10 Most Common Bicycling Injuries

Head & Spinal Injuries

Unfortunately, I have seen a lot of these. As a First Aid provider, probably the most important thing to remember is that ALL HEAD AND SPINAL injuries go to the hospital and the hard part is to make sure that we (bystanders/first aid providers/EMTs/etc) do not make the situation WORSE while trying to help the PT. As in cardiac incidents, there is no short cut on how to treat head and spinal injuries. First Aid providers need to be trained – in a controlled environment/class room.

Having said that, there is some information that I can share outside a First Aid Class but this information should in no way be considered a substitute for learning how to properly treat head and spinal injuries. Many head injuries are obvious – PT is bleeding from his/her nose/ears/mouth or there is blood oozing from their scalp – etc. These are obvious head injuries and it is no contest – keep the PT from hurting themselves – no movement –C-spine and call 911. However, there are the accidents where PT is not aware of his/her head injury. One of the first things to look for is a cracked or seriously scraped helmet. PTs with a helmet like this go to the hospital. If they will not go – call 911 and let the PT tell the ambulance EMTs he/she elects NOT to go for treatment. More than likely, the ambulance EMTs will convince the PT to go to the hospital. Explaining to a PT that they need to sign a release stating they refused medical care in case they die in 30 minutes. This will usually convince a PT to go to the hospital in the ambulance. As a first aid provider you have done your job – you have referred the PT to a higher level of medical care.

In a first aid class – providers are taught how to conduct C-spine and a head to toe – which includes how to feel a head in such a manner to discover any blood/fluids/crepitus (movement of broken pieces of bone) in the skull; broken cheek bones; broken teeth; broken jaw; etc. Included in the head to toe is how to examine the spine for fractures/crepitus/etc and included in learning how to conduct the head to toe is how to roll the PT onto a supine (laying on PT’s back), while maintaining C-spine. There is a lot more that is also learned in how to conduct a head to toe – TAKE A CLASS. After learning how to do it and then practicing how to do a head to toe – it will become a lot easier and less intimidating.

It is very simple – not knowing how to properly examine PT; roll a PT; provide C-spine (control of spine) can result in the PT being paralyzed or worse. Take a class.

Frequently, PTs suffering from a head injury will have an Altered Mental Status (AMS). This can range from slight confusion to not knowing who they are, complete hallucinations, or unconscious (unresponsive). Again, all of these PTs go to the hospital. Personally, I call 911 and I do not wait for a friend to come pick them up. While you wait for the ambulance –C-spine – treat all life threats – do the head to toe – vitals – put them on O2 if you have it – keep records of all vitals & times – keep the PT as calm as possible and if the PT is walking around when you get to them – have them sit/position of comfort and attempt to comfort them while continue with you ongoing assessment. If the PT is AMS – they MAY be uncooperative – do the best you can.

One thing to keep in mind while treating a head/spinal injury, there may be a reason that the PT wrecked and got the head/spinal injury. Thus, the head/spinal injury may be masking another serious medical condition that is taking place. The PT may have had a stroke/a cardiac incident/diabetic incident/seizure/shock due to bee sting/heat stoke/hypothermia- the list can go on. It is very possible that the PT is suffering from another potentially life threatening medical condition that is being masked by the head and spinal injuries received during the accident. Look for medical id bracelets. If others are riding with the PT – obtain SAMPLE info – if the PT is conscious – obtain SAMPLE info. Find out from other riders what was going on when the PT wrecked – what was going on for the 5-30 minutes prior to the accident. Although this information will probably not change how you are treating the PT out in the country with no medical equiEMT-Pent. However, when the ambulance gets there, all the relevant information regarding the PTs condition will be helpful.

The top dog on the ambulance will be the para-medic (EMT-P) – it is sometimes difficult to obtain the EMT-P’s proper attention – they will usually go straight to the PT and start doing their own analysis. Start communication with the EMT-P by stating that you have examined the PT and that you have a xx year old m/f, that had a bicycle fall, PT is presenting with a head injury (briefly describe the injury) and any other info – if you believe the PT had a stroke and then wrecked – state that PT is presenting with stroke symptoms as well as the head injury/etc/ EMT-P’s are usually very busy and VERY concerned about the PT. If you start out by stating the age and sex – etc they will usually pay attention. Example – I have a 45-year-old male PT that had a bicycle wreck – PT has significant head injuries and during my head to toe – PT is bleeding from ears and has broken teeth. Pulse is xx, respirations are xx,. Most EMT-Ps will want to hear this info – typically the EMT-P will repeat the ENTIRE process that you have already done – do not be offended – it is their job. Do not be surprised if the EMT-P acts like you do not even exist after they get to the PT. Most EMT-Ps that I have shared a PT with – know their stuff – once you have handed off the PT (a higher medical authority), it is out of your control. Further, you are not a family member and technically, you do not have a legal right to know what is going on with the PT. However, while on scene, usually they will share info with you but do not be upset if they do not.

Now for the 3rd, 4th, and 5th time – there is a right way and wrong way to examine a head during a head to toe. There is a right way and a wrong way to examine the spine – there is a right way and a wrong way to do C-spine, etc., etc. Take a class. Even at the First Aid level of treatment – knowing how to do the right thing the right way will make a significant difference.