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Faster than Death – First Aid Meets Mountain Bikes

Backcountry First Aid is Embarrassingly Overdue in the Bike Industry

Bikes have gotten better. That seemed to be the tirelessly repeated mantra during our respectable bike testing Bible stay in the rock-strewn trails of Marquette, Michigan. They have also become expensive. Like holy shit, is that a typo? expensive. And aside from getting more expensive, they have received updates that make everything mind-numbingly longer, lower, slacker and faster. Everything now has more taste but is less filling.

A week ago, I watched Mike Brunet, Marquette’s most prolific trail builder, approach a moss-inhabited, steep drawn-out pucker of a chunky, greasy rock roll down. Brunet had most likely built the feature and wore very visible trepidation while aligning his black carbon bicycle with 2.6-inch tires of a 29-inch diameter into the formation of approach. This was moments after he flauntingly gapped over every trail we climbed up, making a mockery of the big wooden takeoffs and long dirt landings he built. This rock had him sweating though. He exhaled, pedaled, hoisted and seamlessly—almost noiselessly, gently thudded down the rock and minefield of a run-out. He turned around and smiled from below, “Easier than the RM6 days.”

It did make me think of Rocky Mountain’s Pipeline video launch, starring Wade Simmons as a trail conspiracy-theorist insistent that the North Shore had become de-gnarred, only to come to the realization that bikes—or, in the case of the video, the re-released Pipeline, had become better. Simmons, like Brunet, certainly also lugged around an old RM6 too—and I still remember that 200-millimeter, 12-pound Marzocchi Monster T fork weighing down the front end while Simmons shamed technical sections in old North Shore movies. My oh my, have times changed. Enough for me to say my oh my.

I digress.

An increasing trend of more capable bikes push riders to higher limits of control.

What happens when bikes get better? We go faster. We yearn for the same sense of flirtation with peril, though it takes quite a bit more to achieve it. So we go faster. Then people die.

Nobody unfortunately knows this better than Bonnie McDonald, who lost her fiance, Will Olson, in August 2015 when he died during Stage 3 of the Enduro World Series and Big Mountain Enduro combined Crested Butte race. Olson was one of four riders who died within three weeks of each other in the summer of 2015. Now McDonald and others of Backcountry Lifeline (BCLL) provide one-day and four-day training courses for riders as well as race organizers in order to maximize the chance of survival before official help has arrived—be it on the course or in the backcountry.

While BCLL was founded in 2015 and has done an incredible job bringing awareness to this grossly overlooked shortcoming of the mountain bike community, Dr. Rob Bixler of the Sierra Buttes Trail Stewardship (SBTS) has provided similar training to its trail crews since 2012 in a no-nonsense, distilled, dire decision-based manner to those in the field, which brings me to the start of this story: in a garage.

It’s a familiar garage.

How can you tell these people ride bikes? A combined group attention span of 30 seconds. Dr. Rob Bixler explains the unavoidable basics before we head into the woods.

Two huge roll-up doors pen in a camouflage 1971 M35 six-wheeler, 2.5-ton military cargo vehicle with a white drop cloth draped over its bedside. Each wheel rests chest-high on me. A mountain of duffels, food, bike gear, water jugs and equipment is being ferried out to a seasoned and resilient looking Toyota pickup bed. A man, perhaps wearing a tactical vest, perhaps not—is checking over two walkie-talkies. Work benches strewn with tools line the perimeter.

I’m in Mark Weir’s Graeagle garage in Graeagle, California. WTB flew me out as part of their sponsorship of this SBTS Backountry First Aid and Safety course, something the company believes in having lived through WTB athletes Mark Weir and Marco Osborne’s harrowingly close calls with death at the Novato Ranch. Weir’s Graeagle garage looks a little dirtier than his Novato garage and doesn’t house a full-length, 18-hole RC car course nor pumptrack out back but otherwise it’s hauntingly similar. Last night we completed the “boring part” as Dr. Rob Bixler puts it, the unavoidable classroom time. In this case, our classroom was Weir’s garage, our blackboard the drop cloth hanging over the six-wheeler 2.5 ton’s elevated cargo hold. Now we’re soon to head to a hut within the Lost Sierra, somewhere past the Lakes Basin trails that bubble over with sharp granite. Hopefully, our bags, food and Marco Osborne’s burdened pickup will be waiting for us at the backcountry cabin where Dr. Bixler—or, Dr. Rob as we refer to him—is to help us practice trailside trauma scenarios.

Real men wear gloves too. Frank Gulla practices stitching up Mark Weir with a set of 3M’s Steri-Strips.

Bixler knew when first developing his course five years ago that he had to keep it active. “I always joke around and tell Mark [Weir,] ‘Hey this curriculum is aimed at you,’ the typical ADHD mountain biker that as soon as you’re halfway into some topic is like ‘Whoa there’s a squirrel over there.'” By setting the stage with a bit of instruction going over basic scene assessment priorities and shared primary goals of every scenario, Dr. Rob is able to mitigate classroom time—time he quickly apologizes for at the course’s start—to purely the first evening. Now, armed with small portable medical kits and cheat sheets prescribing our order of operations, we’re ready to hit the trails.

