Interviewer: From the front lines, April 2016. Four wheeler injuries that's next on The Scope.
Announcer: Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listing to The Scope.
Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah hospital and he has told me in the month of April, that's when you start to see the four wheeler injuries. People go down to the dunes, they get on the four wheeler for the first time of the year. Let's talk about briefly about what you do when a four wheeler injure comes in and maybe what somebody should do on the site if they witness one or are part of one.
Dr. Madsen: This is a great question. Like you said, this is something we start to see every April. And it's usually during Easter weekend. People get away, they go down, they get their four wheelers out, they haven't been driving their four wheelers much they're exited, there are tons of people out there. They've got there kids on the back of there four wheeler and they're having a great time. And it is a great time and then, sometimes, stuff happens.
So the number one I think about if something happens is making sure they are breathing. So if you're on scene and you're with someone who falls off a four wheeler or is injured, you've got to make sure they're breathing. That's first and foremost. Then, you start to think circulation as well. We're going down on the ABCs, making sure their heart's beating, all that. And of course, getting medical attention immediately if any of these things are not in place.
Interviewer: Okay. So the first thing you do is check if they're breathing, make sure they're not bleeding. And then, what about this notion of you shouldn't move somebody that's been thrown from a four wheeler? What's that?
Dr. Madsen: That's a great question too because you might think, "Well, I can't touch this person. I can't move them. I might hurt something." The big thing we are worried about with people is their spine. So if someone is unresponsive, they are not talking to me, but they're breathing, they've got a pulse, the next thing I am worried about is when they fell off that four wheeler, did they somehow hurt their neck? So I want to make sure that they're in a safe place. I don't want to leave them on the edge of a cliff or under a four wheeler, but I also want to limit moving them as much as possible just because if I move things, it could move things in their spine and make a bad injury much worse.
Interviewer: Okay. So how do you test to see if it's a spine thing? Do you prick their foot? "Do you feel that?" I mean, what do you do?
Dr. Madsen: So this is stuff you really won't be doing on scene. My recommendation would be if you're in a safe place, if things are okay there, get medical attention there. Airmed, our air transport team, often has a helicopter on site at Little Sahara during Easter weekend. You can get medical attention and they will then put this individual in a collar to keep their neck stable. They'll put them on a back board to make sure they're not moving around making sure they're taking the appropriate steps so things don't get worse
Interviewer: I feel like we're going a little worse-case scenario here. Most likely, if the person can get up under their own power, they're going to be all right? Is there something else you worry about? Do you worry about concussion at that point?
Dr. Madsen: Absolutely. If they hit their head, if they're not acting right, if they're vomiting, they're confused, you're worried about a concussion, certainly you're looking at them. Do they hurt anywhere? Are you're seeing something deformed that looks like a broken bone? Those are all things to think about once you address the bad things. You can push on their neck too. Just ask them, "Does your neck hurt?" If it's hurting, that would be a reason not to move them around a lot. You want to limit what they're doing if there's a potential for an injury there.
Interviewer: And if somebody does gets up, they get up under their own power, they seem to be okay, they seem to know where they are and what's going on, is it fine to hop back on and continue your day?
Dr. Madsen: Most likely. Yeah, so if they're getting up under their own power, they're acting appropriate, they're not confused, they can tell you, "Hey, my ankle is a little sore, but I'm walking on it," they should be fine, just like any other injure or any other sort of fall.
Interviewer: What are some of the common injuries you do see from four wheelers that do come to the emergency room?
Dr. Madsen: The most common serious thing I see, and you've got to keep in mind I'm seeing the serious stuff if they're coming to us, are head injuries. And that's the big one. If someone falls off, maybe they had a helmet on, maybe they didn't. Obviously, having a helmet puts you at a lower risk than this, but that's the big concern is someone falls off, hits their head and gets bleeding in the brain.
Another very common one is orthopedic injuries. I see, a lot of times, injuries to the ankle and the lower leg. Maybe their four wheeler's falling over, they reach a leg out to try to stabilize themselves, they really can't. You've got all that force coming on your right leg or your left leg, trying to hold things up there and it just snaps the leg. Arms too. Those are probably the most common things I see.
Interviewer: What about the four wheeler ending up on top of somebody? Does that happen that often?
Dr. Madsen: It happens and certainly there, you see more abdominal injuries, injuries to the liver, the spleen. You get all that weight on top of someone, it can cause a laceration there and internal bleeding certainly is something we see not as commonly, but I have seen it.
Interviewer: And how could you tell on site if somebody had those kinds of symptoms?
Dr. Madsen: Yeah so there, you're really going to have to go by, number one, what happened. Was there a four wheeler on top of them? Number two, are they saying, "My abdomen hurts"? If they have been injured, even a handlebar to the abdomen or a four wheeler on top of them and they're saying, "Hey, I really hurt here on the right upper side of my abdomen," and you're kind of touching there and they're saying, "Hey, don't touch me there," that's really concerning and definitely a reason to get a medical attention
Interviewer: Anything that I left out, any scenarios? I mean, gosh, there are so many when four wheelers are involved.
Dr. Madsen: Exactly. I mean, are so many things can happen. Obviously, the key is common sense. Wear a helmet, be safe, know where you're going, be aware. Certainly in a high-volume place of other people coming over ridgelines, things you may not see happening, be careful with kids. That's the scariest thing and, often, the saddest thing when you see kids on the back of four wheelers who just get knocked off, bounced off and get severely injured.
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