was possibly hours away, things can change and you would need to safeguard the spine and potentially move the patient. There are ways to move someone and minimize though not eliminate the chance that you make a spinal injury permanent.
On the street if the person was exhibiting signs of heat stroke then you might take additional measures, but you still wouldn't move the patient because ems would only be a few minutes away. ...and you're not going to cool the core in a few minutes anyway.

Yes, but the point here is that you aren't equipped with a rectal thermometer or in a position to know that.
We're assuming in this case that the next level of care (ems introduction) to the scene is a few minutes away. If this is a wilderness setting where the next level of care was possibly hours away, things can change and you would need to safeguard the spine and potentially move the patient. There are ways to move someone and minimize though not eliminate the chance that you make a spinal injury permanent.
On the street if the person was exhibiting signs of heat stroke then you might take additional measures, but you still wouldn't move the patient because ems would only be a few minutes away. ...and you're not going to cool the core in a few minutes anyway.
Doncha mean that YOU are assuming that the next level of care (ems introduction) to the scene is a few minutes away? There was nothing in the OP that would lead me to make that assumption, nor to assume that the EMS were notified, or are only minutes away, or that the person coming upon the victim has any means of communication available.

Doncha mean that YOU are assuming that the next level of care (ems introduction) to the scene is a few minutes away? There was nothing in the OP that would lead me to make that assumption, nor to assume that the EMS were notified, or are only minutes away, or that the person coming upon the victim has any means of communication available.

If your out in the middle of no where by yourself with no phone then that is another problem. I think its safe to assume that most of us carry cell phones or could find one rather quickly if the need arose. In most places the EMS should be able to get to them relatively quickly (within minutes).

If they are out on some rural road and you don't have an immediate means to communicate with the EMS then you should probably be riding and finding a means. Most people aren't trained on how to respond to this and shouldn't attempt to do anything. Common sense doesn't work well in this situation and even the most well intentioned action can have devastating consequences. At most you could try to cover them or provide the shade quickly before seeking help.

There is no reason to risk their life or add to your own liability by moving the person.

Doncha mean that YOU are assuming that the next level of care (ems introduction) to the scene is a few minutes away? There was nothing in the OP that would lead me to make that assumption, nor to assume that the EMS were notified, or are only minutes away, or that the person coming upon the victim has any means of communication available.
He said pavement surface temp of 175. That means blacktop roads, and unless we're talking about the desert or extremely rural locations, that means EMS is probably less than 10 minutes away.

...and I addressed your concern if it is hours away above. If you believe the person is in danger of death from heat stroke and ems is hours away, then yes, you would need to take certain precautions to try and minimize the risk by an impromptu c-collar and/or additional stabilization before moving the patient from the hot pavement.

In general and in the vast majority of situations, moving the patient is an extremely bad idea.

He said pavement surface temp of 175. That means blacktop roads, and unless we're talking about the desert or extremely rural locations, that means EMS is probably less than 10 minutes away.
I was thinking of urban/suburban setting

The Bureau of Emergency Medical Services, part of the Arizona Department of Health Services, requires ambulances in the Valley to respond to Code 3 medical emergencies, such as heart attacks and strokes, within 10 minutes. Ambulances are required to be at the scene within 20 minutes for all emergency calls.

Current response rate is 88.5% of code 3 emergencies meet the 10min requirement.

This is of course after the call is placed.

Al

As a former USAF Pararescueman, an EMT who worked in the field in the 1970s, and a safety professional who has worked in professional safety for since 1978, I have a few thoughts here. First, we positively do not move a patient unless there is life-threatening situations developing that would necessitate that move. That is a given, and as stated by tpelle above, any movement could potentially compromise the spine as we must assume a spinal injury in a bicycle crash.

Having said that, there are situations which could develop into a life-threatening situation. I live in the Pacific Northwest, in the Willamette Valley and Columbia Basin area of Oregon. For us, there will almost never be a time when we will reach a surface asphalt temperature of 175 degrees F. But I understand that there are places where this may happen. So what are the ramifications of that surface temperature? I'll give some ideas (take them with a grain of salt--figuratively speaking), about two situations, internal body temperature and skin burns.

