(c) 1992, Willis Lamm, TrailBlazer Magazine
"CITIZEN FIRST RESPONDER ON THE TRAIL"
By Willis Lamm
Reprinted with permission of TrailBlazer Magazine for non-commercial use.
YOU witness or come upon an equestrian accident. The rider appears
seriously hurt and the horse is loose. Do you know what to do? Will you make
the situation better or worse?
Several times a day, a rider somewhere in the U.S. is seriously injured.
The help he/she receives from friends and bystanders often can make a significant
difference. Unfortunately this help in an uneducated form can and has done
more damage to the victim than the accident itself. The purpose of this
article is to give you the information you need to help the injured rider,
while at the same time protecting yourself and others nearby.
OBSERVE AND ASSESS THE SITUATION:
An accident has just occurred. Before doing anything, observe the
situation and make an thorough initial assessment before approaching the
emergency or taking any definitive action.
In the situation where "Satan" is storming around in his box stall and his
owner is unconscious in the corner, the present dangers are obvious. Most
accidents, however, have less obvious dangers and as a result, would-be
helpers become too often included in the list of the injured.
If you did not actually witness the accident, take initial account as to
what probably has happened, how many persons and/or horses are involved, and
determine if the problem is still occurring. This assessment could include
asking witnesses what happened.
Upon recognizing that a probable emergency has occurred and no one has
taken any organized action, you need to take charge of the situation and
initiate an appropriate sequence of actions.
You can't do everything yourself, and most serious emergencies get more
complicated before they are resolved. If any other persons are round, get
their attention and ask for their assistance.
SECURE THE SCENE:
DO NOT approach the victim unless it is reasonably safe to do so. Once you
are focused on the victim, you will be inattentive of a loose horse or other
hazards. Assign someone competent to secure or keep away any loose animals.
If the accident has occurred on or next to a roadway, someone may also need to
warn approaching traffic. Maintaining safety for both the victim and the
rescuers cannot be overstated.
If the scene can't be secured, take only actions that can be reasonably
considered as safe and have someone responsible for focusing on safety while
you concentrate on the victim.
CALL PROFESSIONAL HELP:
Once it is safe to approach the victim, try to assess the seriousness of
the injuries. Convey your findings to someone who will call 9-1-1 (or local
emergency number if you don't have 9-1-1 in your area). Obviously, if it is
impossible for you to approach the victim and things look serious, or the
injuries look obviously serious before you approach the victim, don't wait to
send someone to call for emergency help.
The person calling for help should be prepared to answer the following
questions which may be posed by the emergency services dispatcher:
WHAT HAPPENED? Try to be specific. All too often we get dispatched to
"a rider down" which doesn't tell us much. A fall, being thrown, and
running into a tree, for example, can result in significantly different
injuries, which may prompt different medical responses in some
WHAT IS THE VICTIM'S CHIEF COMPLAINT? Falling off a horse is not a
complaint. The pain or injury that results is.
Actual complaint ("He's complaining of a lot of lower back
Apparent chief problem ("He's broken his leg," or maybe simply
IS THE VICTIM AWAKE (CONSCIOUS)? ("He is." "he is not," he wasn't but
is now," etc.)
HOW IS THE VICTIM BREATHING? ("OK," "he's having difficulty," "he's
having a great deal of difficulty", "he's not breathing at all.")
IS THE VICTIM BLEEDING? CAN YOU CONTROL IT? If you are not with the
victim, you may need to explain this to the dispatcher and indicate that
someone else is treating the victim.
- WHAT'S THE VICTIM'S APPROXIMATE AGE? ("Mid 20s," "early 50s," "young
WHAT'S THE VICTIM'S LOCATION? Be specific, and if you can send someone
out to the main roadway to flag down the emergency crew, indicate that
you can do so.
The dispatcher may give you some pre-arrival instructions. Try to remember
or write these instructions down. Someone else in the dispatch center will be
sending help, so take the time you need to get this information down correctly
and then take it to the rescuer that is helping the victim.
If you have more than one victim, be sure to indicate this.
If you are aware of any significant hazards (e.g., significant quantities
of leaking gasoline, possible entrapment by machinery, implements, etc., or
other factors which might require a specialized response) indicate these.
DON'T HANG UP FIRST.
DON'T MOVE ANY VICTIM UNLESS ABSOLUTELY NECESSARY FOR SAFETY AND WITH
PROPER PRECAUTIONS (described below):
PROVIDE CORRECT INITIAL CARE FOR THE VICTIM(S):
A. Check victim(s) for "A-B-C-D."
Check the victim for "A-B-C-D." After any fall or impact injury, this has
to be done with care as there is a reasonable possibility of spinal injury,
and the spinal cord could be severed through mishandling the victim. NO
MATTER WHAT YOU DO, DO YOUR BEST TO MAINTAIN THE SPINAL ALIGNMENT YOU FIND
THROUGH THE NECK AND LOWER BACK!
