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You (on your own) find a mountain biker lying off the trail on his back at the bottom of a big drop, the bike lying quite far away (indicating a fairly high speed crash).
It's a windy day, help is at least 30 minutes away, and he's wearing a lot of armour and layers, and a full face helmet. You are worried he may have a neck/spinal/head injury, but can't tell if he's breathing or not because of the helmet. He is completely unresponsive.
Do you take the helmet off, and if so, how?
No.
You will be able to tell if he's breathing, (helmet or not - Feel, listen, get close), and if he's not, it will become apparent very quickly.
If he's not breathing, No1 priority is to preserve life, so the helmet comes off fast and you get on with it.....
But you gotta get help FAST in either case. CPR is useless without proper medical intervention
Look, Listen, Feel.
Do not take the helmet off.
You work out if he is breathing by getting in very close and listening, feeling for the breath.
If he's not breathing remove the helmet and attempt mouth to mouth ?
Just gaffer tape his mouth and nose, if he splutters, he is (was) still breathing.
Look, Listen, Feel.Do not take the helmet off.
What if you think he isn't breathing?
If he's not breathing remove the helmet and attempt mouth to mouth ?
Why would you need to remove the helmet for mouth to mouth?
What if you think he isn't breathing?
If I knew, not think, he wasn't breathing see above.
yes. If he's breathing he'll be more likely to survive, so you need to know.
Obviously don't just rip his lid off wildly, but if he chokes on his own tongue he's dead, whether he has a broken neck or not, and you can solve that if you know it's happened.
If there are two people around you can safely remove a helmet and keep the neck supported. ICBA to google it, but it can be done.
What if you think he isn't breathing?
As I said, No1 priority is to preserve life. If you can't do that with the helmet on, you take it off. If you don't he'll die anyway
Obviously there's other things you can check before moving him like a blocked airway, which might fix it.
Why would you need to remove the helmet for mouth to mouth?
He said full face Drac. I'd try without taking it off first. Maybe you could do it, maybe not.
For everyone who said "Look, listen, feel", you clearly are not very good at absorbing information.
It's a windy day
he's wearing a lot of armour and layers
In this situation, the only way you will be able to tell if he is breathing or not is by removing the helmet. Or waiting for the autopsy/for him to get up.
For the people that said do remove the helmet
Do you take the helmet off, [b]and if so, how?[/b]
yes. If he's breathing he'll be more likely to survive, so you need to know.
You can do that without taking the helmet off, even a full face.
If I knew, not think,
That's the key. Once you KNOW, and you will know, then you can act accordingly
In this situation, the only way you will be able to tell if he is breathing or not is by removing the helmet. Or waiting for the autopsy/for him to get up.
Really, guess I've been lucky then over the years. As I've always managed to tell if people or breathing in some really bad conditions.
In this situation, the only way you will be able to tell if he is breathing or not is by removing the helmet. Or waiting for the autopsy/for him to get up.
Aye missed that bit, well that's when it's more tricky. It can be done but breathing comes, first then C spine so if your 100% sure they need resuscitation and done all the other checks then yes.
For everyone who said "Look, listen, feel", you clearly are not very good at absorbing information.It's a windy day
he's wearing a lot of armour and layers
Yes I am, I read it carefully. You'll be able to feel it, wind or not. Layres don't stop the chest rising. You can put your hand near his mouth/nose. You can shield him with your body and hands and put your ear within an inch or two of his mouth, and one hand under the chinbar will stop the breeze.
You'll be able to feel it
Sorry, I thought for a moment that this was my hypothetical situation. Please, take over.
the bike lying quite far away (indicating a fairly high speed crash).
See, that doesn't necessarily indicate a crash. He might have walked back up the trail to pick something up and had a heart attack!
From your info it's not 100% certain he's crashed.
I can't believe that nobody has gone to check the bike is OK yet 🙄
I can't believe that nobody has gone to check the bike is OK yet
Your mate loads that into you car whilst they seek help.
Sorry, I thought for a moment that this was my hypothetical situation. Please, take over.
Tell me what difference taking the lid off makes then? It's still the same process to check breathing. If anything I think a lid would HELP you work it on a windy day, by shielding his face for you!
Is the bike ok?
//edit - Must learn to read more carefully 🙂
[url= http://www.ambulancetechnicianstudy.co.uk/helmet.html ]helmet off[/url]
Is the bike ok?
