Dude, are you alright?

Cast your mind. Heading down your favorite local ride you come across a rider down. Maybe he's alone, maybe she's with a big group. Maybe he's lying unresponsive, maybe she's grabbing her angle in agony. What is your roll? Surely you can't pass by. Of course you are not obligated to this person, but ethics alone compel. It's the right thing to do. But what next? If you are going to be one of the folks to give help, what do you do? The following are some of the common injuries and conditions you may come across on the trails, and a few tip-a-roos to help assess what needs to happen next. This won't be any hypertechnical lengthy post, but I've seen more than a few times people miss some very basic and crucial steps in helping someone. It's also not any kind of complete list, just common cycling related issues. I'm very hopeful people will comment on this post and aid in my own learning process!

From basic to more complex and serious:
Sprained ankles:
Signs: "I fell down, my ankle hurts"
I think the main consideration for these injuries is how you will get the person back to front country. In the case of a severe sprain, you may need to help a person walk out of the trail. Just consider weather, temperature and transportation to avoid getting stuck out in a midnight freezing epic. If you have tape or an ace-bandage wrap it tight and get going!

Knees:
Knee injuries are various and wacky, and it's unlikely you'll be looking into any specifics of the injury. I think just treating it as the above is appropriate with the addition of a splint either on hand or jury-rigged from a stick to keep it stable against lateral movement.

Fractures:
Simple:
Simple fractures should be stabilized and dealt with right away. Similar time considerations apply with regard to getting out. With these it is best to avoid trying to manipulate the fracture in any way. Leave that to the emergency room. Again splinting to protect against movement is wise.
Compound:
This means bones sticking out of the skin. Don't try and reduce them out on trail! Just wrap them up if you can with a shirt to cover the exit point of the bone and head out. One exception to this rule is a femoral fracture (thigh bone). A complete or compound fracture of the femur holds significant risk of damage to the femoral artery. If this is damaged, someone can bleed to death in minutes. Wilderness medicine suggest holding traction on the leg until it can be dealt with. This pulls the femur back in line and away from vessels. There are some creative and fascinating ways to rig a traction until in the back country taught by the folks at the Wilderness Medicine Institute. Their courses are invaluable!

Dislocated Shoulders:
Signs: you'll know this one because it looks ridiculously odd and the rider will be clutching that arm with very limited movement.
Reducing a dislocated shoulder is actually remarkably simple and is something you can do on trail, so long as you don't force a stubborn case. Get to it early enough and the muscles may still be relaxed enough to reduce it with ease. Typically the rider's arm will be obviously deformed, and held close to the body with the arm bent at a 90 degree angle. This is convenient because at this point all you need to do is hold the elbow against the rider's body and at the same time take their hand and rotate their arm out away from the body slowly. Somewhere halfway through the external rotation the shoulder should reduce. You'll feel it "thunk" back in followed by the "OUCH!" from the rider. Don't go and use the shoulder after that. Sling it with a t-shirt and go home! Here's a video from the Navy on reducing shoulders. A separated shoulder will have a similarly deformed look to it, but the deformity will be higher atop the shoulder. These are best left to the emergency room because they involve varying degrees of ligament tears.

The Spinal:
This is serious stuff, and can be particularly complicated in the rider's desire to not appear hurt. If you see someone take a bad fall onto their head or back the first thing you have to do whether they are conscious or not is stabilize their spine. A spinal injury that hasn't yet damaged the spinal cord can easily do so if you try to move the rider. I think it is really important to take charge on this if you saw the fall happen. Remind the rider of dinners out of a straw for the rest of their life if they try to move.

Conscious Rider:
If you come across someone either lying down or sitting up but you didn't see the fall, it's never a bad idea to rule out spinal injuries. The way to stabilize a spine is basic: get behind the person, press your palms on the side of the rider's head like your covering their ears, stabilize your arms against there body and hold the heat absolutely still with their eyes level and facing forward. NEVER try to remove the rider's helmet!

Unconscious rider:
Basic first aid teaches the ABC's: Airway, Breathing, Circulation. One of the doctors i learned from just calls them the AAA's: Airway, Airway, Airway. If you don't have an airway, then breathing and circulation are pointless. Many people are deathly afraid to touch someone in this kind of injury, but if you have a rider down and unconscious he or she may die right before your very eyes for lack of a simple airway. If you think the neck is clear, you can LIGHTLY tilt the rider's head back to open the air way. If you feel the neck is compromised, stick two fingers behind their jaw right under the ear and thrust their lower jaw out. This will also open an airway without moving the neck. When the rider begins to come to, they may make some weird snoring sounds. This is just the brain fighting against a limp soft palette and tongue to get air. Again, NEVER try to remove the helmet.
This situation calls for no playing around. Bust out cell phones, send someone to get to one and get either an ambulance or a helicopter in. There is far to much risk trying to even move these riders let alone get them out. If CPR is necessary, the new protocols for those who know how to do it are 30 compressions for every two breaths. Some even say no breaths at all, just chest compressions. Also remember to properly do chest compressions you are likely to break at least one if not many ribs. This is the right way to do them, so don't be swayed by the cracking sounds you hear. Ribs crack outward so there is no risk to the lungs.

Shock:
There are all kinds of shock. The one's you'd likely see on trail would be from injury or blood loss (god forbid). Treating someone for shock involves lying them down, elevating their legs slightly and keeping them warm.

Seizures:
Probably pretty rare, but just remember not to try and stop the seizure. Just keep their heads from hitting anything and keep your fingers away from their mouths unless you want it bitten off!

Chest Pain:
I don't just come right out and say heart attack because chest pain can be a symptom of a few common situations on trail. That being said, the most serious by a LONG SHOT is the heart attack. I've come across people having chest pain while riding, and was so thankful I knew how to recognize it! Listed below are some common things that would cause or be mistaken for chest pain on the trails.
Hyperventilation:
Signs: Shortness of breath, tingling around the mouth. Get the person to stop riding, and breath into the classic paper bag. Your body is freaking out because it has too much O2!
Acid Reflux:
Signs: Burning pain right under the sternum (breast bone). One thing that makes this kind of pain worse is lying down, so you can do that to rule out heart attacks. Carrying a few tums around is great because you can set someone's mind at ease by giving them one as their "chest pain" will dissipate almost immediately.
Heart Attacks:
Signs: Chest pain, Shortness of breath, excessive sweating, nausea.
I would always be very worried if I saw these symptoms. Age is never a determining factor, and if someone is having these symptoms they don't need to be old, or overweight to consider a heart attack. The nature of this chest pain is very deep, centralized and crushing as if someone were standing on their chest. It is worse with exertion, and not worse with breathing or pushing on the chest. The pain often radiates to the left arm or the jaw. It's no surprise that this person needs to get to a hospital in a jiffy! Unofficially, I always carry a vile of Aspirin with my on rides. In fact I carry one everywhere for this reason. Heart Attacks are caused by a blood clot in the coronary artery. Aspirin is a blood thinner and prohibits clotting. If I come across someone with these symptoms (and I have!) I "suggest" they chew up two Aspirin and swallow them, then put on under the tongue to dissolve. It's no cure by any means, but has been proven to decrease mortality in heart attack cases. After which it's time to call the ambulance! Again, CPR protocols are 30 compressions for every 2 breaths.

Also remember, unless you try and do something stupid like perform surgery with a tire iron, you're protected under the Good Samaritan Law when attempting to help someone. If they are refusing help obviously don't force it on them, but don't be afraid to step in and help! Go out and take CPR, First-Aid courses!

Wilderness Medicine Institute: http://www.nols.edu/wmi/

Again, comments are much appreciated!