Several days ago I posted a video showing a cyclist and a deer having an unfortunate encounter. I have to say, I’m used to dealing with cars hitting deer, not the other way around! If you haven’t had a chance to watch the video and think about your management of this situation, take a few moments and do so! It’s a short video!
So, what would I do? What sorts of injuries come to mind when I watch the video? I should note that this video takes place in more of a front country environment, rather than the more typical backcountry environment I normally write about. My management will be from a backcountry perspective, rather than the obvious “call 911” angle.
What do I notice?
These guys are cruising pretty fast. They aren’t working too hard, but they also aren’t poking along. I’m not sure exactly how fast they are going, but out of an abundance of caution I’d include this in the “high-speed mechanism of injury” category.
That deer probably weighs in the 40-60 pound range, which is big enough to transmit some serious force. Again, this leads me to include this incident in the high-speed MOI category.
The deer strikes the front wheel of the bike, causing him to dump to the ground. He lands mostly on his side and back, and taps his helmet against the ground. He doesn’t skid that far, and pops up onto his feet pretty quickly.
We’re on an active road, so other traffic could become an issue.
The deer does not stick around to see if the patient is ok, and puts about 200 yards and a 4 foot tall wire fence between himself and the incident very quickly.
Based on what I’m seeing in this video, I’m going to be alert for signs and symptoms of these injuries:
The patient’s speed at the time of the incident and the way he goes to the ground make me suspicious of head, neck and spine injuries. I’m particularly worried about how he falls and rolls, bending his neck forward chin to chest. This isn’t the worst way for the head to roll, but it’s not ideal. He doesn’t land directly on his head or directly on his buttocks, which are good. But I still want to investigate his spine closely.
I want to be alert for head injuries. He’s wearing a helmet and doesn’t land directly on it, which is good. However, his head does contact the ground. I’d like to check his helmet for damage, and I want to be alert to changing mental status or other signs of brain injury.
I’m curious about possible clavicle (collar-bone) fractures. He lands on his side and rolls over his shoulder; that medial compression is a great way to snap the clavicle (I broke mine by landing on my shoulder after being hit in the head by a soccer ball. Long story.)
I want to investigate wrists and ankles. Our patient suddenly disconnected from his pedals, and I want to make sure that he didn’t torque or break something.
I want to look for wounds and abrasions.
So, how will I manage this patient? Here’s what comes to mind for me:
The patient popped up pretty quickly, and started moving around. If he had stayed on the ground, I’d have taken control of his head, neck, and spine with manual inline control. Since he’s standing up, I’m unlikely to try to get him to lay down, and I’d rather not do something aggressive like a “standing take down” to get him into a horizontal position. I may have him sit down on the side of the road, and then take control of his head and spine.
After confirming that airways are patent, breathing is not affected and the chest is intact, and looking for dangerous bleeding, a careful head to toe exam should show me what injuries I’m actually dealing with. I suspect that this patient isn’t more badly injured than some bruises, some muscle soreness (especially tomorrow!), and some road rash. Still, we need to make sure.
I’d manage any soft-tissue injuries found with cleaning and bandages, or with support/splints if sprains/strains/fractures are found.
If we don’t find symptoms of spine injury, we could consider a focused spine assessment (FSA) or other spine clearance protocol to let go of the patient’s head. Remember, the FSA is for patients WITH MOI for spine injury, but with no signs or symptoms of spine injury. If you’re a little rusty on the FSA, NOLS Wilderness Medicine put out a great video demonstrating the process.
Now that the patient is managed, we can focus on making sure his bike is ok…
So, there you go. If you have any questions, feel free to ask here in the comments, or on twitter with the tag #wwydwednesday. Until next week, take care!