Witnessed Nasty Accident

photonic69

Well that was a shocking start to 2019! After getting up too late to do our usual Brean Down NYD walk we decided on the Bath Skyline. Just setting off From the car half way up a long steep hill we hear a sickening thud. A man in his mid 60s on an eBike had lost control coming down the steep part, hit the pavement and slammed into the wall. My son saw it happen. I was just behind but my view was obscured by a car. We rushed over to see him but he was motionless. Immediately dialled 999 as another guy came to help. The chap was lying face down and I could see blood pooling under his face. His helmet was badly damaged. Following my recent First Aid training I wanted to roll him over to Aid his breathing and administer cpr but the 999 call handler insisted I did not move him in case of neck or spinal injury. This was contrary to the training we had been given and I was extremely concerned as his colour was going grey. Fortunately the first ambulance arrived very quickly followed by a second and paramedics and finally the air ambulance and police. They took control of the situation and turned him. His face, nose and mouth were very damaged and they had trouble clearing his mouth and airway of his false teeth that had broken. They gave cpr and attached the defibrillator which advised that shock was not required (as per our training) they continued cpr and injected adrenaline and other drugs. The police took our statements and details and advised us that we should carry on and take the kids away from the situation as there was nothing we could do further to help.

We left. It was not looking good for the poor chap. I sincerely hope the outcome is better than I fear. My thoughts and prayers are with him and his family whoever they are.

I still can't help but feel that I could have done more with the training we had but now having seen the extent of his face injuries and the difficulty the team had it was probably best to take the advice from the call handler. It was only minutes before the ambulance arrived. If it had been more remote it would have been a lot worse.

Take care on hills.

photonic69

The First Aid quals are:

Sports First Aid
Automated External Defibrillator
Adrenaline Auto Injection Module
Level 3 Emergency First Aid at Work (incl management of catastrophic bleeding)

So fairly competent at First Aid. Now thinking back there was probably little I could have done differently

akh

Well done for what you did. It's understandable you're thinking about it now, but it sounds like you made a positive contribution and did all you realistically could.

andyh01

Sounds horrific, echo point of thoughts with him and his family, and yours hope kid isn't too disturbed by witnessing it.
I've done similar first aid courses, my sports first aid was two day course same with emergency first aid at work both by St. Johns, fortunately I've never had to rely on it and I certainly don't feel confident enough to do anything other than call the professionals and do as instructed.
The sports training is for rugby and whoever is at the head end is in "control" and stays with patient until help arrives, I will therefore let more "confident" people be responsible. I'd rather get blankets and direct ambalance in. Obviously different if on own and no choice in the matter.
The first aid trainer also advised as far as they're aware no one has yet been sued for trying to help and making things worse;, might break a few ribs doing CPR but be saving a life. In this case seems the risk of breaking neck wasn't a necessary risk to save a life and if incorrect it'll be on the operators conscience who are far more qualified than layman even with some first aid "training"

poweredbyidris

Well done PhotoNic - sounds like you made the right decision at every step. Easy with hindsight to say you would've done something different, and I assume that if the ambulance had taken longer to reach you, you could've been more pro-active thanks to your training.

First.Aspect

As others have said, it sounds like you did what you could.

I once had a car roll in front of me and I had to help the family out via the windscreen. Couldn't do anything other than turn ignition off and comfort driver though, who had a nasty scalp wound and wasn't coherent. This has stayed with me for some time and I think of it every time I go through the nearest village. I don't know if he was okay or not.

I was an adult, so your kids are going to have been left with similar deep impressions. But at least they will think their dad is pretty awesome.

Wayne Plunger

Echo what others have said with regard to your attempt to help.

trivial_poursuivant

If it wasn't for the fact he can do stupid things like this, I would have read what MF had to say as he is an army medic and some of the first aid/ triage knowledge they have is second to non.

First Aid courses are great and I am not knocking them but I wonder if the guy teaching it was thorough.

Following my recent First Aid training I wanted to roll him over to Aid his breathing and administer cpr

did you check for his pulse and breathing first? That should be the immediate thing to do before anything. you can easily block an open airway by moving someone over if their tongue falls back, at least if they are laying face down you can put them in the 3/4 prone position and monitor the breathing and pulse that way until the ambulance/paramedic arrives.

cooldad

Bloody ebikes....

johngti

Sounds like you did things right but I’m surprised your trainer told you to roll an unconscious casualty. If he was breathing and had a pulse, after an accident like that not rolling him was the right thing to do. In a past life I used to do first aid training, right up to the 4 day courses and did some ambulance aid courses for myself. It’s only at that level that we started to be able to confidently move a casualty with possible spinal injuries. On the more basic courses we’d tell people not to unless their airway and breathing were compromised.

