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Old    Joe Umali (dakid)      Join Date: Feb 2001       10-03-2006, 1:47 PM Reply   
watching video highlights of the event in singapore prompted me to write this. i watched it yesterday to see how dallas hurt her leg. the crash didn't look out of the ordinary, but nonetheless, she was hurt seriously. the next couple clips kind of concerned me. the med/safety crew where carrying her off in a stretcher and you can see her bouncing a bit in it as they ran her off. the next clip, you see a lady hanging on to her leg which i'm assuming is to keep her leg stabilized.

1. in reference to dallas' injury, shouldn't they have immobilized or stabilized her leg? couldn't her bouncing on the stretcher have caused more injuries? (not saying it did)

2. what are the qualifications of the med/safety crews at events? if they're not emt, firefighers or paramedics, what kind of training do they have, or are they not required any certification?

3. do people's boat crews (outside of events) know what to do in case of a serious injury?



**disclaimer**

i'm in no way criticizing the actions of the safety crew in singapore. i'm merely asking what proper procedures are and their qualifications to perform such duties.
Old    Bruce Banner (breadbutta)      Join Date: Dec 2003       10-03-2006, 2:06 PM Reply   
Thats a good point Joe. Bob, and the EMT crew at Lake San Antonio were great. Highly trained and many years on the books. They were true professionals who treated me and my injury with respect, asking me for input and letting me decide to keep my leg bent for the 40 minute ride to the hospital.
1. Yes, they should have stabalized her leg. But there are many ways to do this. I'ts made me think of a support that could fit under the leg to hold it in place, although for me a pillow worked fine.
2. They should be EMT at a minimum.
3. My son and his girlfriend responded well. Helped me get in the boat. Got help quickly.

I can totally see how somebody could drown with this type of injury.

(Message edited by breadbutta on October 03, 2006)
Old    Jon (jon4pres)      Join Date: May 2004       10-03-2006, 2:09 PM Reply   
^^
The reason that people should wear APPROVED life jackets.
Old    00wakesetter            10-03-2006, 2:15 PM Reply   
The first thing you need to learn is what a broken femur looks like and the swelling that comes with it. No one on the boat including me knew what was wrong with my leg after i did mine and it was the size of a basketball. It took the EMS atleast an hour to arrive so i couldnt agree more with knowing what to do with someone with a broken bone.
Old    kylie-logan (kylielogan)      Join Date: Apr 2006       10-03-2006, 2:28 PM Reply   
Actually, some people disagree on the use of a traction splint. The first thing to know is that it can ONLY be used in a MID-SHAFT FEMUR FRACTURE. If the femur is fractured anywhere OTHER than mid-shaft, it cannot be used. The person holding the leg would have been providing manual stabilization to keep it from moving. The traction splint pulls the femur back into place (or that's the hope) and releases some of the tension caused by the contracting muscles, which I understand is what causes a huge amount of the pain. BUT ... your femoral artery is also in that compartment and if you're bleeding inside from that artery being cut or sliced, there is argument that the swelling actually helps occlude the artery and slows the bleeding. So for some people I think it is half of one, six dozen of another. That's the extent of my knowledge on it. I know how I'm trained to treat one, but fortunately have never seen it and hope I never do!!
Old    Rich Dykmans (richd)      Join Date: Oct 2003       10-03-2006, 3:00 PM Reply   
"The first thing to know is that it can ONLY be used in a MID-SHAFT FEMUR FRACTURE."

My son's was a fairly clean mid-shaft break which is probably why they put him right into that splint. As I posted on the other thread the paramedics told me extending the leg was the thing to do but as you point out there are probaby times when that's not the best thing and perhaps in Dallas' case it wasn't. Calling 911 is probably the most critical thing to do. Would leaving the board on perhaps be a good way to stablize the leg while one is waiting? I remeber his foot just rolling over once the board came off.
Old    Antbug (antbug)      Join Date: Jul 2004       10-03-2006, 3:09 PM Reply   
Joe where are the video highlights you are talk about?
Old    Geoff (liquid1)      Join Date: Oct 2004       10-03-2006, 3:14 PM Reply   
In response to question 2) currently for the U.S. PWT, the pick up jet ski is manned by a FF/Paramedic (for those who dont know a paramedic is an advanced multi year program compared to the EMT cert which can be completed in about a college semester), with swift water rescue and other extensive training. He is also a former Sea World show skier.
The land staff is all trained in water extraction, CPR, and other basic first aid training.
Regarding the removal of Dallas from the water, i didnt see the video, and i guess it depends on the situation. If their was, or the possibiltiy of, a more life threatening injury, and moving her without immobolizing her leg didnt put her in more serious harm, then i can see moving her in an expedient manner. Ill let the experts go beyond that.
And for 3)I regularly ride with 2 RN's, one of which rotates through the E.R. I myself have EMT and water extracation training although all my certs have expired.
I think everyone should seriously consider CPR, and then if possible a water extracation class if possible, because their are unique circumstances involved anytime you have an injury on the water.

