Through a Glass, EMSly – Vaulting

Several weeks back an opportunity was brought to my attention by Maddog. A medic was needed at the Great Falls Vaulters & Topaz Vaulters Spring Fest. All I knew about this event was that it involved people doing things on horses. Sounds like fun, and I’ve never done a standby on my lonesome. Be the Medic.

And so here it is – having never before attended any sort of horsey-thingy as a rider or spectator, with brow-creasing visions of Christopher Reeve flitting through the background.

Cue Sam Beckett: “Oh boy.”

Observations from the perspective of EMS, and some things I learned. “Note to EMS:” notes were taken on scene, addressed to meself, but may be of interest.

First, I contacted via email the fellow who normally did this (obligations precluded him from doing so this year). He advised that the injuries, if any, would consist of a sprained ankle or two. No OMD was associated with the event – the level of care provided would be BLS, almost First Responder – minor first aid, call in the cavalry if required. The most useful item I could bring would be a good book to read. All very matter-of-fact, and low-key, BUT:

Normally one works a scene with a well-stocked ambulance, and a partner. A way to Load, and a way to Go, if required. It is very different indeed to walk into a situation knowing that your ambulance equipment is what you bring with you, and you have no partner trained to any level of EMS.

Alone, all alone…

The Jump Bag, at a Best Guess

For several nights prior to the event some time was spent considering how best to pack the jump bag. Limited space and all that. What could I expect at this event? I had no indicators except a) horses, and b) people. Yes, yes, anything at all could happen – a tornado could hit and smash the arena down, necessitating a collapse truck and extrication equipment. But recall basic EMS training: Scene size up, call for additional resources, THEN triage and treat. Anything major would be preceded by a call to 911, then me to treat while waiting for the responding units.

Breakdown of expected problems therefore fell into a few categories:

Trauma from Horse-related activities: Injuries from a fall from horseback; trauma from getting kicked or bitten (yeah, they bite, my grandfather’s horse bit me once), trauma from getting stepped on. Human lawn-darts as the horse comes to a sudden stop – albeit this may happen only in cartoons.

Farm Equipment and Machinery Mishaps.

General Crowd Stuff: AMI, stroke, heat-related emergencies, OB (always a possibility), maybe an allergic reaction or two.

Most things in the jump bag were left there – abdominal pads, ammonia inhalants, bulb suction and mini-kit for field deliveries, OPA assortment and pocket mask, 4x4s, etc. Stethoscope, BP cuffs, pens and pads for patient info.

Some supplies were beefed up by about 300% – kling rolls, cloth tape in various widths, a couple of rolls of ACE bandages, cold packs and hot packs. Separate carry-bag for adult BVM, adult C-Collar, large adult sized BP cuff.

Around the handles of the jump-bag wrap a SAM splint, ready to go.

Level of care BLS, leave the IV start kit and fluid resuscitation stuff. Come to think of it, I probably shouldn’t even have such a thing since the needles and tubing and all could be considered “paraphernalia”. Eh.

No colors. A newly-purchased shirt says “EMT” on the back, but that’s it. It is important, to my way of thinking, to not show colors unless you are truly representing – by which I mean, no rescue-squad uniform or private ambulance service uniform, unless your rescue squad or service is actually involved in providing EMS support at the event.

Note to EMS: Check with the organizers and see if there is an official code – all event honchoes wear a white shirt, or whatever. Be identifiable to the crowd as someone “with it” so they can find you, if needed.

At the Arena

Very different from television depictions of a rodeo. There is a decided lack of tobacco-chewing going on, and nobody is dressed like a cowboy. This is upscale horse stuff, not wild-west horse stuff. No Marlboro men.

The arena is indoors. The surface of the ring is deep sand, turned and graded by a tractor, rather than hard-packed earth.

Once in a while the action stops and the tractor rolls in to re-grade.

Horses don’t sniff each others’ butts, which makes them quite the noble beasts.

Vaulting

So, what is vaulting? Basically, at this facility at any rate, there are three arenas or “rings”. One ring is devoted to the “barrels”, large steel drums on four sturdy legs, covered with carpet or a thick wooly padding, having on the top two hoops like two halves of a car steering wheel mounted off-center at the apex. Performers climb aboard these barrels and perform handstands and other balance-beam gymnastics, about four feet off the ground.

Center ring is devoted to warm-up exercises on the horses, while the third ring is for the competition proper.

The horses used in these events are generally from draft-horse stock, giving them slower gaits, broader backs for the performer’s use, and generally good dispositions. Most of the horses stand about five feet tall at the shoulder, although there are individual variations. There were a few ponies, mostly for the use of the younger vaulters.

