On many motorcycle message boards there have been discussions about a helmet cam video of a recent crash. From that video I noticed some good points and some things that are all too common at a traffic accident. This article is not to place blame on the rider or bystanders. This is information to help riders understand emergencies and become more prepared for what happens after the crash. So I felt an article covering basic motorcycle first aid was appropriate. This is all based on my experience of 9 years as a Firefighter/Paramedic with a large suburban fire department, having taught motorcycle first aid, and unfortunately seen many motorcycle crashes, including two of my own. This is based on my experience, education and library of medical books. This article is not meant as a replacement for a certified first aid class. Every rider should take a first aid/CPR class. Also remember I am just scratching the surface of emergency trauma medicine and trying to keep this simple and informative regarding motorcycle injuries. My goal is to help fellow riders help others when the need arises. I know if I crashed and was unconscious I would hope someone on scene has medical knowledge to prevent more severe injuries and that’s what this article is about. To minimize body damage and injury post crash.
This article has been a challenge for me to write. I have had to take lots of technical information, medical terminology and sayings that we use in the medical world and convert the terminology to simple English for non-medically trained people to understand. I have tried not to use too much medical terminology. One word you will see used quite often is “patient” I use patient referring to a person that is involved in a crash and is injured. Everything else should have an explanation. If there is something you have read and unsure of its meaning please let me know and I will try to clarify it for you and other readers.
Scene safety is always a number one concern for crews working on scene of a traffic accident. This is why you typically see a fire engine blocking a traffic accident on the road. The fire engine is used as a 10-ton barricade. All too often drivers are “gawking” at the accident and not paying attention to traffic, which can cause a second or third wreck. It is important to always be aware of conditions around you, especially in heavy traffic or twisty canyon roads. If needed, for twisty roads have some bystanders go down the road to the last curve to slow incoming traffic. Be aware of oil spills, leaking fuel or other hazards on the roadway. In a severe accident the car/bike or both may be on fire. A patient can be trapped, pinned or crushed in burning wreckage. This comes down to a rapid extraction. You will often disregard c-spine and other medical precautions to extricate the patient from being burned to death. The risk vs. gain is the patient may have paralysis due to spinal injury but may be alive. The key to scene safety is to see the big picture and not get tunnel vision. The big picture is seeing the whole accident scene, traffic and other conditions around you. Tunnel vision is where you’re only focused on the patient laying on the road. This may be hard for an inexperienced rescuer. What helps is to read through this article and re-create an accident you have seen, been involved in or make one up. Play the scenario in your head and try to apply some of the techniques you have learned here. That will prepare you to be calmer and possibly able to see the big picture when the real time comes.
I want to start with a lesson on blood borne pathogens and what professionals call personal protective equipment (PPE) latex gloves, gown, mask, glasses, etc. I don’t touch patients without latex gloves on, especially if there is blood present. The problem is I don’t know many riders that carry latex gloves in their leathers. If you decide to provide care to a down rider without PPE's you could be exposed to blood borne pathogens: HIV, TB, Hepatitis, etc. For the most part you wont contract any pathogens if you come in contact with blood, saliva, or vomit if you have intact skin. (i.e., no cuts, nicks, scrapes, etc.) on your hands. The risk of exposure is your choice. Keep a pair of rubber gloves in a Ziploc bag and store it with your registration.
As a result of a crash there is the mechanism of injury (MOI) and kinetics of trauma that cause injury to a person. MOI is the strength, direction and nature of forces that cause injury to a patient. In a motorcycle crash, the MOI is the process by which forces are exchanged between the bike and what it struck. When kinetic energy is applied to human anatomy, it is called trauma. Trauma is a wound or injury that is externally or violently produced by some outside force. Trauma results from the collision of two or more bodies in motion. The collision of two or more bodies in motion not only refers to the body impacting a fixed object such as the road but. It also includes internal organ impact such as, the brain impacting the skull or organs impacting the rib cage and other organs. This leads to severe internal injury with very little signs of trauma outside the body to the untrained eye. In a motorcycle crash there are four types of impact: frontal, angular, ejection, and sliding. Impact will lead to bike/object collision, rider/object impact, and rider/ground impact.