It’s not easy dealing with any incident so we’ll done for managing as well as you did.

redvision

Sounds awful, I hope he is ok. Have you heard anything about his condition? Local news often report such accidents.

Fwiw I had a collision in October and was knocked unconscious. Apparently the 999 operative advised those who called for an ambulance not to move me due to potential spinal damage. As it turned out I had several fractures, including breaks to the neck and back and according to the specialists, by not moving me they saved me from further injury - possibly paralysis.

Mad_Malx

Apparently he is still in a serious condition.

https://www.avonandsomerset.police.uk/news/2019/01/cyclist-seriously-injured-following-collision-in-bath/


There have sadly been a number of serious cycling accidents on that bend.

Matthewfalle

Right - initially many apols and much humble pie - was a knob last time and admit it.

I’m just going to offer some words on this - please take it or ignore it as you see fit. as TP has alluded, I have done a bit of this stuff both military and civvie so have a view. This is a view based on what Nic has said above - I wasn’t there so can’t say exactly what I would have done and every case is different. That is my caveat.

With things like this you should be looking at mechanism of injury (the “MOI”) - this is what we as medics and paramedics look for: injuries such as haemorrhaging, visual fractures, etc have to be dealt with but the MOI can lead to us thinking that underlying these distracting injuries are further injuries that are more serious.

Further, the MOI also leads us to thinking what caused the accident in the first place - did the guy faint causing the bike to crash, was it just a loss of control, diabetic collapse, cardiac, was he drunk? This brings in thoughts of secondary treatments. Do we need to look at anti opiates, is he so drunk that he will start to lash out, do we need canulate and get fluids in, etc.

In this case the MOI was the bike crash: initial view is guy puts bike into wall, unconscious, bleeding from the face, looking like low resps. So far so good. Or bad.

Initial first aider thought is as you had - roll him over, aid breathing, get visual on facial. Logical.

The problem with this is if the casualty is still breathing in the prone face down position and it’s only minor haemorrhaging from the face (bleeding can look serious but facial and cranial lead to a lot of blood without much real injury) then without anyone else or any equipment you can just leave him - monitor Airway, Breathing and Circulation, response (through AVPU - Alert, Verbal, Pain, Unresponsive) and disability, keep him warm and just leave him. Well, not leave him, as in walk away but no further interventions. You are now there for the duration.

Face down also means that gravity is helping keep fluids away from blocking his airway - they will come out naturally. You can aid this by placing his head gently to one’s side as per the 3/4 roll/rescue position.

If he is conscious then the best thing to do is to keep him warm, comfortable, hold his hand and talk to him: it’s simple, works and is something I drum into people when I instruct which I do a lot of (lead trauma management instructor).

Remember as well that if you come into contact with any fluids - blood, sputum, etc - then you are now looking at infection control issues. It’s why we wear gloves.

If you move him, what we are looking at from this MOI is potential basal skull injury, potential spinal (especially cervical if it is a head on impact into a wall/pavement leading to compression of the spine and as the old adage goes, C1-5 keeps you alive). Then look at collarbone, ribs, jaws, teeth, etc. Cranial fracture is also up there. There are certain things you look for when ascertaining what’s going on but I won’t cover them here.

Further, as TP has said, rolling him over can lead to the tongue being swallowed (amongst other things being swallowed - teeth/false teeth, anything he was eating, vomit coming up and blocking airways, etc) which means that you have to employ an airway opening technique (head tilt chin lift or jaw thrust) or deal with the foreign object, which takes one person out of the equation completely. Further, if you have an existing spinal injury then it’s really tricky to do - if you are containing that spinal through use of someone providing spinal support (hands around the base of the head/top of neck) then it’s a tricky technique to do plus once you have control of the head you should never ever leave it. If the person providing support hasn’t got them selves into a prone position from the start (people not used to this tend to go on their knees which gets really uncomfortable really quickly leading to them moving around and disturbing the head) it’s got potential to go wrong.

Incorrect rolling of a spinal patient is bad and can lead to paralysis, death and other Bad Stuff. Please don’t do it.