First thing noticed – all these teeny, tiny little competitors. Few were over sixteen years of age, 90%+ were female, thin, and agile. The vaulters wear slippers, not shoes – no ankle support. There’s not a steel-toe in a barnful, and I was told that a horse accidentally stepping on a foot sometimes accounts for an injury. They wear no helmets.

Note to EMS: Yes, an adult could fall backwards off the bleachers or have an AMI, but adult C-collars and BVMs are just about worthless. You didn’t pack enough pediatric supplies.

The horses have a saddle duplicating the barrel arrangement – two hoops at the horse’s shoulders instead of a central pommel or saddle-horn. There is no saddle per se, but a blanket or pad on the horse’s back. There are strap-like stirrups which are used to allow the performers to stand on one leg and strike a pose while riding.

The horses canter or trot – never a gallop – in a circle, usually counter-clockwise. Vaulters always approach the animal from the center, so counter-clockwise means mounting on the horse’s LEFT side, the “normal” way.

Note to EMS: Pay closer attention when the horse is moving CLOCKWISE, as the vaulter is mounting on the animal’s RIGHT. This is unusual both for the vaulter and the horse, and mishaps (I should think) would be more common, accordingly.

At the center of the circle is the longeur or lunger (pron. lunjer, not lung-er). This individual holds a strap connected to the horse’s bit and rotates in the center of the ring, keeping the horse moving in a circular fashion.

The lunger also controls the horse’s speed with voice commands, and a whip, an eight-foot long stick with a 12-foot or so length of cord. Most lungers used this as both an aural and visual cue for the horse, although there was one trainer with anger-management issues, probably a fine fellow, but…

The Day Begins

Note to EMS: Think “lifeguard at a busy pool”

Everywhere, kids are climbing on barrels and fences, jumping around. No different, really, from a playground scene where thirty to sixty kids are playing around except that here the ground is soft turned sand and the kids are used to this kind of playground equipment.

Note to EMS: Usually, there will be a parent or older adolescent spotting the kids on the barrels. But not always, and the kids will sometimes try something they see being done by older more experienced vaulters.

Eagle eyed for three hours, trying to keep an eye on all three rings. Someone engages me in conversation for the first time, and not sixty seconds elapse before the call for “Medic!” comes from the performer’s ring.

“Ah,” thinks he to himself. “It begins.”

After doing her routine, a young lady leapt lightly from the horse and landed, per plan, on both feet. One foot entered a divot left by horse’s hooves and the knee on that leg went “Pop!”.

The patient was laying supine in the arena, both legs in the air, in a good deal of pain. The lunger had controlled the horse and led him/her out of the arena, so that wasn’t a concern. Palpation of the knee joint showed that the patella had popped back into place – a bad sprain, then, rather than an ongoing dislocation. Patient denies neck or back pain, denies LOC, moving air well with equal chest rise/fall – no spinal or rib injuries. complete assessment from head to toe anyway because the knee pain might be masking other injuries. Splint the leg in a position of comfort and move the performer out of the ring. Vital signs, PMH, allergies and all that jazz. Ice pack for the knee. The adult in loco parentis confers with me and decides to go POV to the ER at a later time, if the injury doesn’t worsen. I’ll check on her periodically through the day, changing ice packs.

Note to EMS: The arena(s) shrink down incredibly after the first call.

Competitions continued. Not knowing, of course, if the “injury trifecta” was in play, eyes are peeled even further for the next mishap. However, that first injury works both ways: the performers themselves are, it seems, even more careful, which is a good thing.

Note to EMS: The lungers control the horse’s speed, but the horse will (perhaps uncontrollably) change his gait while dropping a load. Closer attention to the performer during “cleanup in aisle 3” events.

As we all know, one way to ensure that the tones don’t drop is to sit in the unit sipping coffee and studying. It’s no fun for the Gods of EMS because you’re ready. Tones drop when you’re on the can, or in the shower. Predictably, DTs being the conscientious fellow he is, no further medical mishaps occur.

Spring Fest Day 2, The Jump Bag Revisited.

Some rethinking went on overnight. Dump the adult BVM, keep the pocket mask – one size can fit all. Drop the adult C-collar for two reasons: one, it is improperly sized for the performers; a SAM splint can be fashioned into a workable pediatric c-collar (you knew that, of course), and two, with no other trained medic available on scene, DTs is committed to holding c-spine anyway, collar or no, until the cavalry arrives.

Arriving home last evening DTs filled some good-quality (no leaks) Ziploc bags half with water, then chucked them into the freezer to make a dozen or so ice-packs. These will go in a cooler.

Two rings this day, rather than three. The first ring, kids on barrels, has been finished and dispensed with. Barrels are still in evidence, and youngsters still fooling around on them, but both are fewer.

Today the “compulsory” gymnastics are over; the performers now get to do freestyle gymnastics on horseback, sometimes in groups of two or three kids at a time.

Impressive!

And, thankfully, without injury.

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