That info is not available in the OP. You only know he's quite far away from it. By the sounds of it, you get to the casualty before passing the bike.
arguably the first thing to do is dial 999
bassspine, what if you're alone?
bassspine, that link looks like it's aimed at the pros who have been trained how to do it. I wouldn't touch it unless I had to.
I have actually atteneded a motorcycle accident too, and fairly recently. But it was obvious from the swearing that he was breathing OK. His leg however, was not so good. I kept him on the floor where he was.
bassspine, that link looks like it's aimed at the pros who have been trained how to do it. I wouldn't touch it unless I had to.
It's not our guidelines they come from JRCALC. The technique is the same as though.
Squeeze his nose gently, and see if he responds to pain, if he is breathing and alive he should move.
Also why would you wantt to take his helmet off, everyone knows after a crash you should send the helmet back to the manufacturer for a replacement.Also it may not be your size.
bassspine, what if you're alone?
Then you need to know if he's breathing, and you need to get help FAST. VERY FAST. He'll die if he's not breathing.
If he deffo wasn't breathing I'd start the CPR (becasue I'd not know how long he'd been down) to get some oxygen in, then get help within a minute or so (Assuming I have phone signal) But if he's not breathing you won't 'cure' him on your own
Squeeze his nose gently
He is completely unresponsive
It's not our guidelines they come from JRCALC. The technique is the same as though.
Fair enough. I've not b een shown how to doi it, so I'd make the judgement on the breathing first.
Yes I am, I read it carefully. You'll be able to feel it, wind or not. Layres don't stop the chest rising. You can put your hand near his mouth/nose. You can shield him with your body and hands and put your ear within an inch or two of his mouth, and one hand under the chinbar will stop the breeze.
^This. Just because it's 'your hypothetical situation' doesn't mean that you can ignore what can realistically and practically take place. Well, you can, but then there's not much point in having the discussion in this thread.
Oh, and this as well:
the bike lying quite far away (indicating a fairly high speed crash).See, that doesn't necessarily indicate a crash. He might have walked back up the trail to pick something up and had a heart attack!
From your info it's not 100% certain he's crashed.
Don't make assumptions as to what has or hasn't happened, unless the evidence is there to indicate for certain.
Fair enough. I've not b een shown how to doi it, so I'd make the judgement on the breathing first.
Wise.
Anyway my treatment would be a whole lot different to lots on here and given the utter vagueness and Realmans unrealistic there is answer as such.
Don't make assumptions as to what has or hasn't happened, unless the evidence is there to indicate for certain.
Oh oh but he's being hypothetical. 😆
Don't make assumptions as to what has or hasn't happened, unless the evidence is there to indicate for certain.
Fair enough, in my mind I was seeing the bike mangled and not in a position someone would place it in, and obvious signs of a crash, eg: blood, muddy clothes, etc. I just didn't write it that's all.
I don't think in every single situation you will be able to be sure if they're breathing or not. Hence the question.
If he is not breathing and you don't know how long he has been there is he not infact dead#? Thus no need to take the helmet off as attempting CPR is pointless? (I suppose you can check for further signs - fixed dilated pupils and a nice blue colour|) I am always very dubious about doing CPR when you don't know how long the person has been down for. Are you just molesting a corpse?
RealMan - Member
You (on your own) find a mountain biker lying off the trail on his back at the bottom of a big drop, the bike lying quite far away (indicating a fairly high speed crash).It's a windy day, help is at least 30 minutes away, and he's wearing a lot of armour and layers, and a full face helmet. You are worried he may have a neck/spinal/head injury, but can't tell if he's breathing or not because of the helmet. He is completely unresponsive.
Do you take the helmet off, and if so, how?
Posted 35 minutes ago # Report-Post
You go on a bike forum asking for advice, then you take pics of his bike and clothing and post them on EBAY,
Airway, Breathing, Circulation. Its actually quite easy (hypothetically or not) to tell if someone is breathing, but don't bother with a pulse unless you know where to look as a lot of "no pulse" calls are actually "couldn't find a pulse" which is not always the same thing!
Helmet removal is relatively easy, but requires 2 people, mouth to mouth through an full face helmet is easy, hold mouth shut and blow through the nose? (probably a bit nicer than lip on lip action too!)