Marco Osborne stabilizes Teal Stetson-Lee’s spine as Mark Weir, left, and Ariel Lindsley, right, lend a helping hand when practicing reviving a seizure victim.

Bixler’s day job as department chief of Urgent Care for Sutter Medical Group allows him to oversee seven clinics and fills his thirst for the immediacy of  medicine found through Urgent Care as opposed to prolonged, lifelong management. His weekend job as medical director and executive vice president for the Sierra Buttes Trail Stewardship puts profession to practice in a wilderness setting as he runs medical support for events like the Downieville Classic and Lost and Found gravel race while also putting in pickax time alongside fellow trail builders and planners.

This isn’t an uncommon theme in Dr. Rob’s world though. During his medical school days, Bixler somehow found time leading others as an Outward Bound instructor based in Colorado’s remote Sangre de Cristo Mountain Range, finding solace between studies amidst comically sharp peaks. Now, during winter he doubles as the rotating physician in Tahoe Backcountry and Sugar Bowl Ski Patrols. He certainly has found his balance.

Lakes again? They don’t call it the Lakes Basin for nothin’.

I, on the other hand, have not found my balance. I’m now wheezing my way through reasonable elevation and unreasonable switchbacks littered with stumble rocks as we pass by enough lakes to make me wonder if I’m only just noticing the same lake again. And again. There are a lot of them. Right as this fella finds his groove again, Marco Osborne dramatically spills off his handlebars, flattening against the ground. Scenario one has begun.

Teal Stetson-Lee, left, and Clayton Wangbichler, right, inspect their handiwork during the first riding scenario.

A long ribbon of tape along Osborne’s forearm signifies a severe cut so we apply pressure with gauze then use an Ace Wrap. Dr. Rob patiently and silently observes each step from a few feet away. Once we fretfully seem satisfied, though still discussing what-ifs amongst ourselves, we turn to Dr. Rob—time for our scolding—we presume.

The scolding never happens though. Dr. Rob very calmly walks us through the steps we chose, gently asking us what we were learning from our patient based on each of the answers provided. The entire group is involved, somehow there’s a relaxed ease. Nobody is called out to provide an answer, as a group we walk through where we stumbled on indecision, what we were debating, those who feel like contributing are contributing. While it seems casual, it’s a practiced style that Bixler takes pride in:

Dr. Bixler focuses on discourse, always incorporating discussion and debriefing into scenarios.

“There’s more discourse, we spend more time just talking about stuff. Most of the learning happens because everyone has amazing stories of things that they’ve seen, or been through, or dealt with. It makes for a more engaging learning environment rather than me sitting in front of a PowerPoint in a classroom and talking to you, forcing you to try to memorize things,” explains Dr. Rob. There seems real merit to his method. As the afternoon sun shimmers off granite slabs surrounding us and we saddle up for the final pedal to the cabin, it’s pretty apparent that we are far from the typical classroom.

An ancient cabin deep within the Lost Sierra acted as our backcounty base camp.

Focusing on the technical, scientific nature of the injury is one of the areas where Dr. Bixler’s SBTS Backcountry First Aid and Safety course and a traditional Wilderness First Aid course differ. With Bixler’s approach, less time is spent diagnosing and more time is spent prioritizing and practicing evacuation. As time goes on and each scenario unfolds, we gain an extra step of decision making and complication—what ailment should be addressed first? We go from wrapping a forearm to stop bleeding to hauling somebody off with a homemade litter of branches, inner tubes, duct tape and hydration packs. Along the way we deal with an impaled chest, seizures, a disoriented diabetic with a fractured humerus and somebody simultaneously dealing with a broken femur and heart attack. Somehow, it becomes easier and by the end we all agreed that while we aren’t certain we were nailing things exactly as we should, we’re confident that we’re helping with the situation.

Ariel Lindsley poses as an impaled victim as Clayton Wangbichler secures the stick from movement during transport and Marco Osborne lends a helping hand.

By the morning of our fourth and final day, cabin fever has set in and we are in need of some real, uninterrupted trail riding.  Time for high-speed straight-lines to erode into tight rock switchbacks and rim-scraping narrows with one-line-only pinches. Stairs, ledges, and more jumbled rock all pointing downhill. Invigorating as it may be, there’s something almost eerie in realizing that the very thing that calms you down—washes away whatever stresses are closing in on your airways is the same thing that can take your life or leave you helpless in the woods, alone and unable, a gathering pool of shutdown. As my front wheel clumsily edges over deepening ledges and I attempt to hoist my way through things, I can’t help but think of the real consequences of isolated, technical riding. A sobering but needed moment for any who pedal past the point of quick return and cause alone to consider enrolling in a class. Bikes have indeed become expensive—but $200-$300 for a standard Wilderness First Aid, or perhaps an extra chunk for SBTS’ upcoming 2018 Backcountry First Aid and Safety Course is money well spent when it could mean pedaling to see another day.

Marco Osborne sets the pace at the start of day four.