Now on the topics (listed as most severe first)
-Cervical Spine Injury
-Long bone fractures/breaks
-Shock and bleeding
-Other bone fractures/breaks and minor bleeding
Cervical Spine Injury
Due to MOI from a motorcycle crash which means there is always a high index of suspicion of a head or neck injury. The most damaged parts of the spine in a motorcycle crash are the cervical (neck) region and Lumbar (low back) region. The goals with a suspected cervical spine injury are to keep the spine immobile in a neutral/natural position. This will prevent any further insult to the spinal cord if the spine is damaged. If insult to the spinal cord happens it can lead to paralysis and even death. Along with telling the rider to lie flat on the ground someone has to be "married" to the patient’s head. Which means that someone has to keep the riders head stable in the neutral position. Once the patient is laying flat and their head is held secure with hands placed on each ear, supporting the head and body in a neutral position, they are now “immobilized” Explain to the patient was is going on, trying to keep them calm and avoid any body movement. Laying flat and then moving the head up, down, right, left defeats the purpose of c-spine immobilization. Unless you are qualified (e.g., red-cross first aid, EMT, Paramedic), DO NOT remove the helmet. There is an exception to removing the helmet if there is severe head injury and the patient can’t breath due to blood, vomit, etc in the person’s mouth and nose. If this is present you can be assured the MOI did some damage to the spine. In this scenario take extra precautions. Removing a helmet using c-spine is best explained in person. Take a class, ask a friend that’s an emt/paramedic or go to your local fire station and ask if they have time to demonstrate it for you. If you come across a scene and the rider already has his/her helmet off, keep his/her head from moving. People at the scene of an accident often ask questions and the common response is to nod, yes or no. Tell the patient to verbalize answers and not to move their head. There are a few others conditions to note that are indication or severe head/spine injury. Riders post crash will be a somewhat disoriented. Orientation should return in a few minutes. For the most part, they will still be able speak coherently. Now if the patient is speaking gibberish, messing words up, doesn’t know where he/she is or what happened, this is indication of brain injury. Also if the patient complains of numbness, tingling or loss of feeling of any part of his/her body, this is a sign of spinal injury. Another severe example of head/neck trauma is blood coming from the bottom of the helmet with no facial trauma. This means blood is coming from the ears or nose and another example of severe head/neck trauma. The patient most likely will not be conscious and pretty close to death or already dead. For the severe case I recommend not touching the patient if you are not trained. I recommend keeping all bystanders back and if someone on scene identifies himself or herself as an off-duty EMT/Paramedic/Fireman they are highest medical authority and can handle patient care. If the patient is moved tell the law enforcement officer (LEO) where the patients body was after the crash and where it was moved. This information will be used in the LEO’s report of the accident and accident re-creation. If there is a fatality the accident has now become a crime scene. The URL’s below will show a diagram for spinal immobilization and hand placement. Also a presentation on C-spine (I will reiterate the need a first aid class to be proficient)
Long bone fractures/breaks
Due to leg position while seated on a motorcycle and then subsequent impact often leads to a break of the longest bone in a body. The femur is the bone that goes from the pelvis to the knee. A patient with a femur fracture will be in extreme pain, once the adrenaline rush wears off. Often patients with a femur fracture or break resulting from trauma will be writhing in pain. What makes this type of injury severe is femoral artery. The femoral artery runs parallel along the femur bone and supplies blood to the lower body. The toughest tendons/ligaments and strongest muscles in the body surround the femur. When the femur breaks these muscles, tendons and ligaments contract and grind the two fractured parts of the bone together. This can lead to the femoral artery getting pinched and torn open, which can lead to rapid and severe internal blood loss. If the femur fracture is open, meaning the bone has broken through the skin. There will rapid blood loss outside the body. You will often find the injured leg shorter than the non-injured leg and often-unnatural rotation of the foot. The treatment is what we call traction. Traction is basically the rescuer grabbing the patients foot with both hands and pulling on his/her foot downwards away from his/her body. It will require moderate force to pull and when you get enough traction ask the patient if the pain has decreased. If the pain is still quite severe apply more traction. You may become quite tired pulling traction, while waiting for an ambulance to arrive. Once you start pulling traction you can not let go of the foot, since the muscles may contract and it may pinch the femoral artery. If the femoral artery is damaged or pinched the patient will soon go into shock.
Picture of a femur fracture
Amputation can happen to any extremity/limb of the body. If an amputation is present control all bleeding, following the procedures under shock and bleeding. Try to locate the amputated limb and if possible put in to a dry plastic bag and surround bag with cold water and a few ice cubes. Don’t let the ice or water directly touch the injured part. If bag and ice are not available wrap the part in the cleanest shirt, bandage, etc that is available. Then give to the ambulance upon arrival. Most ambulances wont stay on scene long or waste time looking for the amputated part. If you can find it before hand, your helping the patient and ambulance crew.