Concerning increasing the internal body temperature, that will be difficult to ascertain without a thermometer. Ideally, the temperature should be taken rectally to be accurate. This, in a first aid situation, may be difficult, but if you have a thermometer, take the temperature. Be very concerned about any temperature over 102 degrees, as the heat may still be being added to the body from the outside.

Second, concerning burns, this could be a significant factor. Yes, people can recover from burns. But in a bicycle accident, there will already be "road rash," or abrasive, injury to the skin. This could already be extensive. Now, remember the "Rule of Nines:"

http://www.nda.ox.ac.uk/wfsa/html/u10/u1010_01.htm

For a major body burn, about 15% of the body surface is involved in an adult (10% in a child) according to this site. If you scroll down, you'll see the representation of the body and the "rule of nines." According to this, if a bicyclist is down on his or her back, on the asphalt that is burning his/her skin, potentially the back is 18% of the body, and one side of one leg is 9% of the body. One side or one arm (probably the minimum amount involved for an unconscious victim of a bicycle crash) would be about 4.5% of the body surface. So if the asphalt is hot enough to burn the skin (and probably it will keep burning for some time), we could expect to see (9% x 3) + 4.5% = 31.5% of the body burned. Let's say that in the crash a lower arm on the other side, and a lower leg suffered read rash (deep abrasions). That would add 4.5% x 2 = 9% to the skin affected. So this person would potentially have over 40% of his/her skin either burned or abraided by the crash. If those burns were second or third degree burns, then that would be pretty serious.

Now, so far as what would cause a burn for a surface temperature, there are charts available. The Semiconductor Equiment and Marketing Industry (SEMI) has guidelines (SEMI S2) for equipment surface temperatures to prevent burns. SEMI S2 states in Comment R123-6 that the
proposed hazardous surface temperatures for extended handling and touching of glass/porcelain handles, knobs, et., during normal usage (again assuming 1 minute) is 65 degrees C. The limit of MIL-STD-1472D is 59 degrees C for "prolonged contact" with glass. The EN563 burn threshold limit at 1 minute is 56 degrees C. Thus, the proposed temperature limit appears to be slightly high for reasonably foreseeable extended handling contact with glass/porcelain surfaces of moderate thremal conductivity. THe paragraph 18 Table 1 limit is 56 degrees C, which is the more conservative of the recommendations. This limit could be raised based upon the results of the risk assessment of actual and foreseeable normal usage."

Would being on the traveled way (even if blocked) and being under great heat and burn exposure would constitute "exposure to greater injury"

Al

Yes. That said, there are alternatives to moving them that should be pursued first.

I wasn't discounting the rule of nines. The burns are not immediately life threating, so moving the patient wouldn't happen unless the patient was going to be stuck there for a lot longer than it would take ems to arrive (long enough that the burns or increased internal temp would create the immediate problem. That's unlikely. Things could be done to minimize burned surface area without compromising the spine on the scene if the patient was on a very hot surface and say ems was 20-30 mins out.

I've done my share of backboards on substantial and minor mechanisms of injury and I think the take-a-away from this discussion is pretty simple. Don't move the patient unless you see the patient go down from non-trauma, ie, medical. If there's any hint of a non-medical problem meaning a traumatic injury, leave the patient as is and encourage him/her not to move. In general, treat for ABC if you've been so trained, otherwise leave the patient as is and have someone call 911 and return to the scene to tell you it's been done.



John did you work up in AK?

I did not get to finish my thought at work on this subject. I got to the rule of nines, and had to leave it at that. I worked in Oregon, not AK. My PJ work was world-wide, but mostly USA (Florida) and Asia (Korea, Vietnam, etc.).

My thoughts are that there may need to be a different protocol in areas with high sunlight (lots of sun energy--desert areas in summer) than in other areas. I say this because a large body burn, while not immediately life-threatening, can be very debilitating and can also in the longer run be life-threatening. At the top, nosebeam stated that the pavement temperature gets to 175 degrees F. I showed where temperatures at 56 degrees C (132 degrees F) can cause burns over time. Tar and asphalt hold heat well, and could be more dangerous than steel as a heat source.