(Message edited by liquid1 on October 03, 2006)
Old    Joe Umali (dakid)      Join Date: Feb 2001       10-03-2006, 3:15 PM Reply   
http://www.channelnewsasia.com/video/

scroll down to "Teenager Phillip Soven wins HSBC Wakeboard World Cup."
Old    Antbug (antbug)      Join Date: Jul 2004       10-03-2006, 3:18 PM Reply   
thanks
Old    Joe Umali (dakid)      Join Date: Feb 2001       10-03-2006, 3:24 PM Reply   
geoff, is that the standard now for the pwt? if so, that's awesome! a few years ago at irvine lake, wasn't a rider's life endangered because the pick-up jetski driver was more concerned with putting his cell phone and walkie-talkie away, taking off his hat/shirt, etc., before heading over to the fallen/injured rider?

i might have to get certified. i think it's a good idea to have qualified people on the boat in case of injuries.
Old    kylie-logan (kylielogan)      Join Date: Apr 2006       10-03-2006, 3:25 PM Reply   
Rich - I don't know why they would leave the board on other than that they probably didn't have tools right on them to remove the boot. Your son's foot would have rolled over, I'm guessing, because releasing it from the boot would have resulted in the muscles being able to contract a little more, but the boot still has to come off. In Dallas' case, my guess would be that with so many spectators, they simply rushed to get her to an area where they could provide the best, uninterrupted care for her. I'm sure she's in good care; it sounds like her medical team is really on top of everything.
Old    Phantom (phantom5815)      Join Date: Jul 2002       10-03-2006, 3:32 PM Reply   
Of course every situation will be different and remaining calm to assess the situation is one of the most important things you can do.
You support and splint injured area in the exact position you found the person until help arrives or you can get the person to help.
I am against straightening a leg that doesn't want to staighten out on its own.
Supported,Protected & splinted correctly with taking care in transportation is all you can do to help minimize further injury.


This also brings up the point of riding without a 3rd person. It's not about the flag holder.
How many people are still willing to ride without a 3rd now?

**after watching the video it looks like she may have fracture her leg on the take off not the landing.


(Message edited by phantom5815 on October 03, 2006)
Old    Geoff (liquid1)      Join Date: Oct 2004       10-03-2006, 4:40 PM Reply   
Joe, thats has been the standard since 2004, and probably before that, but im not sure off the top of my head. I dont know about the incident you mentioned, but ussually the only delay is in getting to the rider, especially if they are far down course, or if they fall in a hard to see area.
You can ussually get a CPR class from your local red cross or other groups. An EMT class can be found at a many JC's (at least in so cal) and will take a few hours, 1-2 nights a week for a semester or so.
Old    Paul Bernier (wakeriderixi)      Join Date: Jan 2004       10-03-2006, 4:55 PM Reply   
"after watching the video it looks like she may have fracture her leg on the take off not the landing. "



I don't see how you came to that thought... Looks like she under rotated and the vast surface area of the board caused her to come to complete stop upon hitting the water, something had to give!

Not critizing you Phantom for your thoughts!
Old    Rich Dykmans (richd)      Join Date: Oct 2003       10-03-2006, 5:21 PM Reply   
KL: I was just wondering out loud if maybe leaving the board on would be better until the PM's come. In Chris's case I grabbed his ankle and pulled his foot out of the binding because I didn't have any way to cut it off and I didn't know any better. As I've said many times I'm lucky I didn't kill the poor kid.