In this theoretical situation I would:
stabilise the patient with my bag/coat to ensure head/body are not moving freely,
speak to the patient, call out, try a gentle pinch to his ear etc. If no answer --->
open patients mouth and make sure its not full of blood/drool/dirt etc, if it is blocked then clear it as far as you can see with your fingers.
Place hand on chest and feel if it is moving, hold my hand over the riders mouth/nose and feel for air movement. If no obvious breathing try blowing into the patient a couple of times, If they are breathing they will cough and then swear at you, if not then well done, you just got 2 breaths in!
Forget pulse, if they're not breathing they either don't have a pulse or wont have soon, give them some CPR. It might be best to remove the armour (depends on type) but this might compromise a neck injury. Basically, if they need CPR, forget stabilising the neck and get the air in and out and blood round and round (mind you, don't kick em in the head, try and be careful, keeping the chin inline with the midline of the body etc.)
Presumably you've already called 999/112 so keep going as long as you can.
If you absolutely must remove a helmet, bare in mind that the nerves that control breathing etc pass through the spinal column at the neck, so if there is any damage and bone kinks that cord.... try to keep the head absolutely still and in the position it landed.
I am always very dubious about doing CPR when you don't know how long the person has been down for. Are you just molesting a corpse?
So you'd rather let someone die then risk "molesting a corpse"? That's an odd stance.
meehaja, thanks, that could just the first proper reply on here.
if it is blocked then clear it as far as you can see with your fingers.
Apparently you're not meant to do that anymore, as quite a few people have trigged the gag reflex and lost a finger or two (and then of course they've got a few fingers in their airway as well).
Never practised mouth to nose, is it fairly simple?
So you'd rather let someone die then risk "molesting a corpse"? That's an odd stance.
Exactly. You don't know. So you start the CPR. It might be a waste of time, but you'll only know that if you try.
Can we throw the contents of our water bottle over him to see if he responds, water always seems to work in the movies 😉
Realman - the point is they are already dead and are not going to be brought back by cpr. You don't know how long they have been down. How long does someone survive without O2? What are the success rates of CPR in that situation?
I would be looking for the other signs tho - the fixed dilated pupils
What are the success rates of CPR in that situation?
Does it matter? What about yourself? Would you be prepared to just stand there, then wonder "what if?" for the next month or two?
don't know how long they have been down
Exactly.
So, if it's an hour and you do something, you have nothing to loose
But it's just as likely it's 30 seconds as it is an hour. If it's 30 seconds and you do nothing, what will happen? You have [i]everything[/i] to loose.
I would be looking for the other signs tho - the fixed dilated pupils
But I'm not a medical professional, so I don't know what that is. So I'd use the first aid I've been taught. I might be wasting my time, but I won't get it wrong.
Does it matter? What about yourself? Would you be prepared to just stand there, then wonder "what if?" for the next month or two?
Exactly. You try your best. If that's not good enough and he dies, so be it. But you don't just stand there.
Fair enough PP.
I have done CPR a good few times in hospitals. I have never seen anyone brought back in any meaningful way. Its made me very sceptical and that is in ideal circumstances where you have O2 and drugs to hand tho sick people. In the sort of situation described the odds on bringing them back if they really are not breathing and you don't restart them very quickly are next to nil
Of course I would not stand around and do nothing but I don't know how long if at all I would attempt CPR for.
edit - 30 mins from help remember. 30 mins CPR on your own?
I don't think it necessarily applies in this situation, but I can sort of see where TJ is coming from.
When my friend died, the 999 operator asked me to perform CPR on my friend and when I said I wouldn't asked if I could find someone who was prepared to. As my friend had clearly been dead for some time, I decided it was better for my mental health not to perform CPR. The phrasing the 999 operator used annoyed me, but I don't hold any guilt over this decision.
Back on topic a bit more, when I did my lifeguard training it was interesting how many people would try and preserve the spinal cord over all else. Lots of "well done, you got the casualty out of the water without damaging his spinal cord, unfortunately he wasn't breathing so he's dead"
are next to nil
Given 'no chance' and 'next to no chance' of living, which would YOU choose?
True enough, the odds aren't good, but you try your best. 🙂
As my friend had clearly been dead for some time, I decided it was better for my mental health not to perform CPR
Which is obviously a good call in that situation. I'm guessing it becomes obvious they're dead after a certain time, but I've never seen a dead body?
I am not saying I am right but merely posing a question / showing an alternate viewpoint.