Because of that, the first priority would be to insulate the person from the burning pavement. This can be done with blankets (not "space" blankets, however--the heat will go right through them, and they may even melt), preferably wool. Jackets (but who would have them on a 110 degree F day?) could also be used. People putting their hands under the person (our palms will fare better than our backs for hot surfaces), and other improvised techniques could also be used.

We don't, if at all possible, want to move the person. A bicyclist will have almost no clothing to use to move him/her anyway. The American Red Cross, and other first aid providers, recommend against moving a person unless there is no alternative. If an ambulance is on it's way, the best thing is not to move the person.

But, you need to assess whether the surface is too hot to allow the person to stay on it. Use the back of your hand for this, as it is more sensitive than your fingers or palm. Try to get an idea of the nature of the injury, and whether a spinal injury is possible (see tpelle's explanation above). Then you will need to make a decision. If a person will definitely get burned by being on the pavement (more than already has occurred), I would consider the possibility of moving the person, but only if there is an viable alternative nearby, and if the risk of the burn outweighs the potential for further injury. Realize that if the asphalt is that hot, and the person has already been on it for awhile, chances are that the damage is already done, and probably won't proceed further (the person's body water will dissipate heat, even on asphalt). Also, there could be complications in a move to another place that is contaminated if there are third-degree burns.

I've been rather thinking out loud here, and it looks like my thinking has come around to not moving the individual.

John

Space blankets do make a great improvised canopy to shade them though, so there is that. I carry one anyway as it only weighs a couple of oz and they are just too useful in so many ways and can fit in my underseat bag or trunk nicely.

I tend to agree with the thinking of not moving the individual.

As to 175F - I found several varied sources on the web. One stated 172F, another 176F and a third 180F. One can surely count on >160F for most summer days and at these higher quoted values during peak summer months when the ambient shade temp is 115F-120F. Likely pavement temp depends on material, age, wind speed, ambient temp, atmospheric filtering of the sun and of course time of day.

Another source (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WB0-4HF5D8X-5&_user=10&_coverDate=11%2F30%2F1995&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8ade03a07015375436367cffa7090d5e)I found said that skin burning will happen during summer months between 9AM-7PM. 2nd degree burns will occur in summer months between 10AM-5PM in under 35 seconds. As to full depth (3rd degree) I don't know, and 'summer months' vary greatly in ambient temp (90-120F)

I also wonder about the cooling vs. heating effect on the body. I am considering the cyclist who has already worked up high body temp - much cooling is already derived from the activity. Is then flat on ground with maximal pavement contact and no longer has water intake. Yes, rectal temp is only way to tell.

I am not suggesting that moving body is appropriate (unless one is absolutely certain that it is a medical only condition.) But I do wonder about the secondary dangers and what can be done to prevent (shade, cooling water (applied how so as to be OK?)

Apparenly this is of not wide concern or a significant concern even locally given the sparse information available. But it is an interesting question to me, but not a 'worry.'

Al

Gentle application of a wetted cloth will provide a lot of evaporative cooling, and an improvised canopy can help. Make sure you don't compromise airway though. Just getting the direct sun heating off of them will help a lot.

ALWAYS: Remove from IMMEDIATE DANGER is First and foremost. You can't help someone while they are still in immediate danger. The fact that they are cooking on the pavement is a situation that can be resolved with some creative thinking.

Do you know the mechanism of injury? What happen and how did they get there? Did they crash or were they riding along and had a seizure? Heart attack? Stung by a bee? Bitten by an animal?

First I'd like to say I appreciate the great topic.

What is the best, if any, way to move someone in this situation? This is assuming that, for whatever reason, they MUST be moved and quickly. Best way for 1 person to move them...2 people?

