Cycle First Aid by Steve Evans SRPara MCPara Liverpool Century RC Member

1. Cycle First Aid by Steve Evans SRPara MCPara Liverpool Century RC Member Opening Slide, The benefits of cycling far outweigh the dangers or risk of accident, but a fact of life accidents do happen, and quite often not the cyclists fault, so it is sensible to teach all cyclists, Road, Race, Off Road Mountain Bikers, First Aid.Opening Slide, The benefits of cycling far outweigh the dangers or risk of accident, but a fact of life accidents do happen, and quite often not the cyclists fault, so it is sensible to teach all cyclists, Road, Race, Off Road Mountain Bikers, First Aid.

2. Cycle First Aid Whether out cycling alone or in a group the cyclist may be the First Person on scene, so a working knowledge of First Aid would be of use, there is a need to understand the mechanics of Trauma,common injuries, underlying problems and how to treat them and the course tries to do this.Whether out cycling alone or in a group the cyclist may be the First Person on scene, so a working knowledge of First Aid would be of use, there is a need to understand the mechanics of Trauma,common injuries, underlying problems and how to treat them and the course tries to do this.

3. Cycle First Aid Aims of First Aid Preserve Life Prevent Condition Worsening Promote Recovery Send for Help Early 999 or 112 State the aims of First Aid, these are the same whether you are a First Aider, Fire fighter or Police officer,Preserve life even if the patient ends up in a wheel chair, prevent getting worse by keeping the blood within the patient, promote recovery by good spinal control, phone early for help.State the aims of First Aid, these are the same whether you are a First Aider, Fire fighter or Police officer,Preserve life even if the patient ends up in a wheel chair, prevent getting worse by keeping the blood within the patient, promote recovery by good spinal control, phone early for help.

4. Systematic Approach C - Care � Be aware of danger to yourself �A dead rescuer is no good to anybody� and to the casualty and others Moving traffic Blind Bends Spilt fuel Create a NO smoking area Having a systematic approach will help you, as in an emergency situation it is good to have a plan A As stated a dead rescuer is no use to anybody.Create a safe scene, make use of bystanders or other cyclists.Having a systematic approach will help you, as in an emergency situation it is good to have a plan A As stated a dead rescuer is no use to anybody.Create a safe scene, make use of bystanders or other cyclists.

5. Systematic Approach C - Care R - Reconnaissance � You need to know how many Casualties there are, for each unconscious / seriously injured casualty you need an Ambulance ( 3 on the floor = 3 Ambulances ) Each Ambulance only has 1 stretcher so when phoning 999 it is very helpful to tell the Ambulance control how many Patients cannot get up off the floor no matter what reason, unconscious, broken leg etc.Each Ambulance only has 1 stretcher so when phoning 999 it is very helpful to tell the Ambulance control how many Patients cannot get up off the floor no matter what reason, unconscious, broken leg etc.

6. Systematic Approach C � R � Inform � Dial 999 or 112 for the Ambulance Service or other Emergency Services if there is spilt fuel, threat of fire, trapped casualties, dangers to others Early phoning for the Emergency services means help will arrive sooner.Early phoning for the Emergency services means help will arrive sooner.

7. Systematic Approach C � R � I � Treat the casualties according to their needs remember your Priorities Catastrophic bleed, Airway, Breathing Do NOT Move the Casualty unless their life is threatened Having sent for help, sort out Catastrophic Bleeding, Airway being Neck (Cervical) Aware and Breathing.these will be covered in greater depth later on in this course.Having sent for help, sort out Catastrophic Bleeding, Airway being Neck (Cervical) Aware and Breathing.these will be covered in greater depth later on in this course.

8. Common Injuries Head on - Head and Face, Potential Neck � check the damage to the cars windscreen, Chest or Abdominal, fractures to thigh bone, (handle bars) hand / thumb Side impact - Traumatic amputation of lower leg or fractures / dislocated ankle FOOSH - Fractured Clavicle/Shoulder, broken wrist/forearm Over Half of Cyclist who end up in hospital have Head injuries,50% Arm, 40% Leg, 5% Chest/abdomen. Road Rash This slide explains the most common injuries a Cyclist will encounter.FOOSH is Fallen On Out Stretched Hand, a common injury.This slide explains the most common injuries a Cyclist will encounter.FOOSH is Fallen On Out Stretched Hand, a common injury.