A is for Airway. Make sure the airway is open and unimpaired.
If the victim is unconscious, use the chin-lift method to clear
the tongue from the airway (if a problem.) Note (1)
If the victim is unconscious on his/her back and blood or other
fluids are filling the mouth, get help and carefully roll the
victim onto his/her side while maintaining spinal alignment.
B is for Breathing. Make sure the victim is breathing. Artificial
respiration may be required if the victim has stopped breathing but the
airway is clear. Note (1)
C is for Circulation. Make sure the victim has a pulse and is not
profusely bleeding. Lack of a pulse may require initiating CPR
(CardioPulmonary Resuscitation.) Bleeding can be controlled by direct
pressure and/or elevation of affected limbs (if elevation can be
performed without affecting spinal alignment.)
D is for Delicate central nervous system (primarily the spine.)
Mishandling the neck and lower back areas after an impact injury can
cause significant problems, including permanent partial and total
paralysis, or in some cases even death.
PROVIDE BASIC FIRST AID AS NECESSARY while avoiding any unnecessary
movement of the neck and lower back.
Many times, professional help is a long distance away. If practical while
help is enroute, assess the victim for trauma damage. An accepted practice is
by using the CRAMS scale. This scale should be posted in your first aid kit.
(While it is not the intent of this article to make medical experts out of
citizens, CRAMS suggests important observations that can be useful to
professional rescuers, particularly when there will be considerable time
between the accident and the arrival of professional help.)
||Normal pulse & color
||- 2 -|
||Weak pulse & poor color
||- 1 -|
||No pulse at wrist
||- 0 -|
||- 2 -|
||Abnormal (e.g., labored)
||- 1 -|
||- 0 -|
|Abdomen & Thorax
||- 2 -|
||- 1 -|
||Flail or penetrating wounds
||- 0 -|
||- 2 -|
||Responds only to pain
||- 1 -|
||- 0 -|
||- 2 -|
||- 1 -|
||No intelligible words
||- 0 -|
If the total score is 7 or lower, this is a significant finding.
Consider calling 9-1-1 back and advise that a citizen on the scene
checked the victim and he/she got a CRAMS trauma score of ____.
MAINTAIN CONTINUITY WITH THE VICTIM: The first person with the victim
should stay with him/her until relieved by someone of greater competence
unless the dynamics of the scene require otherwise. This provides continuity
of observations which can be conveyed to rescuers, as well as provides
reassurance to the victim.
PREPARE FOR ARRIVAL OF EMS PERSONNEL:
Unlock appropriate gates.
Plan a practical location for EMS equipment to park near the
Have someone meet rescue and ambulance personnel at the main roadway and
guide them to where it is safe to park and to the victim. If this is a
long distance, have them go in a vehicle, NOT on horseback. (I can't
tell you how frustrating it is to make good time to the address of an
injury just to waste precious time looking for the victim.)
Have someone keep approach lanes and required parking areas clear of
traffic, onlookers and animals. This is particularly important at
events where many cars, people and animals are present.
Plan a quick access path for EMS personnel from their vehicles to the
victim(s) and have someone escort them on foot.
(Note: If you have too many "helpers" on the scene, these are valuable
tasks which can be delegated. Since there will probably be more than
one arriving emergency vehicle, several people could be detailed to
Plan on the effect that EMS equipment and personnel and equipment may
have on large livestock and take mitigating steps. (This is
particularly important when emergency crews arrive in fire engines and
when helicopters are involved.)
Consider keeping an open, flat area clear for a medical helicopter
landing zone if you are served by a trauma center that is more than 20
Turn victim(s) over to EMS personnel in a "professional" manner.
Briefly describe what happened (including whether witnessed or
Briefly describe victim findings.
Briefly describe care given and other relevant actions.
Advise as to any scene security problems that still exist.
Lend additional help as requested, else stay nearby and available,
but out of the way.
Professional responders will probably want to view and "repackage" the
injuries that you have treated, so it's usually not a good idea to get carried
away with exotic bandaging. Do what needs to be done to protect the victim
until help arrives.
Also, EMS personnel will want to get some information from those who
assisted the victim, and other information directly from the victim first
hand. Questions directed to the victim are part of an assessment of the
victim's mental function and should be answered by the victim without
Arriving EMS personnel will also provide their own patient surveys,
repeating much of what you may have done. This process will repeat itself
several more times before a trauma patient receives definitive care in a
trauma center. A continuing patient history is important in diagnosis, so
don't think your observations and findings are being dismissed when the
professionals take over and do it all over again.