When does a casualty become a corpse? Finding someone not breathing and you don't know how long they have been not breathing is it right to do CPR? A few mins without O2 to irreversible brain damage.
If you don't CPR tho you had better be damn sure its the right decision and to do CPR should be the default.
When does a casualty become a corpse? Finding someone not breathing and you don't know how long they have been not breathing is it right to do CPR? A few mins without O2 to irreversible brain damage.
I did hear about a woman who fell through some ice into water, and was underwater for 50 minutes. They got her out, got her to hospital, and performed CPR for 7 and a half hours. Apart from a bit of frost bite on her fingers, she made a full recovery.
Actually before ABC is assess, think about your own safety too ;
listen and feel for breathing, if necessary put hand inside clothing on chest, if breathing effort is low you may not be able to see chest movement through clothing. Get help by shouting / mobile if signal available. Keep casualty warm as possible, talk to and raessure if conscious. Deal with any obvious injury only if airway and breathing established. If unconscious breathing >> recovery position, get help as above but may have to consider leaving casualty. Unconscious not breathing > CPR but on your own this is going to be extremely difficult situation, you may ahve to make call on when to stop if no help arrives
I did the 16hr adventure first aid course about 6 months back. The instructor said he'd done CPR three times and two had died.
I suggested 999 as first response because the scenario said I was on my own, so whatever happened next I'd probably be too busy to get on the phone. Any mention of 'unconcious' will get the ambulance scrambled to your location.
Current (6 months or so) training was DR AB (danger, responses, airways, breathing) C has left the building.
The immersion hypothermia is a slightly different issue - according to the trainer on the first aid course I did a couple of months ago, the current thinking on dealing with a hypothermic casualty is "[i]they're not dead until their warm and dead[/i]" so you treat them accordingly until the professionals roll up and take over.
If that's not the case, the trainer and his accomplice (forces paramedic and civvie paramedic) were pretty frank about the success rate for CPR on adults who've had a heart attack/stroke etc - it's pretty much as TJ says.
The last first aid course I was on (which was specifically for osteopaths) had lots of role play discussions, interestingly when this one came up people were less concerned about the potential spinal injury for a cyclist (more about safety from traffic) than they were when it was a motorcyclist. Anyway, you've already got the right answers, if you can't tell their breathing within ten to twenty seconds then you have to assume their not, also key is breathing [b]normally[/b] not one gasp then nothing. google agonal breathing, a lifeguard was found incompetent for mistaking one breath for normal breathing and ceasing cpr. and current evidence shows little benefit from mouth to mouth, its the chest pumps which are most important, the blood is reasonably oxygenated for about six minutes of pumping.
About 6 successful resuscitations now, some with drugs, cpr and shocking odd 1 with just cpr and shocks, then 1 with just CPR.
In fact tune into BBC 3 next week and you may see the evidence. 😉
inigomontoya - Member
, its the chest pumps which are most important, the blood is reasonably oxygenated for about six minutes of pumping.
In the scenario given its 30 mins to get help. This sort of changes the odds somewhat.
inigomontoya - Member
, its the chest pumps which are most important, the blood is reasonably oxygenated for about six minutes of pumping.
In the scenario given its 30 mins to get help. This sort of changes the odds somewhat.
That's the thing though you could do the CPR whilst you wait for the help.
If I was found to not resuscitate someone because I don't believe it works or because I didn't know how long they'd been there I'd be struck off. I mean being outside of work too not just at work.
Drac - sounds good. Without being too rude (I hope) is that successful as in "in a stable rhythm on admission to A&E" or " gets out of hospital and lives happily ever after" ?
The ones I count as successful or responsive with stable rhythm and resps, that might just be a simple grunt or reaction to pain response but least something. I've had them sit up though and ask what was going on. I don't count just a change in rhythm with an out put, myself I don't class that as successful although yes technical it is.
As for happily ever after, well we never find out.
If I was found to not resuscitate someone because I don't believe it works or because I didn't know how long they'd been there I'd be struck off. I mean being outside of work too not just at work.
Its interesting that one. I as a trained nurse have to be able to justify my actions in doing or not doing CPR. If I don't do it I must be damn sure of my ground but there are many occcasions when we don't.
You must be able to draw a line somewhere tho surely - cold with fixed dilated pupils?
Sorry OP - I have puled this thread off at a tangent.
[i]When does a casualty become a corpse? [/i]
When a doctor say so I guess.