9. Common Injuries Upper Limbs are the most common injuries these include Collar Bones and Shoulder.Upper Limbs are the most common injuries these include Collar Bones and Shoulder.

10. Consider the Damage Look at the potential for injuries,internal and external In this slide we can see the Cyclist has substantially damaged the rear of the car so must have been travelling at speed. We would be drawn to the poor cyclist lying on the floor but we must also look to the damage that has occurred helping us to suspect certain injuries.In this slide we can see the Cyclist has substantially damaged the rear of the car so must have been travelling at speed. We would be drawn to the poor cyclist lying on the floor but we must also look to the damage that has occurred helping us to suspect certain injuries.

11. Priorities Catastrophic (life Threatening ) Bleed Airway � clear if blocked or open if not breathing, being aware of potential Neck Injury, Cover open chest wounds Cervical Awareness � DO NOT Remove Helmet unless life is threatened Breathing � if No then start resuscitation A patient will bleed out quicker I.e. die from a massive bleed rather than die from a blocked airway, within 3 minutes from a Femoral bleed versus 3 to 4 minutes from a block airway were the Tongue blocks it.The UK Resuscitation Council states if breathing is less than 6 per minute the patient is officially not breathing as this will not sustain life, so chest compressions should be started.A patient will bleed out quicker I.e. die from a massive bleed rather than die from a blocked airway, within 3 minutes from a Femoral bleed versus 3 to 4 minutes from a block airway were the Tongue blocks it.The UK Resuscitation Council states if breathing is less than 6 per minute the patient is officially not breathing as this will not sustain life, so chest compressions should be started.

12. The No 1 Cause of Death The No 1 Cause of Death in Trauma is a blocked Airway When Unconscious the tongue drops to the back of the Casualty�s throat blocking their airway This is preventable by performing a Jaw Thrust or Chin Lift Most people have a tongue and when they become unconscious they and their tongue become floppy it then blocks the airway.the Jaw thrust holds the patients head and allows the rescuer to open the patients airway so is the preferred manoeuvre were Trauma is involved.Most people have a tongue and when they become unconscious they and their tongue become floppy it then blocks the airway.the Jaw thrust holds the patients head and allows the rescuer to open the patients airway so is the preferred manoeuvre were Trauma is involved.

13. Tongue Blocking Airway As seen in the picture the tongue of the unconscious patient drops to the back of the patients throat blocking their airway.As seen in the picture the tongue of the unconscious patient drops to the back of the patients throat blocking their airway.

14. Jaw Thrust Preferred way of opening a traumatically injured patients airway is by performing the jaw thrust, this must be the first action of choice as it keeps the neck still as we do not want to make neck injuries any worse.Preferred way of opening a traumatically injured patients airway is by performing the jaw thrust, this must be the first action of choice as it keeps the neck still as we do not want to make neck injuries any worse.

15. Criteria for Helmet Removal A Blocked Airway that cannot be cleared in any other way The Casualty's Chest or Abdomen is not rising and falling (Not Breathing) The need for Resuscitation Remember that it takes 2 Persons to remove a Helmet safely We need only to remove full face helmets and only if the above criteria is met, most cycling helmets do not need to be removed in the early stages of an accident.We need only to remove full face helmets and only if the above criteria is met, most cycling helmets do not need to be removed in the early stages of an accident.

16. Control Of Haemorrhage Catastrophic bleed needs sorting out First, remember a patient may bleed out faster than they will die from a blocked airway.Catastrophic bleed needs sorting out First, remember a patient may bleed out faster than they will die from a blocked airway.

