# 45 YO M Pt unconscious, no pulse, on bike trail



## needsleep (Dec 4, 2017)

Real call that came in yesterday. It was not my territory and my station did not respond. Just asking you guys to arm chair quarterback this one.

Call comes in: 45 YO M PT found unconscious, unresponsive w/ no pulse in the middle of a mountain bike trail by another rider. The rider calls 911 and relays this info. You show up and have trouble locating the trailhead. Dispatch is advising of "fire roads" that cut through the middle of the trail. You are rushing to find access to the trail fearing the worst for the patient and knowing every passing second could be critical.

You find entrance to the trail and estimate the Pt to be 1.5-2.5 miles into the trail. It is not wide enough for a vehicle so your partner calls for the rescue ATV but it has an ETA of 15 minutes.

What do you do? Run the few miles with the jump bag? Forget the jump bag and just take the airway bag? What if you got lost and/or couldn't find the Pt and you become another obstacle and distraction for Pt care? Wait for ATV?

Have fun


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## NomadicMedic (Dec 4, 2017)

Was the caller performing CPR? Are you an ALS provider? Do you have gear that is transportable for a 2 mile hike? How fast can you really go on unknown trails, weighted down with resuscitation gear?
Honestly, you’re stuck. If you “ran” 2 miles you’d be in no shape to perform any effective CPR. If he wasn’t getting CPR from a bystander, chances are this is a body recovery. 

Too many questions to answer. Sadly, people that perform activities in remote areas far away from an emergency response need to know that any help may be delayed or might not arrive at all. Lots of people don’t realize that just because you have a cell phone signal, immediate help is not always available. 

At least he died doing what he loved.


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## luke_31 (Dec 4, 2017)

No pulse, not breathing, in the middle of a trail with no easy access for ambulance.  From experience this is a non-workable patient, if they are that far from help by the time you get there the patient will be deceased.  Especially since you don't know when it happened, just the time it was called in.


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## DrParasite (Dec 4, 2017)

1) dispatch nearest ATV before you get out the door, especially if the caller says they are on the trail
2) If you have bikes available, request 3 bikes make their way to the scene (esp if they will get to the scene faster than the ATV)
3) hope the caller is doing CPR, but realize that the patient probably won't make it
4) might even request the regional search and rescue team, put a drone in the air, and call the park rangers (or whomever knows the trails the best, and hopefully has up to date maps)

I'm not running blindly down the trail.  depending on how clear the trail is (is it paved, is it clear of roots, is it level, etc), I MIGHT throw everything on my cot and make my way down.  This call is going to suck, and will require a lot of resources.  and, unfortunately, due to the location of the patient, there is a high probability that it will be a recovery, not a rescue.


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## Summit (Dec 4, 2017)

*What's really going on?*
RPs lie. Dispatch lies. Maybe the patient has no pulse and they are doing CPR. Maybe it is a faint pulse. You don't have any info on whether this is trauma or medical. Maybe the person has gotten better and ridden off by the time you run there!

Its much more likely the patient is either dead or not actually critical than it is you will be able to make a critical difference. Factor that against the risk of response... but maybe we can make a difference...

*What should you take?*
Given that you have no information other than there might be a sick patient who might have been riding a bike. What are this most likely Dx's for this profile that you can also apply lifesaving intervention with "lighter" gear for before extrication teams arrive with heavy gear?

Top in that regime would be: pop a tension ptx, defib/cardiovert life-threatening arrhythmia, bandage/tq hemorrhage, create maintain airway

I'd grab a _lean_ airway kit, tq/abd pads, big IVs, and AED*

*Should you go?*
_Locate?_
Do you really know where the the pt is? Did RP provide coordinates? Did dispatch do a phase 2? Do you have a GPS or an app on your phone you know how to use?  Do you have a map and compass? Do your radios work there?

_Prepared?_
Are you trained for SAR? Are you dressed for SAR? What's the weather? What's the weather going to be in 2 hours? Will the sun still be up? Are you fit enough to run or hike fast for 2.5 miles on a trail with gear while paying attention to junctions and still be useful on arrival?

_Authorized?_
Are you authorized to respond up the trail? Is it even your jurisdiction (most places more than 500 from a road is the jurisdiction of your local sheriff who usually has a SAR team, so you may need their permission as well as your supervisor's permission to respond so you don't get fired because your broken ankle isn't covered by workers comp.