Its interesting that one. I as a trained nurse have to be able to justify my actions in doing or not doing CPR. If I don't do it I must be damn sure of my ground but there are many occcasions when we don't
I have to justify too and saying it doesn't work or I wasn't sure how long they'd been there isn't going to work. Yes there's times when it justifiable.
You must be able to draw a line somewhere tho surely - cold with fixed dilated pupils?
We have a recognition of death yes of course but not on the grounds you mentioned earlier.
Ta.
Don't worry about removing the helmet, leave it on, current guidelines say that CPR is way more important than mouth to mouth, put all your efforts into that as without a pulse everything is useless.....
Don't worry about removing the helmet, leave it on, current guidelines say that CPR is way more important than mouth to mouth, put all your efforts into that as without a pulse everything is useless.....
But what if they do have something blocking their airway, and their heart is fine? I would take the helmet off if I wasn't sure if they were breathing.
Yes, but how is the bike?
What bike? no bike was here when I came officer *walks of whistling*
Realman - maybe take the helmet off if you are sure they are not breathing? You really should be able to tell with it on.
If they're not breathing, and I felt I needed to take the helmet off to perform CPR effectively, I would take it off.
IF I COULD NOT TELL, and could not perform CPR effectively with it on, I would take it off.
hypothermia rules appear to be you`re only dead when warm and dead; sveral case histories now from MR when casualty with core temp <30c have lived when rewarmed ....with great care and expertise 🙂
re helmet removal: proper ventilation will only be possible with helmet removed; it`s no good having an undamaged spinal cord but cannot breathe. My worst 1st aider case was very bad motorcyclist injury, chap choking to death on own blood; was unsure about removing helmet, but rolled him on side which cleared airway; when ambulance arrive first thing they did was remove helmet to get access to airway with guedels , suction etc. Possible damage to spine takes second place in such scenarios
What's the point of a dead person with an intact spine? Maintain airway first and then cpr. 2 breaths 30 chest compressions
Just to throw something else in on my last First Aid course we were told dispense with the breaths just go with chest compressions. We were told that there would still be sufficient O2 in the blood stream and that blood flow to the brain is way more important (especially if you are by yourself as those of you that have done full on CPR for 20 minutes will know).
As for helmet removal, if it has to come off to open airway then so be it but obviously with as much care as possible.
Nothing worse than doing CRP on a dead body either.....
Northerner you are wrong. Breathing first heart second. No point sending blood round with no o2. Brain dies in 3-4 mins with no oxygen
Northerner you are wrong. Breathing first heart second. No point sending blood round with no o2. Brain dies in 3-4 mins with no oxygen
You need to read the latest guidelines.
Jamesb the Ambulance are trained and experienced professionals so use to removing helmets.
1st aid training last weekend said so
1st aid training last weekend said so
Then he needs to read them.
Guideline changes
It is well documented that interruptions in chest compression are common11, 12 and are
associated with a reduced chance of survival.13 The ‘perfect’ solution is to deliver
continuous compressions whilst giving ventilations independently. This is possible when
the victim has an advanced airway in place, and is discussed in the adult advanced life
support (ALS) chapter. Compression-only CPR is another way to increase the number
of compressions given and will, by definition, eliminate pauses. It is effective for a
Resuscitation Council (UK)
16 RESUSCITATION GUIDELI NE S 2010
limited period only (probably less than 5 min)14 and is not recommended as the
standard management of out-of-hospital cardiac arrest.
It is also known that chest compressions, both in hospital and outside, are often
undertaken with insufficient depth and at the wrong rate.12, 15
The following changes in the BLS guidelines have been made to reflect the importance
placed on chest compression, particularly good quality compressions, and to attempt to
reduce the number and duration of pauses in chest compression:
1. When obtaining help, ask for an automated external defibrillator (AED), if
one is available.
2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1.
3. Give each rescue breath over 1 s rather than 2 s.
4. Do not stop to check the victim or discontinue CPR unless the victim starts to
show signs of regaining consciousness, such as coughing, opening his eyes,
speaking, or moving purposefully AND starts to breathe normally.
5. Teach CPR to laypeople with an emphasis on chest compression, but
include ventilation as the standard, particularly for those with a duty of care.
In addition, advice has been added on the use of oxygen, and and how to manage a victim
who regurgitates stomach contents during resuscitation.