Several weeks ago, I was riding outside of LaCenter, when I came around a corner to find the girl who had passed me less than half a mile earlier in bad shape. She had lost traction on a little gravel in a corner, left the road, and ended up ramming the butt end of a guardrail sideways at rural road speeds. No seat belt. Growing up with medical professionals, I'd always heard good advice, but the only thing anyone at the scene knew for sure at the time was, don't move her. There wasn't any obvious profuse bleeding. None of us knew anything about cpr, although she was breathing, if not very well. From the places she had obviously been inside that car, it's amazing she was breathing at all.
I'm convinced. When you're stuck contemplating what you're going to do if things gets worse, and if you might just kill or paralyze this person through your own ignorance, simple common sense isn't even an option in a situation like this. Either you know what you're doing or you keep your hands off until someone qualified arrives. And even out on the rural roads, the pros were on the scene in a few minutes. A cell phone was by far the most important bit of first aid equipment any of us had.
I've got to agree here:

In general, treat for ABC if you've been so trained, otherwise leave the patient as is and have someone call 911 and return to the scene to tell you it's been done.

There is no "best" way to move the victim in this situation. You have to evaluate the situation before you, and make a decision based upon what is on the ground. You need to know yourself, your strengths and weaknesses, your size, the victim's size, and the road conditions in order to do a one-person move. Notice I did not say "lift," as there are several alternatives.

One Person

--You can drag the person by the ankles. Advantage--it's quick, and will move the victim of a bigger size. Disadvantage--can lead to more spinal injuries, contribute a head injury (leave the bicycle helmet on if you do this and the victim is wearing a helmet).

--If the victim is on his/her back, you can cradle the head (keeping it in the same orientation you found it, if possible) with your elbows as you reach under the armpits and pull the person.

--Shoulder-knee arms carry. Advantage--it's fast, can easily be used for a lighter victim than yourself. Disadvantage--in a spinal injury, most likely will further injure the spine.

--Fireman's carry (older nomenclature). Advantage, if you know how to get an unconscience victim up, you can carry them further. Disadvantage--again, you will most probably further injure a spinal injury.

Two Person & more

--Fore-and-aft carry--push the person to a sitting position, one person behind grabs under the arms and around the front; the other person steps between the legs (looking the same direction as the person behind), grabs the knees, and both lift, then move the person to the safe area. Advantage--it's quick and sure for moving a person fast. Disadvantage--spinal injuries could be made worse.

--Improvised litter--use a blanket placed on two poles (one pole inside the first fold of the blanket, the other innside the secod), roll the victim on his/her side, place the improvised litter under with material to spare, roll the victim onto the other side, pull the material out the other side, roll the victim back on his/her back, and then pick up both ends. This can be done with jackets and vests too, but the material must be strong. Ideally, one person would be stabilizing the head/neck, while two other people lift the victim at the ends of the improvised stretcher. Advantage--less risk of spinal injury. Disadvantage--still risk of making a spinal injury worse.

There are a number of other carries available, but just looking over these tells you that you are making a decision that the danger of leaving the person is greater than the potential danger of increasing the injury to the spine.

John

Several weeks ago, I was riding outside of LaCenter, when I came around a corner to find the girl who had passed me less than half a mile earlier in bad shape. She had lost traction on a little gravel in a corner, left the road, and ended up ramming the butt end of a guardrail sideways at rural road speeds. No seat belt. Growing up with medical professionals, I'd always heard good advice, but the only thing anyone at the scene knew for sure at the time was, don't move her. There wasn't any obvious profuse bleeding. None of us knew anything about cpr, although she was breathing, if not very well. From the places she had obviously been inside that car, it's amazing she was breathing at all.
I'm convinced. When you're stuck contemplating what you're going to do if things gets worse, and if you might just kill or paralyze this person through your own ignorance, simple common sense isn't even an option in a situation like this. Either you know what you're doing or you keep your hands off until someone qualified arrives. And even out on the rural roads, the pros were on the scene in a few minutes. A cell phone was by far the most important bit of first aid equipment any of us had.
I've got to agree here:

In general, treat for ABC if you've been so trained, otherwise leave the patient as is and have someone call 911 and return to the scene to tell you it's been done.
One of the maxims of medicine is "do no further harm." In the above situation, even though an ambulance is on its way, one thing that almost anyone can do is to stabilize the victim's head/neck in-place (the way you find it), allowing no further movement that would further compromise the spinal cord. To do this, get behind the victim, talk calmly about what you are doing, gently place your hands to both sides of the head with your fingers toward the jaw, and tell the person to relax and not move. Keep that position until the paramedics arrive, or unless there is breathing/heart difficulty and mouth-to-mouth or CPR must be performed.

