Tuesday, October 8, 2019

911-Rider Down!

I AM LOOKING FOR COMMENTS (commend box below): I will update and refresh with new info as applicable.

Let's face it, accidents can happen anywhere as can medical emergencies. A little slip of the tire can lead to that "perfect crash" with a traumatic brain injury, spinal cord injury, vascular injury or any or all of the above. I took a handlebar to the groin a year or so ago and was convinced that I had a traumatic femoral artery dissection (the softball sized hematoma that almost instantly developed was one of the reasons...). Likewise, even the healthiest of us are not immune to the possibility of a heart attack; or a simple bee sting could lead to anaphylaxis.

So, do you stay inside and play video games? No, you live life to the fullest because living in fear isn't living. My job probably has me a little more focused on the things that can go wrong, and that perspective also has me think about what I would do if I was out in the woods and had to deal with a medical emergency on the trails.

While my training has me more suited than many to manage traumatic and medical emergencies in the field, don't forget that my typical work environment includes a hospital full of resources, from staff to supplies--whether that's an interventional cardiologist to help manage a cardiac arrest or an emergency department technician to help hold direct pressure on a bleeding wound. It's all there for me, and if I've ever got someone on the ground in the woods, I'm going to be looking for a nurse to give me some vital signs and a 0-10 pain score.

All that being said, true "wilderness" emergency medicine requires people to provide prolonged stabilization and treatment as it can be hours (or days) before a patient can be evacuated. You'd think that in local suburban areas that a prolonged evacuation wouldn't happen, but it certainly can. Even being a mile or so into the woods can exponentially increase the time EMS providers can get to a patient and then get him or her out. And that's IF they can find the person easily.

In a perfect world, everyone would have something like FindMeSpot, a GPS device that will--at the touch of a button--send an exact location to emergency providers and it will activate the appropriate resources. I've got one of the devices, and I use it when I'm really remote, but I don't think about using it on my local suburban trails. Should I?

In some instances, a 911 PSAP dispatcher will be able to obtain your location, but not always. And if an exact GPS location CAN be shared, will it look like a dropped pin in the middle of nowhere. Without knowing the best way in to a location or out, or any details about the terrain, that location is really only a starting point.

As an example, this dropped pin is in an area of the Norwood Pond trails, but unless you know the area well, you wouldn't be able to get to that point quickly.

I'm trying to think through certain scenarios and how people would manage a problem, and I'm looking for input.

Imagine this; you and a friend are in the woods, riding or running or whatever. Your friend collapses and you need to start one-person CPR. Or maybe you need to stabilize a cervical spine injury and hold pressure over a bleeding wound.

How do you administer a life-saving intervention AND contact 911 AND give your specific location?

I've thought about various options such as sending your location via text message but how will you do that will pressing on someone's chest? And if you were able to manage that, how would a GPS coordinate that dropped a pin in the middle of a green area on a map help you get found? How would it tell EMS providers the best route--which depending on terrain--may be a longer route? What if you have a trail name--will that help a 911 operator get a local fire department or ambulance to you?

I've been looking for specifics on suburban search and rescue and I'm not finding much. I can find all sorts of programs and solutions for mass casualty events and natural disasters, or search and rescue in true wilderness, but not much on the local suburban trail system that's only a few miles from a hospital but rugged and difficult to navigate...

Some things to think about: the average walking speed over rough terrain is 3mph. So getting 1 mile into the woods is about 20 minutes, and then if a person is being carried out, you're looking at probably 30 minutes.

You CAN set up improved location settings on your phone, but it's accessed by activating Emergency SOS (on the iPhone) as opposed to calling 911 directly.

Please add to the conversation if you can by commenting below of back on Facebook. Thanks for your input.


Unknown said...

Excellent read, David! Thanks for tagging me. My reactions to your post fall into two themes: preparedness and awareness. I'll split this into two comments since there's a limit.