17. Wound Types Contusion (bruise) Laceration � tearing of the tissue Incision � clean cut with sharp knife Puncture � penetrating wound Graze / abrasion � Road Rash The Different types of wounds bruising of Lungs and Brain are life threatening,Laceration is easier to control, straight cuts are harder to control, think of a cut garden hose, blood pours of a vein and pumps out of an artery, leave penetrating objects in place, we will cover road rash now.The Different types of wounds bruising of Lungs and Brain are life threatening,Laceration is easier to control, straight cuts are harder to control, think of a cut garden hose, blood pours of a vein and pumps out of an artery, leave penetrating objects in place, we will cover road rash now.

18. Road Rash OUCH !!!OUCH !!!

19. Road Rash These injuries look and feel painful Look beyond the gore Are there underlying injuries Fractures Internal Injuries/bleeding Head Injuries This slide explains what to look for.This slide explains what to look for.

20. Road Rash Treatment Check for Underlying Injuries Wash out Dirt and Grit Cover with Clean dressing Needs scrubbing within a medical centre to prevent scaring and promote healing Moist dressings help the healing process Check for Infection later on,i.e. redness, hot to touch, swelling in Armpit or Groin The treatment of road rash.The treatment of road rash.

21. Body�s Reaction to Bleeding The body reacts three ways to control bleeding Blood clots Ends of vessels contract Blood pressure falls A chemical reaction takes place when red blood cells are damage they clump together to form a clot,if you stretch an elastic band when it snaps the ends curl over and so do human blood vessels, but over time they uncurl and start to bleed, as blood leaves the body there is a drop in pressure, we help the body by raising wounds above the heart providing the limb is not broken.A chemical reaction takes place when red blood cells are damage they clump together to form a clot,if you stretch an elastic band when it snaps the ends curl over and so do human blood vessels, but over time they uncurl and start to bleed, as blood leaves the body there is a drop in pressure, we help the body by raising wounds above the heart providing the limb is not broken.

22. Blood Loss P - Posture / Position E - Expose / Examine Remembering we might consider raising the limb and the patient might feel faint it is good practice to either sit or lie the patient down, we then need to see what we are dealing with I.e. penetrating trauma.Remembering we might consider raising the limb and the patient might feel faint it is good practice to either sit or lie the patient down, we then need to see what we are dealing with I.e. penetrating trauma.

23. Foreign Objects We cannot see what the end of this object looks like so leave it in place as we do not want to do more damage, increase bleeding or let infection in.We cannot see what the end of this object looks like so leave it in place as we do not want to do more damage, increase bleeding or let infection in.

24. Splinter from the Velodrome track

25. Blood Loss P - Posture / Position E - Expose / Examine E - Elevate P - Pressure Continuing with PEEP we need to raise the un fracture limb or head above the heart and apply direct .or indirect pressure to the woundContinuing with PEEP we need to raise the un fracture limb or head above the heart and apply direct .or indirect pressure to the wound

26. Pressure Points Brachial � Upper arm, underneath the bicep muscle pressing against the upper arm bone Get students to find this pressure point.Get students to find this pressure point.

27. Pressure Points Along side major bones are major blood vessels by pushing the bicep muscle up and away you can normally find the brachial artery.Along side major bones are major blood vessels by pushing the bicep muscle up and away you can normally find the brachial artery.

28. Pressure Points Brachial � Upper arm, underneath the bicep muscle pressing against the upper arm bone Femoral � upper 3rd of the groin pressing the femoral artery against the rim of the pelvis this will take 2 thumbs The femoral artery is very hard to find and takes a massive amount of pressure to stop the bleed.The femoral artery is very hard to find and takes a massive amount of pressure to stop the bleed.

29. The femoral artery runs over the rim of the pelvis.The femoral artery runs over the rim of the pelvis.

30. Pressure Points Brachial � Upper arm, underneath the bicep muscle pressing against the upper arm bone Femoral � upper 3rd of the groin pressing the femoral artery against the rim of the pelvis this will take 2 thumbs Apply for Max 10 mins then release for 1 minute to flush the build up of toxins then re-apply if required As the slide says only apply pressure for 10 minutes before considering reapplying it.As the slide says only apply pressure for 10 minutes before considering reapplying it.