Casing the back side of the wake. How many remember the video of Christie Fisher doing that on a 180 and hitting it all straight legged. Her injury I believe was very similar to what has been described as happening to Dallas. The way I see it it's like jumping off your roof, landing on 1 leg with your knee locked.
Old    Randy Scagliotti (wakedad33)      Join Date: Oct 2005       10-03-2006, 6:11 PM Reply   
Rich you just painted a nasty picture in my head, ouch...
Old    Joe Umali (dakid)      Join Date: Feb 2001       10-03-2006, 6:20 PM Reply   
fisher's injury was a wake-to-wake gone bad, casing the 2nd wake. her injury was a tibial plateau fracture. i think she may have torn some ligaments, too.
Old    Rich Dykmans (richd)      Join Date: Oct 2003       10-03-2006, 7:31 PM Reply   
So Christie's was the lower part of the leg? I thought it was right below her hip as well but it's been a while now. Was it a wake to wake 180 or a straight WtW? I just remember how straight legged she was when she cased the backside of the second wake.

Randy,

Not pleasant memories believe me. Brady tore his ankle up pretty good a couple of weeks ago behind our boat. I haven't heard yet if he needs surgery but I guess it's a possibility.

They just keep going bigger and bigger.
Old    andy zarlengo (colorider)      Join Date: Jun 2001       10-03-2006, 8:13 PM Reply   
Christie Fishers was a simple wake to wake. Cased the wake and then fell. Looked like an absolutely normal crash. I was there for it.
Old    Rich Dykmans (richd)      Join Date: Oct 2003       10-03-2006, 8:17 PM Reply   
Thanks for the clarification on that.
Old    Phantom (phantom5815)      Join Date: Jul 2002       10-03-2006, 8:17 PM Reply   
Paul- It doesn't look like it to me that she even attempted to finish a rotation and landed on her belly.
From what I've seen in the past, Dallas has always gotten the board underneath her. In the video she appears still laid out when she hits the water
Old    Rod (rvh3)      Join Date: Jul 2003       10-03-2006, 8:30 PM Reply   
Joe,
I'm curious as to how you found that link to the video of Dallas. I'm impressed!
Old    Sparky Jay (wake_upppp)      Join Date: Nov 2003       10-03-2006, 9:28 PM Reply   
"This also brings up the point of riding without a 3rd person." Phantom brings up a good point. I don't ride with any less than three because one person may not be able to help the injured person alone. Could make a bad situation worse. Also, contrary to popular belief, 911 is not the prefered "first call" to make. Calling the local sheriff of the county you're in will have a much faster emergency medical response than 911, at least here in Cali, since 911 goes through a CHP central dispatch, and then is routed accordingly. People use 911 so much for non-emergency related calls that it can be a slow process. Keep the numbers programmed in to your cell for the areas you ride.
Old    Reid Shimabukuro (reid808)      Join Date: Mar 2005       10-03-2006, 9:42 PM Reply   
Unfortunatly I've seen this happen 3 times. My brother Ryan (a regular on Wakeworld), a good friend and an employee of my former wakeboard shop (RNR Surf & Ski). A broken femur can be fatal. As stated earlier in the discussion, the femoral artery is located in that area. What compounds the problem is being in water. If the rider lands face down time becomes critical. Water in the lungs will kill you! Pnuemonia and many other respirtory infections don't take long to develope. Some of the water quality overseas are marginal at best. Just things to remember. I'm currently a Firefighter/EMT and have been one for the last 16 years. I also love the sport so much that I opened a shop some years ago. Watching the brief video clip isn't enough to make a fair assessment of the situation. A traction splint is the preferred tool providing the broken femur is not an Open Fracture (Compound). What the traction split does is provide some relief. It would help more if the break was clean and not a spiral fracture. While Dallas was in the water she would have been in the most comfortable position. A rapid trauma assessment could be done while she's floating. The neutral bouyancy keeps her leg suspended. Manual stabilization of her leg will keep her leg from flapping around (sorry for any graphic descriptions). Getting her on the swim platform is where she will start to really feel pain. A backboard could have been placed under her while she was in the water. Monitoring her LOC (Level of Conciousness) is critical. A person can go into shock quickly. So many things to remember. Best thing that a rescuer can do is stay calm and assure the patient that they're doing everything you can. My prayers go out to Dallas and her family. I had the opportunity to pull her and the entire Fox Team a few years ago.