HAVE SOMEONE PROVIDE CORRECT INITIAL CARE FOR THE HORSE(S.) (This will be
discussed in greater detail in the next segment; "SAFE EMERGENCY HORSE
Take the horse(s) a safe distance away from the victim(s) for
Determine if veterinary help is needed (from a distance if safety
Briefly convey your findings to someone who can telephone a veterinarian
and relay that information.
Keep the same person with the horse, if practical.
Maintain security at all times.
Consider that the entire situation will be both unusual and tense, which
horses will react to accordingly.
Uninjured horses can be turned out into a secure paddock or arena,
however consider that some horses will want to get back to their riders
and may jump fences, break down gates, etc. potentially injuring
themselves and people nearby, and this tendency may increase as the
tempo of the emergency increases with the arrival of emergency personnel
and equipment. Use conservative judgement.
Injured horses may have enough adrenaline flowing that they may exhibit
completely unexpected powerful and athletic behavior.
An escaped panicked horse will not see turning helicopter rotors, which
can add a new dimension of chaos to your emergency scene.
The involved horse may refuse to go into a box stall or other
enclosure without a fight. If such difficulties are encountered,
weigh whether pursuing this option creates more of a potential
danger than selecting another plan.
Always have a competent, experienced horseman handle involved
Always handle horses extremely calmly and use conservative
judgement in emergency situations.
Never, ever, ever, ever leave the horse alone.
Consider that other uninvolved horses could be similarly excited,
depending on what's going on and the related level of
Once confined, don't approach the horse unless you have to.
Consider that even the calmest horse can react unexpectedly and do
you serious harm.
If you have to approach the horse, use proven, safe handling
If you have to provide first aid for the horse, find a proper
location, eliminate distractions, and focus solely on the
Consider postponing definitive care for the horse until the noise
and activity surrounding the injured rider subsides.
You may be in an emotionally charged state. Consider carefully
the advantages and disadvantages of life in a wheelchair before
"jumping in" to handle the horse. If the horse is secure, it's
often best to let things calm down a bit before taking action.
Perform all rescue activities while maintaining the safety of the
rescuer(s), victim(s), nearby persons (helpers and spectators), and
CONSIDER THE POSSIBILITY OF A MEDICAL HELICOPTER LANDING:
If the injury is significant, a medical helicopter may be enroute.
The helicopter needs a safe, open area to land... preferably away from
areas where livestock are kept and could be panicked by the rotor wash
and resulting flying debris.
EMS responders may not consider the effect the helicopter may have on
livestock. Thus someone should scope out an open area, clear of wires
and obstructions, close enough to easily carry the victim on a litter,
but in a location that would minimize panicking livestock and the
injuries and damage which could result.
In addition to the livestock problems, stables often have plywood,
roofing tin, and other light, flat materials stored for repairs which
could become dangerous if lifted by rotor wash. These objects should
be identified and secured, if necessary.
Surfaces such as inside arenas are not generally desirable due to the
large amounts of sand which will be whipped up. Removing vehicles from
a firm parking area, for example, may be a better choice.
If the discussion of a medical helicopter comes up, someone should be
prepared to assist EMS personnel in identifying the safest location for
the aircraft to land.
PLAN AHEAD FOR EMERGENCIES:
Have a first aid kit.
Maintain access to an emergency phone wherever practical.
Pre-plan how emergency personnel can best access your facility for
emergencies in various locations.
Pre-plan the safest, most secure place to confine a horse involved in an
accident. The closest pen may be convenient but may not be the best,
and you don't need an adrenaline pumped horse charging through the
middle of your emergency just when you think you have gotten things
DISCUSS EMERGENCY RESPONSES WITH FRIENDS, STUDENTS AND BOARDERS:
We don't like to think about being involved in emergency situations, so we
don't talk about them much. However, a little bit of well thought out
planning, conveyed to others so that they will understand it, will help a
great deal when a serious accident finally occurs. Don't wait until after you
experience a serious accident first-hand to get prepared.
Most local emergency service providers understand the serious risk
associated with the sport of horses, and will be surprisingly helpful in
assisting you with "pre-emergency" preparations, procedures and even help with
workshops for your friends, boarders and students. This is an important
element in reducing the serious trend in horse related injuries, and for those
of you who are professionals, keeping your insurance rates under control.
At the very least, you may be a more effective source of help the next time
you encounter a serious accident.
Airway and breathing management are included in CPR courses taught
by the American Heart Association and the American Red Cross, and
are oftentimes available through your local fire department or
Emergency first aid information is available from the American Red
Our thanks to TrailBlazer Mazazine for permission to post this
series on our web page.
You can visit the TrailBlazer website at www.horsetrails.com.
Email the author
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