31. Shock Signs & Symptoms Pale, cool, clammy skin Ashen, cyanosed skin Fast weak pulse Rapid shallow breathing Nausea Feeling faint � lower level of consciousness These are the signs and symptoms of shock, when the body is under attack it shuts down the outer edge thus keeping the blood in the core feeding the brain, heart and lungs.These are the signs and symptoms of shock, when the body is under attack it shuts down the outer edge thus keeping the blood in the core feeding the brain, heart and lungs.

32. Shock-The Falling Lift Early � Disorientated / Confused Compensates by � Fast Pulse - Rapid Breathing - Pale cool Clammy Skin Feels Faint Late Sign � Cyanosed Late Sign - Unconsciousness As the patient starts to go further into shock the body starts to compensate, the brain starts to lack oxygen and so speeds up the heart rate and breathing and shuts down the skin, once it can no longer cope the patient starts to pass out and goes blue (cyan), the passes out before dying.As the patient starts to go further into shock the body starts to compensate, the brain starts to lack oxygen and so speeds up the heart rate and breathing and shuts down the skin, once it can no longer cope the patient starts to pass out and goes blue (cyan), the passes out before dying.

33. Shock - Treatment Treat the possible cause Loosen tight clothing Rest � comfortable position Reassurance � Nil by Mouth Consider raising the legs � Not in Cardiac cases The role of the first aider is to help the body to help itself.The role of the first aider is to help the body to help itself.

34. Head Injuries Laceration to scalp Concussion � shaking of the brain Compression � Bleeding in skull Skull fracture � cranium / base Head injury is high in cycling injuries and so the different types are laceration a cut head which bleeds lots and is difficult to dress.concussion of the brain can mask bleeding within the brain, compression means the brain is being squashed and can lead to death, fractures of the skull can lead to bleeding within the brain.Head injury is high in cycling injuries and so the different types are laceration a cut head which bleeds lots and is difficult to dress.concussion of the brain can mask bleeding within the brain, compression means the brain is being squashed and can lead to death, fractures of the skull can lead to bleeding within the brain.

35. Levels of Consciousness Alert and responsive Verbal - Responding to speech Pain - Responding to pain Unresponsive -No response These are most important when dealing with severe head injuries It is important to note the initial level of consciousness as this will help to tell the paramedics if the patient is getting better or worse.It is important to note the initial level of consciousness as this will help to tell the paramedics if the patient is getting better or worse.

36. Compression Head Injury Left picture good health no blood in skull and pupils equal, left picture shows bleeding within the skull causing compression of the brain with associated signs.Left picture good health no blood in skull and pupils equal, left picture shows bleeding within the skull causing compression of the brain with associated signs.

37. Compression Head Injury Bleeding within the Skull compressing the brain Loss of Consciousness Unequal Pupils Flushed face Slow full bounding pulse Vomiting TREATMENT = 999 Ambulance Be Neck Injury Aware Compression can lead to death if not spotted or treated quickly.Compression can lead to death if not spotted or treated quickly.

38. Concussion Shaking of the brain Loss of Consciousness � amnesia Vomiting Headache/dizziness = Hospital Broken helmet = more serious Treatment, Monitor the Patient for changes, take to hospital if concerned Concussion can mask a brain bleed so should be treated as serious.Concussion can mask a brain bleed so should be treated as serious.

39. Head Injury Treatment Gain history Monitor AVPU, Breathing, pulse Dress any wounds If Unconscious A.B.C. Treatment remember the patients level of consciousness is really important.Treatment remember the patients level of consciousness is really important.

40. Functions of the Skeleton Gives shape and support Protects internal organs Along side major bones are major blood vessels / nerves for protection This slide is explains some of the functions of the skeleton.This slide is explains some of the functions of the skeleton.

41. Classifications of Fractures Closed � the bone is fractured but there is no external wound Open � there is an external wound leading to the site of the fracture. The bone may be protruding Complicated � the ends of the bones have damaged underlying organs Today fractures/ broken bones now only come in 3 categories and can be a mixtures of the above. Today fractures/ broken bones now only come in 3 categories and can be a mixtures of the above.

42. Hand Injuries Picture of different hand injuries at a cyclist might suffer.Picture of different hand injuries at a cyclist might suffer.