Also, if you are inclined to learn these new skills, think about taking a first air/CPR class.

ALWAYS: Remove from IMMEDIATE DANGER is First and foremost. You can't help someone while they are still in immediate danger. The fact that they are cooking on the pavement is a situation that can be resolved with some creative thinking.

Do you know the mechanism of injury? What happen and how did they get there? Did they crash or were they riding along and had a seizure? Heart attack? Stung by a bee? Bitten by an animal?
There is one other thing that you must, absolutely must, do, and that is to protect yourself. It does the victim no good at all if you go out into a highway and get yourself hit and seriously injured. You need to survey the scene for dangers to yourself and the victim, then take the appropriate action. That action may be to first ensure that traffic cannot get to the victim by having it effectively stopped (flares, blocking with a vehicle--yes, that could be some bikes, etc.). This could serve the duel purpose of stopping the danger to the victim, while at the same time removing the necessity of moving the victim. It could also save your own life.

John

I want to state it again here. If you haven't been trained don't move the person. It's as simple as that.

Wait for EMS. A desire to be a good person/samaritan and help doesn't replace knowledge. If you don't want to feel helpless go take a first aid, first responder, or emt class. Someone that has been trained will a) know how to move a person with minimal risk to causing further harm and b) understand what factors to consider in deciding whether a person needs to be moved.

I'd also disagree with someone holding the head in place without training. If, for example the patient roles over to puke (fairly common) and you're not ready to move with them you can make the problem worse by pinning the head in place as their body pivots onto the side. Encourage the injured individual to remain still (if conscious) and try to keep the scene safe for the individual to the extent you can. Don't add to the mess by adding additional victims for EMS to deal with if the scene is not safe.

It's not likely that you're going to be able to do anything with no gear on hand to save the person's life anyway (cpr not withstanding), but you might make things a lot worse.

I'd rather be burned than paralized, so don't move me.

I want to state it again here. If you haven't been trained don't move the person. It's as simple as that.

Wait for EMS. A desire to be a good person/samaritan and help doesn't replace knowledge. If you don't want to feel helpless go take a first aid, first responder, or emt class. Someone that has been trained will a) know how to move a person with minimal risk to causing further harm and b) understand what factors to consider in deciding whether a person needs to be moved.

I'd also disagree with someone holding the head in place without training. If, for example the patient roles over to puke (fairly common) and you're not ready to move with them you can make the problem worse by pinning the head in place as their body pivots onto the side. Encourage the injured individual to remain still (if conscious) and try to keep the scene safe for the individual to the extent you can. Don't add to the mess by adding additional victims for EMS to deal with if the scene is not safe.

It's not likely that you're going to be able to do anything with no gear on hand to save the person's life anyway (cpr not withstanding), but you might make things a lot worse.
So is your bottom line recommended action for any "untrained" cyclist who comes upon an injured person: Do nothing, no matter what? Only EMS people have the training necessary to determine if a person's life is in danger?

Yes. Even a trained person can't do much without gear. There is typically little corrective action that can be taken on scene, especially if it's a serious injury or medical condition, and even more so if there is no gear. Unlike tv, CPR rarely works. It's still worth knowing, though. If you understand how to treat ABC's those obviously trump everything else including a spinal injury and are worth attending to.

Moving someone is a matter of training. It takes a fair amount of practice to be good at it. There are plenty of folks that are very sloppy about it, including professionals.

For the sake of this scenario, however, if you didn't see the person go down/don't know for certain that it's a medical condition, then you have to assume trauma. Trauma that could indicate a spinal cord injury. If the ABCs are ok, then the patient's best interests are served by bystandards waiting for EMS who can evaluate and provide proper care and deliver to the next higher level of care while doing no harm.

In this scenario, if the patient is going to die in the next ten minutes/before EMS arrives, it's not likely that there would be much you could do anyway to prevent it, other than doing cpr/rescue breathing or attempting to stop a major bleed via quickclot or a tourniquet.

edited to add-> Put your emerg contact info on the outside of your helmet on both sides. One will usually survive and be readable. Include any meds you take, med conditions, emerg cont name and phone, and blood type.