God Bless,

Reid
Old    pjdave (pjdave)      Join Date: Oct 2002       10-04-2006, 1:32 AM Reply   
At our events (Gravity Games H20, Planet x games and wake slam jam) Paramedics are on shore waiting. We also have surf life savers out in 2 irb's or jetskis ready to attend to any incident.
Old    Chris R (crracer)      Join Date: Nov 2003       10-04-2006, 2:26 PM Reply   
Joe,
Being a paramedic and also breaking my femur four years ago I can tell you from experience that it does depend on the location and extent (open vs closed fx as well as amount of swelling)of the break when it comes to treatment.

There are a few black and white details:

1.)Rich is right! Activating the 911 system ASAP is very critical due to the possibility of bleeding out that exist with a femur FX. Once a person begins to bleed from an artery such as the femoral artery they have the ability to lose up to 3 Liters of blood into their thigh. Once a person goes into shock the body really does began to use compensatory mechanisms to help the blood pressure hang in there even though the body is lacking the blood return back to the heart, due to the femoral bleed, which is crucial in getting a good strong contraction from the ventricles of the heart. If medical attention isn't provided in an acute manner the shock will be come irreversible!

2.) A rule of thumb for broken extremities is splint in the position it's found.

The exceptions: When there isn't a pulse present, or if the extremity doesn't look pink. We check for pulses and capillary refill which is done by pressing down on a nail bed and making sure there is a quick return of blood underneath the nail bed.

Now the gray area...I think leaving the bindings on would be a good idea maybe take them off of the board if it is possible, but let the PM's or other healthcare professionals make the call as to when the binding should come off. Traction can be applied if fx is closed meaning no signs of bleeding out side the body and if the fx appears to be at or below the middle of the femur. But again if there isn't a present pedal (top of the foot) pulse, then re-align the leg into a straight natural position and gently traction should be applied in a downward manner. Re evaluate the pt's pain level and presence of a pulse before and after the move....hopefully by the time u do this stuff 911 will be there! I unfortunately was riding out at a supercross track in the hills and laid in the mud for 45mins before ems arrived. I was in shock so I wasn't given morphine till the hospital...

I still haven't found a word to describe that kind of pain.

Hope some of this helps
Joe get CPR cert. and get some basic first aid training. You are around this sport so much it would be very valuable.
Old    Mike (tige_n_it)      Join Date: Nov 2004       10-04-2006, 6:56 PM Reply   
A lot of good information here. How do you handle someone while there in shock?
Old    Sparky Jay (wake_upppp)      Join Date: Nov 2003       10-04-2006, 7:15 PM Reply   
Like I said, 911 is NOT the fastest response time. County sheriff where you ride...have it programmed into the cell.
Old    kylie-logan (kylielogan)      Join Date: Apr 2006       10-04-2006, 8:05 PM Reply   
i think everyone should have first aid training of some sort. A lot of it is common sense and is how people normally react to serious situations. It's worth giving up a day of your time to learn basic CPR. The EMT-Basic courses are like one semester long and are well worth it. If you don't want to go as far as EMT-B, you can take a Firefighter First Responder Course or an Outdoor Emergency Care course. As for shock, I'm sure the docs and EMT-P's on this site can give much more info than me (EMT-B), but there is not much you can do for someone "in the field." Keep them warm and give them O2 if you have it. Basic "shock position" is lying supine with the legs raised 8-12", but there are qualifiers as to when to do this or not do it. When I did my hospital clinical, we had a patient in diabetic shock who was almost out of here. The nurse raised the foot of the bed and his BP increased immediately, so I believe it works. I believed it even more after the doc came back into the room, said it did no good and dropped the legs ... and the BP. No more comment on that other than to say it sold me on the shock position.
Old    Chris R (crracer)      Join Date: Nov 2003       10-04-2006, 10:04 PM Reply   
Hit the nail on the head Kylie, nice! If the pt isn't having problems breathing lay em flat and raise their legs, u can lower their head as well. Warmth and o2 are key. Once a person begins to bleed they are already behind the 8 ball as far as transporting oxygen goes! (Oxygen is transported via our red blood cells)

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