If you’re sitting here and reading this, your body is working normal at equilibrium and all physiological activities are fairly constant. This is called homeostasis. When the body gets knocked out of homeostasis, due to trauma, it can lead to shock. There are many types of shock. For this discussion, we are concerned with hypovolemic shock. Hypovolemic shock is due to a loss of blood. Shock is inadequate tissue perfusion. There are 3 stages of shock, which will not be discussed for our topic, as providers of first aid we need to be aware of the signs and symptoms of shock. Some of the signs and symptoms of shock are:
-Restlessness and anxiety*
-Weak and rapid pulse* (If you know how to feel pulses)
-Cool and clammy skin
-Pale or mottled face
-Breathing rapid and shallow*
-Eyes dull or lusterless with dilated pupils
-Possible nausea and vomiting*
-Possible fainting and coma*
As you can see a lot of these signs and symptoms are what riders exhibit after riding, not to mention after a crash. The key signs to be aware of I have marked with an asterisk (*). The ways to limit shock are to stop the loss of blood if there is an open wound. Use direct pressure with a t-shirt or whatever is clean and available. Learn pressure points, which is direct pressure on the vessel that is bleeding. The very last option is to use a tourniquet. Which should be the absolute last resort, due to severe uncontrolled blood loss and a long arrival time for an ambulance or fire engine. If you use a tourniquet, note the time in which it was applied and understand that the patient most likely will loose that limb. Now that all bleeding is controlled there is a need to get the remaining blood back to the heart. The patient should already be laying flat and someone holding his or her cervical spine immobilized. Now elevate their legs above their heart. Prop their feet up on about the height of a helmet. If there are signs and symptoms of shock with no obvious blood loss, internal injury has to be suspected. Treat the same with feet/leg elevation.
There are 3 levels of burns: First degree or superficial, second degree or partial thickness, and third degree or full thickness. First degree is your common severe sunburns, Redness, tenderness. Not a major concern in the field and not much treatment as first aid providers. With a second-degree burn the skin will be mottled red with blisters that are weeping and painful. On a second-degree burn you can use cooling with clean preferable sterile water, to decrease pain. If blisters are opened, keep as clean as possible. The most severe and painful is a third degree burn. The skin will be pearly white and or black charred, translucent and parchment like. Skin will be dry with bulging veins. Use dry sterile dressing to keep burned areas dry and clean. Do not use water for cooling. Second degree burns with open blisters and for third degree burns the goal is to keep the burned area clean and sterile to avoid serious infections.
Other bone fractures/breaks and minor bleeding
There are many types of fractures and breaks that can happen to various bones in the body after a crash. For the purpose of first aid, support the injury in a position of comfort for the patient, either with a splint or supporting it with your hands. Most minor cuts and scrapes will be fine unbandaged. Try to keep wounds as clean as possible. They generally will clot and close quickly. If a wound continues to bleed, wrap tightly (not tourniquet tight) with something absorbent and elevate above the heart. Bleeding should stop in a few minutes.
911,Scene control and bystanders
If you come across an accident here is how to call in the accident to 911. In California all cellular 911 calls go to a CHP dispatch center in Sacramento. The dispatchers have no idea where you are located. The best description you give of your location will give the best information to the fire/police/medical units responding. Use coordinates such as north, south, east and west. Use landmarks or businesses for descriptions. Tell dispatchers pertinent information, such as “We are on Mullholland Highway about 2 miles east of the Rock Store.” If someone has GPS give the coordinates to the dispatcher.
Limit the bystanders to the most medically qualified on the scene to talk to the patient. If no one is medically qualified you need to take control and keep everyone quite and delegate jobs to be done. Be aware you will often have people come up and say they are nurses or doctors. Find out what field they are in. I have come up on a scene of an accident and a nurse is sitting this guy up who was in a major accident, with no regard for c-spine. I asked her what field she was a nurse in she informed me that, she was a LVN (Licensed Vocational Nurse) a gurney jockey at a convalescent home. Just because a person says he/she is a Dr or Nurse doesn't make them qualified in trauma. When the ambulance or fire department arrives have one person in charge speak to them and give them a overall picture of the scene, this is called a “size-up” basically tell how many patients, how injured and what care has been given. Then let them do their job, if they need your help, they will ask for it. No one should be getting in the way of the professionals; you have done enough to help the patient already. Don’t get upset or frustrated if they don’t give you 100% of their attention. They have a lot going on; just let them do what they are trained to do.
First aid classes
I highly recommend all riders to have a basic first aid class. The American Red Cross has a 9 1/2 hour Community First Aid course. This also includes a CPR certification. I have not talked about CPR in this article since a class is most appropriate. For those living in Northern California, Harry "Doc" Wong a chiropractor and well known rider and host of many community rider lessons provides a Red Cross First Aid class that is customized for riders, focusing on rider injuries. Also, many community colleges and adult learning annexes offer first aid classes. Take a class, ask questions, and learn how to help not just crashed riders, but your family, friends and neighbors. If you have friends or family members that are ER nurses or Dr’s, EMTs, Paramedics or firemen ask them to demonstrate some of the procedures I have listed here and also take any advice they have to offer. Also feel free to Google anything I have discussed for further learning. Feel free to copy and post this article to other motorcycle message boards. Please don't modify it without my permission and just give me credit.
I hope you found this helpful. Any questions fell free to ask.
EMT class info online