As a geek, I always like to understand the limits of the technology I use. Because of this (and for work, as the software our company makes uses GPS on smartphones and tablets), I paid $2 or $3 for an app called "GPS Diagnostic" on the Apple App Store. It gives you probably every bit of information your iPhone can produce as it relates to location and GPS signal (I'll send you some screenshots).

It's rare that you won't have GPS signal (as long as you have some clear sky overhead). The true issue is that you won't have the cellular or data connection to send that location information or call for help. On a side note, Google Maps allows for downloading of maps for offline use, which can be used to get your latitude or longitude even in the absence of cellular or data reception.

It's also worthwhile to note that when you make a 911 call from any modern mobile phone, all available cellular networks can be leveraged to connect that call. Basically, if you're a Verizon customer, if the only available network is AT&T, then you'll still be connected. As such, even if your phone shows low or no service, you should still always try to call 911 if you need it!

It's always helpful to pre-plan as well. Know where cellular service is lacking should prompt you to utilize one of the many GPS "distress call" devices that rely on satellite telephony and not terrestrial towers, even in areas that abut "civilization." For example, there are a number of conservation areas on Cape Cod that have poor cellular service, but are only a couple miles from the road or trailhead. The cost of these devices have gone down tremendously, but usually still require a subscription.

As far as guiding responders to your location, you bring up some good concerns. Sharing your location is not the same thing as sharing the quickest route to get there, and the quickest route may not be the route that can be taken when carrying a patient on a litter. In this scenario, you can best prepare yourself with local knowledge, but may also have to rely on the responders knowledge of their service area and topography to reach you.

- Michael P.

Unknown said...

While I don't have a defeatist attitude, I know we can't carry a tertiary care center or the kitchen sink in our back pockets, so we won't always be equipped to handle every situation comprehensively. I know we're not happy about that, but such is life. Sometimes situations that would be survivable in urban or suburban areas are lethal in remote or wilderness settings.

So what's the happy medium? For medical professionals, the first-aid or medical equipment you bring with you should be congruent with your professional practice and training (e.g., first responders shouldn't bring chest decompression kits on nature hikes). At a minimum, in MY opinion, you should have with you the ability to control hemorrhage in two limbs —that is, at least two tourniquets (we use the combat application tourniquets or "CATs" at our service, although there are many many types and manufactures out there). Hemostatic and gauze dressings, self-adherent wraps, etc. are all helpful too. Triangular bandages (i.e., cravats) are like the Swiss Army knife of the first-aid bag and a handful of those is always helpful too.

From there, I'm not sure what else is helpful. For sure, if you're expecting a lengthy departure from society on a wilderness expedition, your first-aid / medical kit would be more substantial. But for biking through trails I'm unsure of how much value this additional equipment (e.g., chest decompression, basic airway adjuncts, irrigation solution, cervical collars, etc.) would bring to the table.

For the non-medical folks, I'd argue that your first aid equipment should be comprised of convenience items (e.g., bandaids) and hemorrhage control items. Tourniquets and training on how to use them are ubiquitous these days, with mass shootings (throughout the country) and shark attacks (locally) making the media, but the more likely scenario is a car accident, industrial injury, home accident, recreational injury, etc.

Finally, there will always be dire and no-win scenarios. A cardiac arrest in a remote and difficult to reach location, that you mentioned, comes to mind. The only thing that you can do is your best, and if you only have to pause chest compressions for a few moments because you've setup your iPhone to contact emergency services with a long press of the side buttons, then that's more chance your friend has for survival.

- Michael P.

David Alden said...

Mike, thanks for your input! I agree on your points about bringing some first aid supplies and I have become COMPLETELY lax in this respect. Perhaps this is a good reminder. I've found that making my own kits was waaaaaay better then the store-bought kits with "200 pieces," 175 of which are tiny bandaids. I'm going to check out that App!

kathy said...

David a totally excellent read. when I think back when I use to hike alone, never telling anyone where I was going nor did I even take a cell phone. I did have a small first aid kit that I always made with me. Mainly because it was habit of having kids, even the basic things knife, matches, even a few snacks.but Now I look back.. smh...