HEAT, DEHYDRATION AND REMOTE RIDER TRAUMA

The Technique

1. Learn the difference between heat exhaustion and heat stroke, because it decides whether this is a rest stop or an emergency. Heat exhaustion is a rider who is still with you: sweating heavily, weak, dizzy, headachy, cramping, feeling sick, maybe vomiting, but able to answer you sensibly and follow what you say. Get them out of the sun, get the gear and helmet off, cool them, lie them down with legs raised if that helps, and give small frequent sips of water or an electrolyte drink if they are fully alert. Heat stroke is different, and the difference is the brain. A heat stroke casualty is confused, aggressive, slurring, stumbling, behaving oddly, seizing or unconscious. Their skin may be dry or may still be wet with sweat, so do not use sweating to rule it out. Heat stroke is a life threatening emergency, so call for help immediately and start cooling at once. If a rider with heat exhaustion is not clearly improving within a short time of resting and cooling, stop treating it as heat exhaustion and treat it as heat stroke.
2. Cool aggressively, and stay inside lay scope while you do it. Cooling is the treatment, and starting it now beats starting it later, so cool while you wait for help rather than instead of calling. Get them into shade or build shade over them. Strip the helmet, boots, body armour and jersey. Wet the skin over as much of the body as you can and keep it wet, and fan hard, because moving air over wet skin is what actually pulls heat out. Put cold packs or cold wet cloths at the neck, armpits and groin, and keep swapping them as they warm. If there is a creek, dam or trough close by and you have enough hands, immersing the body in cool water works well, but only with someone holding the head clear of the water at all times and never with a person who is not fully alert being left in the water for a moment. Do not give fluids by mouth to anyone who is confused, drowsy or not fully awake, because they will choke. Do not put a casualty in a hot vehicle to drive them out before you have cooled them. Keep cooling until they are behaving normally or handed over.
3. Practise hydration on the bike instead of catching up afterwards. In tropical and remote riding you lose fluid faster than thirst tells you, and gear that protects you also traps heat. Start the day already topped up rather than drinking to catch up at the first stop. Carry more water than you think you need, in a hydration pack you can drink from while moving rather than a bottle in the ute, and drink small amounts often. Replace salts as well as water on long hot days, using an electrolyte mix or salty food, because hours of heavy sweating on plain water alone can dilute the body's salts and make a rider unwell in its own right. Avoid trying to fix a hot day with a large volume of plain water in one go. Urine that is dark and infrequent is a simple, honest signal that a rider is behind. Alcohol the night before and a big caffeine hit in the morning both stack the deck against you.
4. Treat dehydration as a decision making hazard, not just a comfort problem. Before a dehydrated rider feels ill, they get slow. Reaction time stretches, line choice gets worse, the eyes lock onto the obstacle instead of the exit, technique falls apart on the exact section they cleared easily an hour ago, and irritability creeps in. On a dirt bike in remote country that shows up as a crash long before it shows up as collapse. So treat unusual clumsiness, uncharacteristic mistakes or a short temper as heat and fluid symptoms until proven otherwise, and get that rider off the bike. The rider themselves is the least reliable judge of this, which is exactly why the group has to make the call. There is no version of a remote ride where pushing on dehydrated is a better plan than stopping in the shade for half an hour.
5. Build group protocols that catch a fading rider before they crash. Ride in a group with a lead and a sweep rider, and make it a rule that the sweep never passes a rider and nobody rides past a regroup point. Set regroup points at every junction and hold them until every bike is accounted for, so a rider down is discovered in minutes rather than at camp. Schedule hydration stops by the clock rather than by feel, and at each one look at every rider rather than just asking, because a rider heading towards heat stroke will tell you they are fine. Ask each rider something that needs a real answer, like which way you turned at the last junction, since confusion is the sign that matters. Pair riders up so each has one specific person watching them. Agree before the ride that any rider can call a stop for themselves or anyone else and that the call is never questioned afterwards. Carry water for the group rather than only for yourself, and know where the next reliable water is.
6. Run trauma priorities in the right order after a crash in remote country. Secure the scene first: a bike down on a blind corner or a rutted single track is a hazard to everyone still riding, so post someone up track to stop or slow riders before you kneel down. Kill the engine and put the bike upright or fully down and away from the casualty, since a hot exhaust and pooling fuel are both real. Then DRSABCD in order. Talk to the rider before touching them and tell them not to move. Assume a neck or back injury after any hard crash, particularly a headfirst impact, a rider knocked out, or a rider who cannot remember the crash. Control serious bleeding with firm direct pressure as covered in the trauma bleeds and breaks lesson. Check for chest injury and a belly that is rigid or painful, both of which mean urgent evacuation. Get shade over them and insulation under them, because the ground in hot country burns and the same rider can be hypothermic overnight. Then make the evacuation call early using the process in the emergency comms and evacuation lesson.
7. Follow the helmet doctrine rather than your instincts. The helmet stays on. It is removed only when it stops you managing the airway or when you need to start CPR, not to help someone breathe more easily, not to see their face, and not because they asked. Open or remove the visor or goggles instead, and pull the mouthguard clear if fitted. If it genuinely must come off, use two people. The first kneels above the head and holds the head and neck still and in line with the body, supporting under the jaw and at the base of the skull. The second unclips or cuts the strap, spreads the sides of the helmet outward, and eases it off in stages, tilting back to clear the nose and then forward to clear the back of the head, stopping if it binds. Support of the head must never be lost, so the second person takes over holding as the helmet comes clear. Practise this on a friend in the shed while everyone is calm, because it is not a skill to invent at a crash. Any rider who was knocked out, is confused, is vomiting, or has a worsening headache stops riding for the day and gets medical assessment, no discussion.
8. Manage the collarbone and shoulder properly, since it is the injury this sport hands out most. Suspect a broken collarbone when a rider has landed on the shoulder or an outstretched arm and is holding the arm against the body, with pain at the top of the chest near the base of the neck, sometimes with an obvious lump or step in the bone. Suspect a dislocated shoulder when the shoulder looks square rather than round and the rider cannot move the arm. Do not attempt to put anything back in place. Support the arm in the position the rider finds least painful and let them hold it if that is more comfortable than anything you can rig. A sling made from a triangular bandage, with a second broad bandage around the chest to stop the arm swinging, works well, and padding in the armpit and between the arm and chest makes a long ride out bearable. Check the fingers before and after for warmth, colour and feeling, and loosen anything that changes them. Transport them sitting up rather than lying flat, because lying flat is agony and makes breathing harder. Get worsening breathlessness, numbness in the arm, or skin tenting over the bone assessed urgently. A rider with a broken collarbone should not ride their own bike out, no matter how convincing they sound.

