Before we begin... I am a qualified doctor currently training in Anaesthetics and I have an interest in equestrian events medicine and trauma. This blog does not aim to replace first aid training, and I would recommend that all those spending time around horses gain formal training.
Horses are inherently unpredictable and therefore there is always a chance that when you are spending time with horses an accident could happen. That’s a fact, and one that we can’t change, but what we can change is our knowledge of how we manage the situation when things go wrong. This is the first in a series of blogs on what to do if someone is hurt or injured around their horse.
As an Anaesthetic trainee with an interest in equestrian events medicine I am passionate about teaching people what to do when someone is seriously injured. This may seem basic to those of you who have had some first aid or medical training but it is the simple things that can save people’s lives. What I aim to do in this blog is to explain what you need to do if someone has a bad fall.
So here is the first scenario...
A rider falls from their horse and is lying on the ground. They are awake and talking but saying that they have pain in their back or neck. What do you do?
1. Do not move them and encourage them to keep their head and neck as still as they can. Do not let them get up if they have pain in their back or neck. Spinal injuries are common in horse riding related falls, and keeping someone still is vital to ensure that they do not develop any further spinal cord injury.
2. Call an ambulance urgently and inform them that the patient is conscious but has pain in their back or neck. Relaying this information and details of any other injuries accurately will allow the ambulance service to allocate the correct resources to you.
3. Keep them warm. In patients who have undergone significant trauma, staying warm is key and lying in mud or on wet sand can make people cold very quickly. Horse rugs are great for this!
4. Keep them talking. This will allow you to recognise when/ if they become confused or drowsy indicating a potential head injury.
5. Keep a timeline. Try and keep track of the timing of events, and if there are any changes in the patient's condition make a note of when they occur.
So what do you do if someone is unconscious following a fall?
If someone is unconscious you must first of all check that they are breathing. If you are confident checking for a pulse then do this as well, but if not then there are three things you need to do:
• Look – see if their chest is moving as they breathe
• Listen – put your ear to their mouth and make sure you can hear them breathing
• Feel – put your hand lightly on their chest and see if you can feel it moving
If they are not breathing and there is no pulse then you need to commence CPR immediately. (I will not cover this in detail but more information can be found at https://www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-automated-external-defibrillation/#sequence)
1. Once you have determined that they are breathing, do not move them. In particular make sure that you do not move their head and neck in case they have an injury here. Keep a close eye on their breathing as their condition can change very quickly.
2. Urgently calling an ambulance, keeping them warm, and keeping a timeline of events apply in this situation also.
Other things to consider:
• Does anyone there know anything about their medical history? Allergies, known medical conditions and medications are again very helpful for the ambulance. If these can be written down and given to the crew this will help on arrival at A&E.