(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.

GET ASSISTANCE:

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:

  1. 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 jurisdictions.

  2. 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 pain")

    • Apparent chief problem ("He's broken his leg", or maybe simply "he's unconscious".)

  3. IS THE VICTIM AWAKE (CONSCIOUS)? ("He is", "he is not", he wasn't but is now", etc.)

  4. HOW IS THE VICTIM BREATHING? ("OK", "he's having difficulty", "he's having a great deal of difficulty", "he's not breathing at all.")

  5. 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.

  6. 6.WHAT'S THE VICTIM'S APPROXIMATE AGE? ("Mid 20s", "early 50s", "young child", etc.)

  7. 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!

  1. 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.

  2. 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)

  3. 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 Respiration). Bleeding can be controlled by direct pressure and/or elevation of affected limbs (if elevation can be performed without affecting spinal alignment).

  4. 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.

Note (2):
  • 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.)

CRAMS

CATEGORY DESCRIPTION: SCORE (points)
Circulation Normal pulse & color - 2 -
Weak pulse & poor color - 1 -
No pulse at wrist - 0 -
Respirations Normal - 2 -
Abnormal (e.g., labored) - 1 -
Absent - 0 -
Abdomen & Thorax Non-tender - 2 -
Tender - 1 -
Flail or penetrating wounds - 0 -
Motor Functions Normal - 2 -
Responds only to pain - 1 -
No response - 0 -
Speech Normal - 2 -
Confused - 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:

  1. Unlock appropriate gates.

  2. Plan a practical location for EMS equipment to park near the emergency.

  3. 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.)

  4. 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.

  5. 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 these assignments.)

  6. 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.)

  7. 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 minutes away.

  8. Turn victim(s) over to EMS personnel in a "professional" manner.

    • Briefly describe what happened (including whether witnessed or unwitnessed).

    • 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 help.

    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 CARE".)

    1. Take the horse(s) a safe distance away from the victim(s) for assessment.

    2. Determine if veterinary help is needed (from a distance if safety warrants).

    3. Briefly convey your findings to someone who can telephone a veterinarian and relay that information.

    4. Keep the same person with the horse, if practical.

    5. Maintain security at all times.

    6. Consider that the entire situation will be both unusual and tense, which horses will react to accordingly.

    7. 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.

    8. Injured horses may have enough adrenaline flowing that they may exhibit completely unexpected powerful and athletic behavior.

    9. An escaped panicked horse will not see turning helicopter rotors, which can add a new dimension of chaos to your emergency scene.

    10. 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.

    11. Always have a competent, experienced horseman handle involved horses.

    12. Always handle horses extremely calmly and use conservative judgement in emergency situations.

    13. Never, ever, ever, ever leave the horse alone.

    14. Consider that other uninvolved horses could be similarly excited, depending on what's going on and the related level of activity.

    15. Once confined, don't approach the horse unless you have to.

    16. Consider that even the calmest horse can react unexpectedly and do you serious harm.

    17. If you have to approach the horse, use proven, safe handling techniques.

    18. If you have to provide first aid for the horse, find a proper location, eliminate distractions, and focus solely on the horse.

    19. Consider postponing definitive care for the horse until the noise and activity surrounding the injured rider subsides.

    20. 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 horse(s).

    CONSIDER THE POSSIBILITY OF A MEDICAL HELICOPTER LANDING:

    1. If the injury is significant, a medical helicopter may be enroute.

    2. 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.

    3. 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.

    4. 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, and these objects should be identified and secured, if necessary.

    5. 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.

    6. 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:

    1. Have a first aid kit.

      • Have it readily available.

      • Know what is in it.

      • Know how to use it.

    2. Maintain access to an emergency phone wherever practical.

    3. Pre-plan how emergency personnel can best access your facility for emergencies in various locations.

    4. 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 under control.

    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.

    Notes:

    1. 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 rescue squad.

    2. Emergency first aid information is available from the American Red Cross.


    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.

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