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First On The Scene – 9 FMX injuries explained

Injuries in freestyle motocross are a matter of when, not if. Anyone who owns a dirt bike and rides it regularly can tell you endless war stories of broken bones, sprains, burns, KOs and times where they thought they were going to die.
While crashes and injuries are a common occurrence in freestyle (and it’s guaranteed to get worse as the progression of the sport keeps escalating and the tricks get harder), can you honestly say that you would know what to do if your mate crashed his brains out (figuratively speaking) and you were the only one around? How can you tell if he’s punctured a lung, or suffering from internal bleeding? What do you do if he’s got his shinbone sticking out of his leg?
All sobering thoughts, yes, but it’s something we feel you guys should be educated on, so you know what to do when things turn ugly. We enlisted the help of the great people at the St John Ambulance Service to take us through the most common dirt-bike-related injuries, what the symptoms are, and what to do – and not do – if you’re the only one within cooee of help.

SPRAINS
Sprains are probably the most common of all dirt-bike-related injuries, and normally you’ll sprain either a wrist, a finger or an ankle, but it’s also possible to sprain your knee and neck. Basically, a sprain is a complete or partial tear of the ligaments, due to a hyper-extension of the area affected. The severity of sprains can range from a slight stretching of the ligaments, right through to virtually breaking your ankle, wrist, etc.

SYMPTOMS:
• Initial severe pain, and the victim may feel a “popping” sensation.
• Tenderness and swelling around the joints.
• Bruising
• Inability to weight-bear or withstand any pressure on the affected limb.

YOU’RE A CHAMP IF YOU:
• Apply the RICE (Rest, Ice, Compression, Elevation) technique for the better part of 48 hours after the incident, to minimise the risk of serious injury.
• Get ice on to the area as soon as possible, and use a compression bandage to stop the swelling. If a compression bandage isn’t available, a normal bandage wrapped fairly tightly around the area will do a similar job.

YOU’RE A CHUMP IF YOU:
• Think you can “jog it off” and continue as if nothing happened.
• Rub Deep Heat on the affected area. Both of these will only increase the bruising and risk further injury.

BROKEN ARM OR LEG
While there has been a huge improvement in protective gear for riders over the past 10 years, broken bones – particularly broken wrists, arms and legs – are still one of the most common injuries among us riders. Wrists and forearms are obviously the most likely to break, but it’s not very common to break your upper arm.

SYMPTOMS:
• Victim may have heard a crack
• Swelling or deformity of the area. If it’s a broken wrist, there could be a dip in the wrist joint.
• Sometimes the patient can feel a grinding when he tries to move it.
• Bruising can come up quickly.

YOU’RE A CHAMP IF YOU:
• Immediately stop what you’re doing and come to help. Don’t keep riding thinking your buddy will be OK.
• Call the ambulance
• Immobilise the patient
• Use the riding jersey to make a sling to support the broken arm.

YOU’RE A CHUMP IF YOU:
• Think it’ll be OK to move the broken arm or leg.
• Bandage over the fracture. This will increase the pain as the bandage adds pressure to the broken bone.

BROKEN FEMUR
By far one of the most serious bones you can break is your femur (the bone between your knee and hip). As well as being the biggest one in your body, it’s also a major blood-producing bone. Modern knee braces can cause femur breaks as the brace takes the shock away from the knee and transfers it to the top of the brace.

SYMPTOMS:
• Patient will go into shock
• Patient may have heard a crack
• Sometimes the broken leg is one or two inches shorter than the other.
• The broken leg will also automatically rotate outwards away from the hip-bone, pushing into the tissue and causing immense pain.

YOU’RE A CHAMP IF YOU:
• Immediately stop what you’re doing.
• Call the ambulance
• Immobilise the patient.
• If, and only IF you have a First Aid course, you can gently try and pull the leg down and roll it inwards, then splint both legs together with a bandage, your riding jersey, etc. The ambos have a hydraulic system that does this efficiently and with less pain, so only undertake this if you know what you’re doing.

YOU’RE A CHUMP IF YOU:
• Try and put your mate in the back of your car and transport him to hospital yourself. He won’t remain your friend for very long.

DISLOCATIONS
Suffering a dislocation of any bone joint can be an excrutiating experience, and the shoulder, which seems to be the most common of all FMX and MX-related dislocations, is no exception. Basically, a dislocation is when a bone pops out of its socket.
 
