Due to the mechanism of injury, this is a possible spine injury.
Abrasions on left upper back.
Over the next 45 minutes, you talk over the evacuation possibilities with your companion and the patient and sketch out a plan in the event the patient can’t walk. You’re a long way from the trailhead and even if your cell phone works, it looks like it may be dark, or tomorrow morning, before help will arrive.
Under your calming influence the patient becomes less anxious. You gather another set of vital signs and don’t find anything new to report. You decide to perform a focused spine assessment. The patient is A+Ox4, is sober, is not distracted, has good CSM in all four extremities, and denies any spine pain or tenderness upon your second palpation. You confer with your friend and the patient and all agree you can release control of the spine.
You help the patient stand, explaining the orthostatic vital signs test, which you don’t remember, but look up in your Wilderness Medicine Field Guide. She is a bit dizzy, but this quickly resolves. Her HR does not change and she says she feels OK. This negative orthostatic vital sign change is welcome news. In fact, her only complaint is a sore and abraded shoulder. This is another indication she dodged a bullet and doesn’t have any major injuries.
She wants to look for her horse. You want to clean the abrasions and monitor her condition–after all, it was a spectacular horse wreck. The solution presents itself when the horse, no worse for the wear, wanders back into the meadow, and you can take care of it while your friend cleans the abrasions. Although very sore, the rider is able to walk, and she is seems to be physically well. You take her to your camp where she makes a cell phone call home telling her folks not to worry, she will be out tomorrow. Not wanting to wait, her parents load the contents of her surprise graduation party onto the pack animals. That night you and twenty new friends dine surf and turf style under the stars. Lobster anyone?