43. FOOSH-Arm Injuries Fallen on to out stretched hand FOOSH.Fallen on to out stretched hand FOOSH.

44. Broken Collar Bone A typical cycling injury can you see the step or drop of the arm.A typical cycling injury can you see the step or drop of the arm.

45. Broken Collar Bone As you can see within the body why we see the step.As you can see within the body why we see the step.

46. Complications of Collar Bone injury Damage to Underlying Organs- Punctured Lung causing difficulty in breathing Damage to blood vessels- Arteries and veins leading to blood loss Damage to nerves- loss of movement or sensation Along side major bones are major blood vessels and nerves.Along side major bones are major blood vessels and nerves.

47. Signs and Symptoms of Collar Bone Injury Pain over the area of the break A bump may be felt or a step seen A reddish-purple bruise starts to appear The shoulder appears to sag or drop Inability to raise the arm due to pain People report a popping or snapping sound Signs and Symptoms of a fractured clavicle.Signs and Symptoms of a fractured clavicle.

48. Treatment of Collar Bone Injury Look for Underlying problems, breathing or massive swelling Apply a sling or at least support the injured side Treat for shock Give pain relief if available Send to hospital for an X-Ray Do not allow to ride any further Treatment for fractured clavicle.Treatment for fractured clavicle.

49. Leg Injuries Pictures of different types of breaks.Pictures of different types of breaks.

50. Signs & Symptoms of a fracture Swelling Loss of movement Irregularity Pain Deformity Unnatural movement Crepitus Tenderness Shock If along side of bones are blood vessels then they might be damaged causing swelling, damaged nerves means loss of movement, misshapen bones are deformed and irregular, pain comes from misplacement of the ends of the bone, crepitus is felt as the ends of the break grate against each of other, obviously it would be tender and each bone when broken has a shock value, so a fractured upper arm is like loosing 2 pints of blood a fractured fermur is like loosing 4 pints of blood and a fractured pelvis is the same as loosing 10 pints of blood.If along side of bones are blood vessels then they might be damaged causing swelling, damaged nerves means loss of movement, misshapen bones are deformed and irregular, pain comes from misplacement of the ends of the bone, crepitus is felt as the ends of the break grate against each of other, obviously it would be tender and each bone when broken has a shock value, so a fractured upper arm is like loosing 2 pints of blood a fractured fermur is like loosing 4 pints of blood and a fractured pelvis is the same as loosing 10 pints of blood.

51. Fractures - Treatment Upper limbs � support in a comfortable position Lower limbs � do NOT move unless life is threatened Lower limbs � do NOT attempt to straighten limbs Treat for Shock Do no harm is the way forward, you can cut off the circulation to a hand or foot by straining a limb.Do no harm is the way forward, you can cut off the circulation to a hand or foot by straining a limb.

52. Strains & Sprains Strain � history of over stretching - sudden sharp pain - swelling possible cramps Sprain � history of twisting a joint - pain at joint - swelling possible discolouration Not all limb injuries involve breaks but without the aid of X-ray sometimes you can�t tell the difference.Not all limb injuries involve breaks but without the aid of X-ray sometimes you can�t tell the difference.

53. Strains & Sprains Treatment Treatment for both R.I.C.E. Rest Ice � bag of frozen peas in a cloth Compress � not to tight Elevate � to the height of a stool Treatment of strains and sprainsTreatment of strains and sprains

54. Spinal Injuries The Trauma Head holdThe Trauma Head hold

55. The Spine The spine, 33 bones balanced one on top of each other is a double s shape, with the head the weight of a ten pin bowling ball balanced on top.The spine, 33 bones balanced one on top of each other is a double s shape, with the head the weight of a ten pin bowling ball balanced on top.

56. Catastrophic neck fracture.Catastrophic neck fracture.

57. Spinal Injuries - Causes Sports accidents Road Traffic Collisions Falls Vertical Deceleration Injury Diving Accidents Head injuries Direct force injuries Different causes of spinal injuriesDifferent causes of spinal injuries

58. Spinal Injuries � Signs & Symptoms History is Vital May be no obvious signs of injury Lack of sensation Pins & Needles Inability to move limbs Back or Neck pain No symptoms present � damage yet to be done Rescuers put more people in wheel chairs than accidents, within the spinal column is the spinal cord which cannot be repaired when damaged.Rescuers put more people in wheel chairs than accidents, within the spinal column is the spinal cord which cannot be repaired when damaged.