SYMPTOMS:
• Patient will complain that the affected area hurts and may not be able to move it.
• The shoulder will slump lower and look deformed compared to the other.
• Circulation to the arm may be compromised if the patient says his hand feels cold and/or has pins and needles.

YOU’RE A CHAMP IF YOU:
• Support the arm of the dislocated shoulder with a sling. With motocross jerseys, it’s pretty easy to pull the jersey up and pin it in place to make a makeshift sling.

YOU’RE A CHUMP IF YOU:
• Try and put a dislocation back in place, even if it’s just a finger. If the dislocated bone is fractured, you might end up with a chip of bone getting stuck in the joint when you try and push the bone back into position.

COMPOUND (OPEN) FRACTURES
A compound fracture is when a broken bone pierces the skin and sticks out. These things look pretty nasty, and thankfully, aren’t anywhere near as common as normal bone breaks. Most compound fractures occur with the tibia and fibula bones between the knee and ankle.

SYMPTOMS:
• As well as the symptoms of a normal break (patient may have heard a crack and may feel a grinding sensation, there’s a deformity), you will notice the broken bone piercing the skin, causing an open wound.

YOU’RE A CHAMP IF YOU:
• Deal with this in the same way as you would any other fracture or break. Immobilise the patient and call the ambulance.
• Pad the exposed bone with a triangular banadage on each side (these bandages are common in first-aid kits) to protect the wound from getting infected and having dust and shit land on it.

YOU’RE A CHUMP IF YOU:
• Wrap a bandage around the fracture
• Wash or clean the wound with water, or any antiseptic washes like dettol.
• Try and push the bone back under the skin.

CONCUSSION
Concussion occurs when someone has taken a heavy knock to the head, but they can range from the mild concussion where the victim will only have a headache, through to serious cases when they’ll experience vomiting or seizures. A concussion takes place when the brain gets banged around inside the skull, causing it to go into shock.

SYMPTOMS
Depending on the severity of the hit, the victim of a concussion could experience any of the following symptoms
• No memory of the event
• Disorientation
• No comprehension of time or place
• Headache
• Dizziness
• Drowsiness
• Nausea
• Blurred vision
• Vomiting (advanced concussion)
• Seizures (advanced concussion)
• In some cases, particularly in FMX and racing, the victim can be so pumped full of adrenalin they don’t even know they’re concussed and will act fine initially. However, after about 10 minutes the adrenalin will wear off and the patient will go downhill rapidly and show some of the signs listed above.

YOU’RE A CHAMP IF YOU:
• Recommend they go to a hospital or a doctor to get checked out. People tend to take concussion lightly and can potentially end in hospital with bleeding on the brain if it’s not treated quickly. The grey matter inside your noggin is very complex and it’s best to take a couple hours out of your day to get checked out rather than a couple of days out of your week if you leave it unchecked.

YOU’RE A CHUMP IF YOU:
• Ignore the signs
• Let your buddy drive him/herself to the doctor or hospital,
• Supply them with any alcohol.

UNCONSCIOUSNESS
Getting knocked out from a big crash can be momentary, where the rider will be out cold for a few seconds, or it can be longer, although for the person treating the patient, it can often seem like minutes instead of seconds.

SYMPTOMS
• The victim will be unresponsive.

YOU’RE A CHAMP IF YOU:
• See if they respond to the AVPU formula the St John Ambulance Service uses. Are they Alert? Do they respond to Voice? Do they respond to Pain (squeeze a hand or push down on a fingernail – don’t punch or kick them)? Are they completely Unresponsive?
• Lay the rider on his side, as airways always take precedence over neck injuries.
• If you suspect there’s a problem with their airway, take the rider’s helmet off with the help of a mate – one to provide neck support in case of neck injuries, and one to remove the lid. Where possible leave it to the ambos to remove the helmet, though.

YOU’RE A CHUMP IF YOU:
• Leave them on their back.
• Punch, kick or shake the person to see if they respond. Shaking in particular can aggravate a spinal injury.

SPINAL INJURIES
OK, now we’re getting into the serious stuff. Spinal injuries are every rider’s worst nightmare, as it can leave them paralysed or with a disability for the rest of their life. The areas controlled by the different vertebrae differ as you make your way down the spine. Spinal breaks high up in the neck affect all the nerves, while the mid-to-lower neck can affect the biceps, but not the triceps. That means the victim can contract the arm, but not extend it. Simply put, there are four different areas of the spine: the cervical (neck) section is made up of seven vertebrae, there are 12 in the thoracic (the vertebrae that join on to your ribs), five in the lumbar (lower back) and those fused to the bottom, including the tailbone (sacral).