I'm glad the issue was raised re: ID inside a helmet. As a cycling instructor actively involved in the CAN-BIKE program (and now BikeEd here in the States), I was sent samples of these trick units by the owner of HelmetGear: http://www.helmetgear.ca.

They're very well designed. As others have mentioned, there are ID bracelets and pendants on the market as well.

Allan

In my earlier response I stated that one must always assume that the mechanism of injury to cause a spinal injury is present, and to NOT move the patient. The exception to this, as I also stated, would be if you observed the person going down, and plainly there was no such mechanism of injury. The example I gave was someone feeling ill, getting off the bike and sitting down, then keeling over unconscious.

I think the www.helmetgear.ca (http://www.helmetgear.ca) thing posted above has possibilities. I didn't watch the link all the way through, but I gather it's a tag affixed to the outside of the helmet which, when peeled off, has vital info inside?

It seems like a cheaper, albeit less elegant solution, is to buy a Sharpie and write your info neatly on the outside of the helmet. But, write it on the OUTSIDE, as I still think emts are going to be reticent to remove the helmet of an injured victim.

Keep in mind that there's likely to be nothing going on UNDER the helmet that can be treated in the field by an emt. That's why they will most probably err on the side of safety and not remove the helmet.

I agree with the assessment that the situations we are discussing here are pretty much limited to places where an ambulance is 5 or 10 minutes away after dialing 911. Helicopters take likely a little longer - it takes a helicopter a few minutes to start up and spool up, as well as to circle to slow down when it reaches the LZ. If you're way out in the back country, or out in the middle of the Mojave or someplace when this bad crash occurs, well, somebody just might die.

Regarding placement of head blocks, etc. when a helmet is in place. Emts are taught to improvise. I was on a run once where we had to package and transport a lady that had suffered a recently-broken neck, and she had one of those "halo" jobbies screwed into her skull. THAT was a problem for the old head blocks. We immobilized her the best we could with pillows and gauze bandages.

Curious, how many of us carry a 1st aid kit? I have a small hiker's kit that I carry in my backpack.

I've moved a person who had obvious (lower) spine injuries and compound fractures in both legs away from a burning gas tank, it was rather unpleasant for us both esp as he was on fire from the waist up when I got to him. A car rear ended him at speed as he was putting gas into his sedan with a gascan, via the intake behind the rear license plate. He lived, barely, & that example is one that definitely called for moving the victim. Not a lot of instances where I'd move a body otherwise. He really shouldn't have lived, I was about 100 yards away walking home and saw it before during and after, I believe he was drunk (the other driver was definitely drunk & fled on foot despite his head injuries) or he wouldn't have survived.

However if I encountered a body on the pavement in the dead heat of a Texas summer there is a good chance I'd move them unless I had an accurate eta for medics. I don't believe the danger would be from burns in that situation, the true danger would be their overall/core body temperature rising too high in the time they're lying there. Heat stroke begins at 105F-106F core temperature and it would not take long to reach in the circumstances presented, perspiration stops as heat stroke sets in, breathing is often shallower in accident victims reducing an important heat vent, their proximity to the ground puts the air temperature they are breathing above their own core temperature. Core temp could go well beyond the redline in just 15-20 minutes, recipe for vegetable soup brain.

Thank goodness that the possibility of encountering such a situation is slim. The real question here is what to do with accident victims found with honeypots stuck to their heads in Yellowstone...do you crack the pot off & wash them to keep the bears off or wait for EMS?

The real question here is what to do with accident victims found with honeypots stuck to their heads in Yellowstone...do you crack the pot off & wash them to keep the bears off or wait for EMS?
depends if they're allergic to bees and if you have an epi-pen, or if you have bear binaca aka bear pepper spray

Curious, how many of us carry a 1st aid kit? I have a small hiker's kit that I carry in my backpack. I carry what I refer to as a quick bleed kit in a sandwich size ziplock. In it I carry 4 4x4s, a roll of cling gauze and 4 quikclot sponges. Anything else needed, I'll wait for EMS or deal with when I get home.