*(If you don't have one, consider how much a LP15 or whatever large unit will slow you down vs the benefit of defib + multilead and etco2 useful for determining termination).


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## Summit (Dec 4, 2017)

DrParasite said:


> depending on how clear the trail is (is it paved, is it clear of roots, is it level, etc), I MIGHT throw everything on my cot and make my way down.  This call is going to suck


I agree. If you try and push your cot up and down 2.5 miles of even the best trail, the call is going to suck. 

This is an easy extrication with 2-3 people and an ATV+towed litter... or hand carry with a wheeled litter with 6-10 people.


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## Kevinf (Dec 4, 2017)

Yea, you gotta love getting dispatched into the middle of the woods. We were recently dispatched for a sick person on a paintball field. Said paintball field entrance was unmarked so that was fun. Then the gravel road terminated in a dirt parking lot which let to the field a half mile down a rough trail with regular obstacles at knee height. We found the patient laying in a ditch (said patient was roughly the size of an NFL linebacker), conscious but not alert and unable to stand or ambulate.

We called to have fire rescue dispatched to our location as soon as we found out the patient was half a mile down a trail, and we extricated the patient with a stokes loaded onto a gator. But it was still almost a 2 hour scene time with extrication just for that short distance.


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## DrParasite (Dec 5, 2017)

Summit said:


> This is an easy extrication with 2-3 people and an ATV+towed litter... or hand carry with a wheeled litter with 6-10 people.


even easier with one of these:


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## Summit (Dec 5, 2017)

DrParasite said:


> even easier with one of these:


That's very nice for a paved bike path or a fire road without water bars. Otherwise, it could have clearance issues on a mountain bike trail.

Here is a six wheel setup with higher clearance, shorter wheel base. Not hard walled, but it has a soft enclosure, litter mount, and two provider seats with belts and comms hookups for the attendants (godo for radio/driver communication), plus mounts for monitors:





These attach to a hitch on an ATV which gets you through much rougher terrain. You can put a litter in there or just pad it really well:





Plus you can put skis on it and hook it to a snowmobile in the winter:





But for single track mountain biking trail (or hiking trail) a wheeled/handled mount for a litter is best:


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## Tigger (Dec 6, 2017)

Chainsaw and an orange AStar. That was my solution a few weeks ago for this sort of terrain, granted the patient was not dead.


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## needsleep (Dec 7, 2017)

Just as an FYI, it was a confirmed DOA. Perhaps us rehearsing these events both mentally and physically can help facilitate an efficient response. However, just as another poster noted, when individuals go off the paved path (figuratively and literally) there is only so much we can do for a timely response.


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## Summit (Dec 7, 2017)

OP So what did your colleagues do in this situation?
What was your answer to "what would you do?"



Tigger said:


> Chainsaw and an orange AStar. That was my solution a few weeks ago for this sort of terrain, granted the patient was not dead.


I wish my agency issued me chainsaws :-D

One time I had to hand saw much of a tree because the patient was so tangled up in it.


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## needsleep (Dec 7, 2017)

Hiked in carrying the supplies needed with the idea that the ATV would just surpass them whenever it arrived and carry in the supplies needed. 

Its been clarified that the trail was just a simple one-way in, one-way out trail with no branch off's (unlike a hiking trail) which would reduce and chances of getting lost and/or missing the Pt. I believe I would have done nothing different given I'm physically capable.


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## RocketMedic (Dec 8, 2017)

I'm usually down for a nature hike.


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## Tigger (Dec 8, 2017)

Summit said:


> OP So what did your colleagues do in this situation?
> What was your answer to "what would you do?"
> 
> 
> ...


We don't have them. But I gots a radio.


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## johnrsemt (Jan 10, 2018)

Add multiple trails to that problem, with no one knowing which trail the patient is on for sure.  Especially when you have hiking trails on one side of a lake, and MTN bike trails on the other side of the same lake, both numbered with the same numbers, and people calling them in didn't know for sure which side of the lake they were on.
Had that problem a few times at the National Scout Jamboree in July.  Hopefully they are going to get the numbered part fixed before the World Jamboree in 2019.


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