SYMPTOMS:
• The victim will be unable to move their body below the affected area (paralysis)
• Pain at the injury site
• Pins and needles at the extremities
• Inability to detect sensation (you could put their hand over a flame and they wouldn’t know).
• If the spinal injury is high in the neck, they may have difficulty breathing.

YOU’RE A CHAMP IF YOU:
• Call an ambulance immediately, and if there are others riding nearby, tell them to stop.
• Leave the victim on the track, immobilise the head and tell him/her to stay still.
• Immobilise the lower legs by bandaging them together in the same way you’d splint a femur.
• Please note that there is no safe way of moving someone with a suspected spinal injury, so leave it to the ambulance staff, who should be well and truly on their way.

YOU’RE A CHUMP IF YOU:
• Try and move the patient off the track.

INTERNAL BLEEDING
Internal bleeding can sometimes occur when a rider takes a big hit – normally by the handlebars – to the stomach or chest area. Interestingly, it’s more common for a rider to take a hit to the left side of the stomach, which can result in a ruptured spleen.

SYMPTOMS:
• If the patient has taken a hit to the chest and is coughing up bright, frothy blood, it’s likely they have had a broken rib puncture a lung.
If it’s an abdomen-related injury, the victim will show the following signs.
• Shock
• A pale and clammy complexion
• A fast, weak pulse
• Bruising to the stomach
• The abdominal muscles will be rock-hard as they automatically contract to protect the organs from more damage.

YOU’RE A CHAMP IF YOU:
• Make them comfortable,
• Put a pillow under their legs to take pressure off the abdominal muscles,
• Keep them warm and wait for the ambos to arrive.

YOU’RE A CHUMP IF YOU:
• Give them anything to eat or drink. Even if they ask for something, which is fairly common, don’t give them anything. Any food they consume can delay surgery.

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HOW TO UNDERTAKE CPR
Last year the St John Ambulance Service changed the way they taught CPR, to make it easier for people to perform it in an emergency situation.
Now, simply remember DRABC (Danger, Response, Airway, Breathing and Circulation).
First up, check there’s no danger before approaching the victim: maybe the flaggies haven’t seen the downed rider and the race is continuing, or perhaps there are still guys hitting ramps that didn’t see the accident unfold. Only once you’ve made sure all the hazards are removed or dealt with should you approach the victim, as it’s better to have one person down than two.
Check for the patient’s response (The R in DRABC) using the AVPU formula we talked about in unconsciousness (Are they Alert? Do they respond to Voice? Do they respond to Pain? Are they completely Unresponsive?).
If they’re unresponsive, check their airways (the A in DRABC) to see if there’s anything blocking them. If so, roll them on to their side to remove the obstruction, then check to see if they’re breathing by looking for a chest rise and fall, and listening at their mouth and nose.
If, after 10 seconds, you haven’t felt, seen or heard any sign of breathing, tilt the patient’s head back to open up the lungs, place your mouth over theirs, then give two rescue breaths. The chest should rise and fall; if it doesn’t, the air is going into their stomach and you haven’t got the head tilted back far enough.
Once you’ve seen the chest rise and fall, place the heel of your palm in the middle of the victim’s sternum and push down hard. The rate should be 30 compressions for every two breaths, and you need to complete five of these cycles in about two minutes. The rate has increased from the past to maintain blood pressure. It can be exhausting, so if you think you’ll struggle, have a mate nearby to “tag team” with. Keep this up, either until the patient comes around, or the ambulance service arrives.

IMPORTANT NUMBERS
In case of emergency, you can dial 000 from both mobiles and land-lines (or 111 if you live in New Zealand). If you happen to be out of mobile coverage on your Australian mobile, you may still be able to get out by dialling 112.

DO A COURSE!
What we’ve covered here is the very minimum of what should be done in an emergency situation. We reckon it should almost be compulsory for every rider to do a first-aid course of some description before they get their licence, but until that day comes you should enrol in a basic course, which takes just 15 hours and only costs around $155. The nice folks at St John Ambulance Service hold regular courses, and there’re many regional offices across every State in Australia and New Zealand. To enrol in a course, or to become a member of the St John Ambulance Service, call 1300 360 455 (Australia) or 0800 785 646 (New Zealand).