I might've seen a guy die yesterday

Miscellaneous and Personal Stuff I Must Share
1

I took my mom mountain biking for her first (and now, last) time. We went on an easy - as someone said, “Rated G” - though somewhat long, trail. We were having a great time, and almost to the easy part. The trail is a loop that is uphill for about 7 miles and then very gently downhill for about 8 miles. We stopped to eat lunch at around the 6 mile mark. As we were eating, a couple in their mid 60s passed us, and we smiled and waved like we had been doing to everyone all day.

We finished eating and continued on, getting very close to the gentle, easy, slightly downhill section of the trail. As we rounded a corner we saw a young couple standing on the trail and a guy lying in the middle of it. My very first thought was “great place to take a break :rolleyes:,” and then almost immediately I thought “:smack:, he’s not taking a break, he probably has a sprained ankle or something.” I wish.

As we got to them and stopped our bikes, I saw that a woman (soon found out to be his wife) was leaning over his face giving mouth to mouth, and screaming in between “He’s not breathing, He doesn’t have a pulse.” The husband of the young couple who arrived there just before we did was on the phone to 911. He said they had arrived about 1 minute before, and the wife of the victim said the accident had been about 5 minutes before. Almost as soon as we arrived, a European guy showed up from the other direction and started giving CPR. His heart got going, but it would stop 2 more times before the helicopters got there.

The wife stuck with the mouth to mouth the entire ~90 minutes we waited for the first helicopter, and I’m ashamed to admit that I’m glad it was her and not me. His teeth were clenched and I think he had bit through his lip, because his mouth area was awful bloody (and so was hers - his blood), and I was afraid I was looking at a corpse. I hope I could’ve done it if no one else had been around. I think I could have. My mom monitored his pulse and I took my shirt off to lay over his legs. I felt so fucking helpless.

When the first helicopter arrived they got his heart stabilized and had the wife continue giving him breath with one of those squeeze bottles instead of mouth to mouth. It was another ~20 minutes before the medevac helicopter would arrive with more equipment and then another ~20 minutes before they would take off with him. I did what I could - get this, move that, hand me that, etc. I was (and am) awful worried about how much oxygen he was getting for the almost 2 hours before the medevac guys pried his mouth open and intubated him. Until that point I never saw his chest rise, only his stomach. He kept warm, and kept most of his color, besides some purpling of his fingertips, the whole time, so I guess that’s a good sign.

After the last helicopter took off, my mom and I, plus the young couple, plus another guy who had arrived shortly after us (the European left abruptly when the first helicopter landed), rode the remaining ~8 miles of the trail in silence, in the fading sunlight. I had time to think on this ride and realized that, after the guy who showed up 2 or 3 minutes after us, not a soul came along for over an hour and a half. We talked for awhile in the parking lot and took our time loading our bikes and gear before leaving. On the way out of the park we saw a sheriff’s deputy and he told us the gentleman had a broken neck and was still not conscious or breathing on his own.

We had hypothesized (and found out through discussion that the police and paramedics independently came up with the same hypothesis) that the guy had had a heart attack and fell off his bike. He was an experienced rider 64 years old, and didn’t have any defensive wounds. The abrasions on him were to the right side of his forehead, his right shoulder, and the backs of his hands. He had basically done a faceplant with his arms back, which made us think he was unconscious when it happened, but we were wrong. He was negative for a heart attack. It was just a freak, freak accident.

I came home and gave my wife a huge hug and told her how much I love her. I felt a profound sense of mortality yesterday and it hasn’t faded yet. I can’t stop thinking about this guy, and I even dreamed about him last night like I knew I would. I dreamed he coughed up some blood and gravel that freed his airway, and woke up, complaining that the paramedics had been too rough with him. It was a very happy dream in that I felt like he was ok, but I also kind of knew it was a dream; I knew I was fooling myself. He’s probably not ok. And like one of the guys on the scene said later, we barely have a right to be upset. We got to go home and hug our wives and have a drink and go to bed last night. This man’s poor wife was alone and scared in a hospital room with her husband on a ventilator, and her nightmare is probably just beginning.

Mountain biking has quickly become my favorite activity. I’ve done it 3 or 4 times a week minimum since August, and planned on it being part of my life, well, forever. Now I just feel sick thinking about that happening to anyone I care about. I feel sick thinking about it happening to this gentleman I don’t even know. I’m sure I’ll get back on the bike, but I need some time off to reflect. And I’m definitely taking a wilderness first aid course.

2

That is a horrible thing you witnessed, but you should never give mouth to mouth to a stranger with blood in their mouth. You put yourself and fundamentally your wife in danger. Your first aid kit should include a disposable face shield to prevent any fluids from carrying from the victim to you.

3

wow

nothing to say, really; just I couldn’t read that and not acknowledge your experience

yep

you’re right

4

I guess that’s the type of thing your learn in the wilderness first aid class I’ve neglected to take like an idiot. But most of the trails I ride are in city limits - - who the hell expects to come across this and not get help for 90 minutes? :frowning:

5

Someone who’s exposed to body fluids should also get a blood test to ensure that they haven’t caught anything. This summer, there was an accident on the highway north of Saskatoon, in which several people stopped to help. For about a week afterward, there were warnings on the radio that anyone exposed should get checked, because at least one victim was known to have a blood-borne disease (HIV or Hep C).

6

Note that it was the wife of the victim giving mouth to mouth, not Cisco. I think it’s pretty safe to assume that if her husband had any blood-borne diseases she would be a) aware of them and b) have been exposed to them previously.

ETA: Sorry you and your mom went through this experience, Cisco… not a good end to a family outing, that’s for sure. Good on you for stopping to help, though. Any chance you can follow up and see if the poor guy was able to pull through?