To roll a spinal patient over there are several techniques/bits of equipment (either a log roll, scoop board, other bits dependant on where you are) but these take training and you need the actual equipment. You won’t be taught these on basic first aid courses as you don’t have the time to practise them and you need someone else who knows what they are doing to work with you,

For the average bod in the street the best thing to do is immediately call an ambulance, check 《C》, A, B, C, control D (Disability) and E (Environment), control the situation - get someone to take children and other bystanders away, keep the patient warm etc as above. Prepare a full statement for the ambulance - time of accident, what happened, AVPU status. If you can, accurate pulse and resp rate although the ambulance guys will do all this on their arrival.

Ask the patient if they are comfortable - what might look like a really weird position to you could be comfortable for them and if they are comfortable why move them?

Also, by talking to them you are also immediately monitoring Airway and Breathing - if they can talk then they can breathe. Listening to them also give loads of information: are they slurring? Do they smell of booze? Are they making sense? Slurring can point to brain injury, stroke, drunk, hypothermic, hyperthermic: loads of stuff but to a medic it’s a good indicator.

For haemorrhaging all the average guy/girl in street will be able to do is apply pressure, elevation and maybe wrap something around the wound - even if you have a first aid kit it’s going to a crepe bandage and maybe some swabs. Please do not go buying off the internet other things that you think will help. Military we have some great things, civvie ambulance we also have access to some military techniques and equipment but to the average bod it’s a no - no. Compression and elevation please.

Also, remember patient dignity: please treat any patient like you would want your children or mother to be treated - keep gawkers away, cove any injuries, if you have to uncover them to look at anything then cover them up straight away. This rule applies to both the high street and operational situations. I tend to get very angry when people forget this.

If you can then a brief Primary survey is always great but please don’t go Secondary or Tertiary - not only would you not know what’s you are looking for but then there’s are also legal aspects.

We will then use other techniques to ascertain what is going: we’ll start at the basics - blood sugar, O2 levels, move on to Glasgow Coma Scales, 3 lead and 12 lead ECGs and onwards.

Hope the above makes sense - am more than happy to discuss any of it further either here or pm.

And again, apologies for being a knob. It’s a talent of mine. I have a degree in it.

andyh01

@matthewfella, I think I understood your original point (that even a two day course doesn't necessarily provide one with the necessary training/experience to deal with an actual serious incident) just poorly expressed at the time and I could understand how it could be misconstrued.
Good on you for realising your shortcomings, it could of been bad day/rushing unlike your detailed explanation and respons.

trivial_poursuivant

AndyH01 wrote:

@matthewfella, I think I understood your original point (that even a two day course doesn't necessarily provide one with the necessary training/experience to deal with an actual serious incident) just poorly expressed at the time and I could understand how it could be misconstrued.
Good on you for realising your shortcomings, it could have been bad day/rushing unlike your detailed explanation and respons.

Lol

Alright Fella?

You deserved that!!

Matthewfalle

Trivial poursuivant wrote:

AndyH01 wrote:

@matthewfella, I think I understood your original point (that even a two day course doesn't necessarily provide one with the necessary training/experience to deal with an actual serious incident) just poorly expressed at the time and I could understand how it could be misconstrued.
Good on you for realising your shortcomings, it could have been bad day/rushing unlike your detailed explanation and respons.

Lol

Alright Fella?

You deserved that!!

Matthewfalle

AndyH01 wrote:

@matthewfella, I think I understood your original point (that even a two day course doesn't necessarily provide one with the necessary training/experience to deal with an actual serious incident) just poorly expressed at the time and I could understand how it could be misconstrued.
Good on you for realising your shortcomings, it could have been bad day/rushing unlike your detailed explanation and respons.

Cheers dude - much appreciated.

superkenners

My old Dad has just bought an ebike. I've already expressed this fear given he opted to remove the speed limiter and, at a decade older than this poor chap, has the reaction times of a koala.

I generally enjoy saying I told you so, but it has its limits, as does my fondness of natural selection and general tenancy to show little sympathy with people who do stupid things (horse to water and all that). I suspect there will be quite a few in this unfortunate boat.

andyh01

Not wishing to start the dreaded helmet debate, however, one of the points of the restrictions is what protective equipment is required. On the higher rated ones they're classed more as moped and therefore by law, require full facial crash helmet, not sure whether leathers and boots are required by law.

gethinceri

Leathers & boots are not a legal requirement on any form of road transport.

andyh01

I thought for mechanical propelled eg motorbike UK legislation states you must wear helmet?;

helmets
You must wear a safety helmet when you’re riding a motorbike on the road (except members of the Sikh religion who wear a turban). All helmets sold in the UK must meet certain standards – see GOV.UK for the safety helmet standards.

proto

Helemets, yes. Not ‘full facial’ crash helmets.