WHAT YOU CAN DO AND GOOD THINGS TO KNOW

Count to 5:

1. I’m #1 – always ensure your own safety when assessing a scene.

2. What’s wrong with you—interact with your victim, introducing yourself and offering help. A response back can quickly check off A, B, and C below and consent is something to be followed in today’s litigious world.

3. Don’t get it on me! Always make sure to put on gloves before diving into helping someone—and gloves are something you should have in your pack.

4. Are there any more—more riders either mean more problems or more helpers, it’s good to know.

5. Keep them alive.

 

Know your A, B, C’s. Airway, Breathing, and Circulation. D and E stand for Disability and Environment or Exposure. These are high-priority, critical items.

 

Next, take a SAMPLE from your patient, interacting with them to learn the following:

S – Signs and Symptoms

A – Allergies

M – Medications

P – Past medical history

L – Last in/out

E – Events

 

At the very least, knowing the above will help you in relaying info to Search and Rescue if you’re lucky enough for cell service or have a locator beacon that allows two-way communication.

For $25, Adventure Medical Kits’ Mountain Series Hiker provides one of everything for most common injuries for one person and fits easily in a hydration pack.

WHAT TO BRING WITH YOU ALWAYS

“At the bare minimum, you should have something to control bleeding and do something to be able to support or stabilize a joint recognizing there will be things in the mountains you can use as well. Gauze pads, a combine, first aid tape or a multi-use item like an Ace Wrap fit the bill,” explains Dr. Rob Bixler.

For our class, we used Adventure Medical Kits’ Mountain Series Hiker Kit, which retails for $25 and has one of everything for addressing one person—if dealing with longer trips or more people, simply go with a bigger kit. A variety of first-aid kits should be available at any gear or multi-sports shop.

Dr. Bixler instructs atop a granite vantage point in the Lakes Basin. An increasing number of courses are becoming available that spend more time trailside.

AVAILABLE COURSES

As Mark Weir put it, “Now I realize that I always had time to do this, I just didn’t make time to do this … I feel more able to really be a solution, not a problem.”

Sierra Buttes Trail Stewardship Backcountry First Aid and Safety Course. SBTS is planning to offer potentially two options for the Backcountry First Aid and Safety Course for 2018. The first would be based out of Downieville, California, using the shuttle and the natural regroup stopping points along the traditional downhill to act as scenario locations. The second option would be based out of Quincy, California, and would provide more intermediate and all-around trails to riders. Multiple courses are planned for 2018 with pricing still being finalized, so stay tuned for upcoming details at the SBTS website.

Backcountry Lifelines Basic First Aid for Mountain Bikers or Wilderness First Aid for Mountain Bikers courses. Basic First Aid for Mountain Bikers is intended for settings within one hour from Emergency Medical Services and is composed of a single day.  Wilderness First Aid for Mountain Bikers is intended for riding that is greater than an hour away from help and is a four-day course with SOLO (Stonehearth Open Learning Opportunities) WFA certification and an optional CPR certification for an additional $35. Backcountry Lifelines also provides an Incident Command System course for event organizers and race coordinators, walking attendees through SPOT tracking devices as well as satellite phone usage. Though Colorado-based, BCLL offers clinics a number of places. Visit Backcountry Lifelines’ website  for full details of pricing and availability.

Otis Guy Teaching Services – Wilderness First Aid Training. Bay Area-based? Learn from Marin County-based Mountain Bike Hall of Famer Otis Guy in a WFA course with a mountain bike emphasis aimed at prevention with added slides for NICA high school coaches. Guy offers multiple course options for coaches, parents and the general public including two Saturday clinics as well a four evening option to break up the 16 hour course, which goes for $220. Check out the NorCal High School Cycling League’s calendar  for dates and availability.

Backcountry Mountain Guide’s WFA Mountain Bike Series.  Santa Cruz, California-based Backcountry Mountain Guides offers WFA training as well as WFR (Wilderness First Responder, the more thorough, 80-hour course) recertification for mountain bikers in courses designed around curricula to satisfy the Wilderness Medical Association’s published recommendations. The WFA course goes for $249. Check out Backcountry Medical Guides for more info.

Traditional Wilderness First Aid Courses. There is nothing wrong with certified, traditional WFA courses, the very courses that the new crop of mountain bike-centric options are based around. “We put a strong emphasis on assessing the patient, and collecting all the information in an effort to make good decisions about treatment and evacuation (if necessary). So no matter what the activity, the skills learned in a NOLS Wilderness First Aid course are beneficial to anyone enjoying the outdoors,” explains Liz Fischer, owner of Pasadena Outdoor Education and faculty member for NOLS (National Outdoor Leadership School) Wilderness Medicine. While traditional NOLS, SOLO, and Wilderness Medical Associates WFA courses may not necessarily be mountain bike specific, they’ve been around for good reason, they work. Check out Pasadena Outdoor Education, NOLS Wilderness Medicine , Wilderness Medical Associates and SOLO for options near you. Courses range from $225 to $270 pending sponsors for a 16-hour WFA split 50-50 between classroom and scenario time.

Learning is fun again. Teal Stetson-Lee, left, and Ariel Lindsley provide a helping hand as Mark Weir poses as a victim of a broken femur with symptoms of heart attack onset deep within the backcountry.