Common Mistakes

Using sweating to rule out heat stroke. Fix: judge on the brain, so confusion, odd behaviour or reduced consciousness means treat as heat stroke and call for help.

• Delaying cooling until the casualty is loaded in a vehicle. Fix: cool on the spot with shade, water on the skin and hard fanning while help is on the way.
• Pouring water into a drowsy or confused casualty. Fix: nothing by mouth unless they are fully alert, and cool them instead.
• Accepting I am fine from a rider who is making uncharacteristic mistakes. Fix: ask a question that needs a real answer, and pull them off the bike on behaviour rather than on their say so.
• Whipping the helmet off a crashed rider to help them breathe. Fix: leave it on, take the goggles and visor off, and only remove for airway or CPR with two people and continuous head support.
• Letting a rider with a broken collarbone ride out because the track is short. Fix: sling and swathe, seated transport on another vehicle, and medical assessment.

The Drill

On a hot day at camp, run a two part scenario. First, a rider is walked in acting confused and unsteady: the group must get gear off, shade up, skin wet and fanning going, name a caller, and correctly withhold fluids, with cooling underway within three minutes of the casualty arriving. Second, a staged crash fifty metres up the track: the group posts a track guard, kills the bike, runs DRSABCD out loud, and applies a sling and swathe to a suspected collarbone. Standard: track guarded before anyone kneels down, helmet left on with a stated reason, and the casualty seated, slung and shaded within ten minutes.

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