If you're not familiar with Z-Medica's Quikclot it's a sponge or granular powder that you pour or place into a life-threatening bleed/wound to coagulate and stop the blood loss. In their testing they had a 100% save rate on cows with severed femoral arteries. That's a bleed that can kill you in two minutes. It's really amazing stuff and has saved many lives. It came on the market about three years ago, I think and is slowly making its way into the kits of police and first responders. It's different than the shrimp shell thing that's obscenely expensive and arguably doesn't work nearly as well. While I doubt/hope I'll ever have to use it, I like knowing that it's there.
www.zmedica.com (http://www.zmedica.com)
www.quikclot.com (http://www.quickclot.com)

Also, if you are inclined to learn these new skills, think about taking a first air/CPR class.
Yes, that incident was definitely a motivator. There's nothing quite like the feeling you get when someone is obviously in terrible shape, and you don't have a clue what or what not to do. I don't think there was anything anyone there could have done in this situation; she had managed to ricochet back into a decent posture in the drivers seat and wasn't conscious or trying to move around. But things could have been a lot different!

The real question here is what to do with accident victims found with honeypots stuck to their heads in Yellowstone...do you crack the pot off & wash them to keep the bears off or wait for EMS?

Depends. Is the accident victim himself a bear, one who mutters "Bother" all the time. Wearing a slightly small red shirt, hangs out with a bipolar donkey, an amped out cat and something that looks like a cross between a rat, and armadillo and a small pig?

As to the original question, act on your best instincts in the situation.

What about pouring water on the person and the pavement under him/her. If the location is not remote, pleny of water should be available. If the location is remote, I would assume that the cyclist(s) would have at least some water.

Maybe one would be scared of waking an unconcious person and having them move from being startled. Sometimes it's hard to make the best of a bad situation.

Here is my story.

My bike friends came upon a cyclist who was lying in the road after an accident.

When they asked if he felt his legs he said no.

well they started to smell the burning flesh and decided to move him.
The guy was in a another bicycle accident and lost movement to his legs.
So he was handcycling at the time of accident.

What about pouring water on the person and the pavement under him/her. If the location is not remote, pleny of water should be available. If the location is remote, I would assume that the cyclist(s) would have at least some water. you'd have to move the person to get water under him.
water also increases heat transfer. take a dry rag and a soaking wet rag and grab a hot pot. You'll feel the wet one's heat faster. A soaking wet layer can transfer heat up to 25x faster than a dry one.

Here is my story.

My bike friends came upon a cyclist who was lying in the road after an accident.

When they asked if he felt his legs he said no.

well they started to smell the burning flesh and decided to move him.
The guy was in a another bicycle accident and lost movement to his legs.
So he was handcycling at the time of accident.
I still wouldn't move him because you don't know that he doesn't have a spinal injury at a higher level than his previous injury. You could get something under his legs if you could isolate them from his pelvis.

Here's a story from my old fire dept days:

One day one of our Captains was driving to work in his personal car, and came across a car accident that had just happened. The car had the driver's door jammed, and there were flames showing beneath the car and coming out from under the hood. The Captain got the passenger side door open, and found that the driver was moaning and complaining about his leg. The Captain saw that his left foot was twisted sideways and down under the pedals. The car was a stick-shift muscle car with bucket seats.

Anyway, the Captain told the driver that he had to get him out of the car, and that he was going to try being as gentle as possible but it was probably going to hurt. He got his arms around the driver's chest and started pulling and lifting him over the console to get him out on the passenger side.

The driver started yelling about how much his leg hurt. The Captain had already moved him a foot or so, but when he looked down at the guy's foot to see if it was coming out from under the pedals OK, he saw the guy's foot was still in the same place under the pedals, but that there was about 18" of his leg now sticking out from his pants cuff! The Captain realized that the guy's leg was pulling off! Turned out it was a prosthetic leg, and the pain was coming from the straps, etc. that was attaching it to the guy's stump!

The funny thing was that, when we rolled up on the engine, there was the driver laying over here and his leg was laying over there, and nobody seemed real concerned about it.