59. Spinal Injuries - Treatment If you suspect a spinal injury The Casualty must Not be moved unless their life is threatened Keep the head still � Trauma Head hold Do not allow others to interfere Remember � there is no second chance Always rule out spinal injury when dealing with a traumatic cycling injury.Always rule out spinal injury when dealing with a traumatic cycling injury.

60. Trauma Head Hold The preferred hold of the suspected spinal injury.The preferred hold of the suspected spinal injury.

61. Spinal Injuries If there is Vomit or blood in the Casualty�s airway and it cannot be cleared. Then there is need for a Log Roll to be performed Log Rolls can only be performed safely with 4 persons, one to hold the head and control the rest of the group, there is a need to work as a team and roll the Casualty on to their side as one unit (Log) This is only used when the alternative is death.This is only used when the alternative is death.

62. Cardio Pulmonary Resuscitation Funny graphic.Funny graphic.

63. Priorities for CPR D - Danger R - Response S - Stop Life Threatening Bleeding A - Airway - be Neck Injury Aware B - Breathing NO dial 999 C - Compressions / Rescue Breaths (1 person to hold the head) The new approach to the unconscious patient.The Action button only works if you are also using the BHF Buying Time DVD.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything.The new approach to the unconscious patient.The Action button only works if you are also using the BHF Buying Time DVD.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything.

64. Trauma Head Hold When performing CPR on the suspected spinal injury, one person to perform the trauma head hold and the second rescuer to perform chest compressions.When performing CPR on the suspected spinal injury, one person to perform the trauma head hold and the second rescuer to perform chest compressions.

65. Hand Position - Adult

66. Adult Basic Life Support The UK Resuscitation Council recommendation for Life Support, note there is a reluctance for rescuers to start chest compressions as the patient may be gasping in their dying breaths, below 6 breaths per minute the patient IS dying, start Chest Compressions.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything. The UK Resuscitation Council recommendation for Life Support, note there is a reluctance for rescuers to start chest compressions as the patient may be gasping in their dying breaths, below 6 breaths per minute the patient IS dying, start Chest Compressions.as of October 2010 the rate of Chest Compressions is 100 to 120 at a depth of 5 to 6 cm, bystander chest compressions are better than not doing anything.

67. Effectiveness of Rescuer CPR There is a need to if possible change the person doing the chest compressions every 2 minutes as you quickly lose efficiency.There is a need to if possible change the person doing the chest compressions every 2 minutes as you quickly lose efficiency.

68. ICE in your Mobile It is recommended that you place In Case of Emergency (ICE) in your contacts within your Mobile phone It is good practice as Emergency workers like Doctors , Nurses and Paramedic will be able to contact your family if you are Unconscious or Badly injured Place Name, Number and relationship After the London Bombing the Emergency Services had difficulty contacting relatives of the Unconscious and Badly Injured and a Paramedic suggested that ICE in your mobile would be a good way of carrying this information as most cyclists will take their mobile out with them in case of breakdown or trouble.After the London Bombing the Emergency Services had difficulty contacting relatives of the Unconscious and Badly Injured and a Paramedic suggested that ICE in your mobile would be a good way of carrying this information as most cyclists will take their mobile out with them in case of breakdown or trouble.

69. Really Bad Cycling InjuryHelmet Hair Now to add some humour after all this doom and gloom.Now to add some humour after all this doom and gloom.

70. Any burning questions, THE END. Any burning questions, THE END.

71. Cycle First Aid by Steve Evans SRPara MCParaLiverpool Century RC Member Steve Evans NHS Paramedic with over 39 years in the Ambulance Service and author of this presentation, Steve is also a member of Liverpool Century Road Cycling Club.Steve Evans NHS Paramedic with over 39 years in the Ambulance Service and author of this presentation, Steve is also a member of Liverpool Century Road Cycling Club.