7

Yes, I was aware of that but he had questioned if he could do it in her place. I was suggesting that even if he could, he shouldn’t without the proper precautions.

8

I think the newest advice regarding chest compressions and rescue breathing is that chest compressions only are best for the lay public, unless the victim has breathing problems causing the heart failure.

U of A News
American Heart Association

ETA: I’m sorry you’re shaken by this. My dad had a few ‘events’ before he finally passed, and I’ve often thought of those who were around him during those times.

9

We only did exactly what 911 told us to do, and yes he had breathing problems causing the heart failure. His neck is broken. I have no doubt that his injury would’ve been fatal within minutes had he been alone. My only worry is that is was fatal anyway.

Edit: To be clear, “breathing problems” meaning he was not breathing at all, presumably due to the spinal injury, presumably meaning he will be, at best, quadriplegic. :frowning:

10

Isn’t true that giving mouth to mouth can be dispensed with if it is highly likely that paramedics or other medical treatment can be gotten in a matter of minutes? Also, I’ve always assumed mouth to mouth was to supply the victim with oxygen. How much oxygen is in expelled air?

11

>you should never give mouth to mouth to a stranger with blood in their mouth
Where can we get more information on this? I know that the much publicized risk of HIV is much lower if you are treating somebody outside of the high-risk demographics. Risking exposure to HIV is a big deal, certainly, but so is letting somebody expire to avoid it. A disposable face shield would be a good thing to have on hand, now that you bring it up, but I have never even seen one - much less one in a bicycling kit.
>quadriplegic
Pentaplegic, apparently

>How much oxygen is in expelled air?
I understand that expelled air has about 80% of the oxygen level of normal air, therefore 16% oxygen as compared to 20% for normal air.

12

For my job I am required to have a first aid ticket and that is one of the points given in the course. Basically before administering any first aid you must establish your own safety. Ingesting a stranger’s blood is not safe and after being exposed to it the professionals would have two people to deal with instead of one. Even if the risk is low it is still a huge one, and you would need to go through massive testing to make sure you were clean. Some diseases take months to show.

Cheap disposable masks are available at any safety supply store. I know they are required as part of the basic first aid kits for businesses, at least where I live. You can cheap ones for a couple of bucks. It’s not a bad thing to keep in a glove compartment or backpack.

13

It looks like about 0.16% of 60 to 64 year olds in the United States have HIV/AIDS.

http://www.cdc.gov/hiv/topics/over50/resources/factsheets/over50.htm
http://ceic.mt.gov/C2000/SF12000/Pyramid/pptab00.htm

14

Don’t forget Hepatitis B and C

15

It looks like a one-time exposure to an HIV-infected person’s blood through one’s mucous membranes or a needle stick carries a risk of less than 1%.

“risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 (see table above).”
[HIV/AIDS - Wikipedia]

“A significant risk exposure can be defined as a percutaneous injury or the contact of mucous membranes or non-intact skin with potentially infectious blood, body fluid or tissue. Body fluids that pose a risk of transmission of HIV virus are shown in Table 1. The risks of transmission of HIV vary with the type and severity of the exposure. A Health Protection Agency summary of published surveillance reports, looking at HIV transmission from occupational exposure to HIV, found that 22 of 6955 individuals with percutaneous exposure to HIV became infected, indicating a risk of 1 in 300 or 0.32% (95% CI 0.18–0.45). Of 2910 individuals with mucocutaneous exposure to HIV, there was one seroconversion indicating a risk of 1 in 3000 or 0.03% (95% CI 0.006–0.19) [23].”
[Occupational exposure to HIV and the use of post-exposure prophylaxis | Occupational Medicine | Oxford Academic]

I think a plausible estimate of the risk of getting HIV by giving mouth-to-mouth to the rider in this posting is less than 1% of 0.16%, or less than 0.0016%. If I thought that giving mouth-to-mouth would substantially improve this stranger’s chance of survival, I would do it.

16

No. If a person is not breathing on his own he needs oxygen, period. Just remember that giving mouth to mouth is worthless is the patient’s airway is blocked by vomit, blood, an ojbect, swelling, etc etc.

17

I think the lesson is clear that anyone who participated in outdoor sports that take them away from immediate help (such as x country skiing, mountain biking) should invest a little time in a first aid/cpr class. There can be nothing worse than standing by feeling helpless in such a situation wishing you knew what to do to help.

18

You can get disposable face masks in a tiny velcro closure pouch (maybe 1 inch by 1 inch) designed to go on your keyring. Slightly larger ones can hold a pair of gloves and a disposable mask, or a mask with a one-way valve.

19

Definitely learn what you can to help deal with such situations, but please don’t let this stop you from going out and enjoying mountain biking. This kind of accident could happen in the city too–I nearly did a face plant falling off my bike in a parking lot once, and I did do a face plant into a curb last year walking down the street and slipping on a rock.

Sometimes shit happens, and we’re all one second away from tragedy. It’s just that we don’t normally think about it, and having it shoved in your face is unsettling. So yeah, do what you can to process it–anybody would be shaken by this. But failing to live because of what might happen isn’t going to guarantee nothing bad will ever happen, and you’d miss a lot of fun in life in the meantime.

20

You exhale about 16% oxygen (versus 21% in room air). Research shows that the most important factor in surviving cardiac arrest is early CPR with good, uninterrupted compressions and early defibrillation. Our treatment plans are aimed at minimizing any interruptions to CPR, as well. In addition, the American Heart Association stopped teaching rescue breathing to lay rescuers a year or two ago.

St. Urho
Paramedic