1 First Aid at a Mtrcycle Crash Site by Andrew Ewens Ph.D. D.A.B.T. This infrmatin is intended t be a start in educating yurself n what t d if yu encunter an accident. This infrmatin shuld nt be viewed as an authritative surce f medical advice. Yu shuld take further steps t educate yurself, such as taking certified CPR classes, a Red Crss First Aid class, talking t yur dctr r lcal fire department/rescue squad. Practice rutines s yu are familiar with hand psitins, etc. These are nly suggestins, each situatin may warrant different respnses. Tw Wheel Turing will nt be held respnsible fr any injury that may ccur as a result f fllwing these steps. Respnsibility fr injury resides within every individual t educate themselves as much as pssible. When riding yur mtrcycle, it is yur respnsibility t have the prper knwledge, experience, and equipment t travel safely. It is suggested t print this article and keep it n yur bike, in yur jacket and the glve cmpartment f yur car fr reference. Gd Samaritan Law If yu are hesitant t help smene wh has been injured, fr fear f being sued, please keep this in mind: there are Gd Samaritan laws, which vary frm state t state, that declare that the victim may nt sue yu if yu are helping in an emergency situatin fr n cmpensatin, unless yu are grssly negligent. In fact, sme states make it a crime if yu d NOT help a victim. Nt all jurisdictins prvide prtectin t laypersns. The Natinal Highway and Traffic Safety Administratin reprted that in 1990, 3270 peple died in mtrcycle accidents. The lss f life, even while ding smething yu enjy is still tragic. Hw can the death rate frm riding be reduced? Since mtrcycles d nt have many safety mechanisms t prtect the riders during an accident, sme devices have been develped t prevent accidents frm ccurring in the first place. These preventive methds will nt be discussed here. I want t discuss what happens and what can be dne t save lives during and after a crash. Speed is very imprtant, nt nly because it is a majr factr in determining the severity f a crash, but because it is under the cntrl f the rider. The amunt f energy in an accident increases by the square f the speed. Fr example, the energy f a persn driving 40 mph is 4 times greater than that f a persn driving 20 mph, a relatively small difference in speed (energy = 0.5 x weight x speed 2 ). Thus, yu can see the imprtance f aviding excessive speeds and/r the ptential benefit f decreasing yur speed as much as pssible if a crash is abut t ccur. Anti-lck brakes can help t safely slw yu dwn mre quickly, but panic braking can als cause a lss f cntrl making yur situatin even wrse. (Refer t Best Braking Practices fr mre infrmatin) A last resrt alternative is t frce yur bike dwn n the lw side. In this case, sliding alng the pavement will slw yu dwn, while increasing yur chances f being injured with abrasins (aka 'rad rash'). Hwever, these are usually less severe than ther
2 (think brute-frce impact) types f injuries. Of curse, in rder t slw dwn befre a crash, yu must have time t act. Many accidents ccur withut warning, s that these maneuvers cannt be taken. Much f the jy, as well as the danger, f biking is being 'ut there,' withut seat belts, air bags, steel caged passenger cmpartments and shatterprf windshields. In the absence f 'the cage,' prtective equipment is imprtant t limit the amunt f injury that can ccur in an accident. Helmets prtect the head frm direct injury, and wrk well at slw and mderate speeds. 60% f the peple wh died in 1990 frm mtrcycle accidents were nt wearing a helmet. Other safety equipment includes garments and fabrics that prevent injury frm skidding n the rad and/r burns frm cntact with ht bjects. With any mtr vehicle crash there are three main levels f injury that can ccur. Slw speed crashes typically result in injuries that are minr and nn-life threatening. High speed crashes ften result in lethal injuries, where death is immediate. In the case f high speed crashes, nt much help can be given immediately fllwing the crash that will prevent the death f the driver. Mderate speed crashes may result in injuries that can be life threatening, but may nt immediately cause death. This is the level f injury where immediate medical attentin can make a life r death difference. The fcus f this essay is n what fellw riders, wh are nt paramedics r dctrs, can d t save a life in a crash invlving mderate injuries. Calling One f yur best life saving devices will be yur cell phne, as yu can administer aid and talk at the same time. N cin is needed t call 911 frm a pay phne. Try t remain calm and speak clearly. Let the 911 call taker ask yu the questins. Call takers are specially trained and there is a reasn fr each questin they ask. Sme questins may be asked mre than nce t clarify r verify the infrmatin. N ne is deliberately stalling r delaying respnse t the emergency. As sn as the call taker gets enugh infrmatin, the call is sent t the apprpriate dispatcher fr dispatch. While this is ccurring, the call taker will ask additinal questins and/r give yu instructins that will help yur particular emergency. Rest assured, even thugh the call taker is still asking yu questins, yur call has already been dispatched t emergency persnnel. Instructing the peratr t "hurry up" r "get them here nw" des nthing t make units arrive any faster. Last but nt least, d nt hang up the phne until yu are instructed t d s by the call taker. Sme states have ther emergency numbers and have nt yet implemented a 911 prgram. Yu may want t call the State plice nn-emergency number in a state where yu are traveling t get updates n changes. D NOT call the emergency numbers themselves t see if they wrk. If yu ever call an emergency number by mistake, d nt hang up. If the call taker cannt identify yu, they will dispatch emergency persnnel t try t find yu, as they have n way f knwing that it isn't a real emergency.
3 First Aid Remember A B C 911 = Airway, Breathing, Circulatin + call 911 What d yu d if yu are riding with a friend and they are invlved in an accident? Even if yu are nt a paramedic r a dctr, there are sme actins yu can take that may save yur friends life. Yu might als want t cnsider the risks inherent in slitary sjurns dwn deslate cuntry back rads. The mre peple yu ride with, the mre peple wh can help ut if there is an emergency. Althugh it may be fun t get int thse fllw yur nse relaxing cuntry rides, it is advisable t keep track f where yu are shuld the need t call fr help arise. Alternatively if yu have a GPS receiver, yu can use it t determine yur lcatin. Many injuries that can ccur are highly visible: rad rash, a bleeding laceratin f the head, r a brken leg bne that is sticking ut f the skin. Hwever there are many injuries that can't be seen, such as sme spinal injuries, clsed head injuries and internal bleeding. It is very imprtant in any crash, especially a mtrcycle crash, since there is little prtectin t the driver, that the injured g t the hspital. They may feel fine and lk fine, but nnetheless be injured enugh t cause death later. Penetrating bjects shuld nt be remved, but stabilized t keep them frm mving. This is because mre damage may ccur during remval and the bject may be preventing severe bleeding. Secure the crash site : If injured peple are still n the rad, stp traffic frm cming int the crash site. DO NOT MOVE INJURED PEOPLE OUT OF THE ROAD, LEAVE THEM WERE THEY ARE UNLESS THEY ARE IN IMMEDIATE DANGER BY BEING AT THAT LOCATION. Use traffic cnes, flares, and reflectrs r simply stp the traffic yurself, but being aware f yur wn safety als. Once traffic is stpped, try t seek assistance frm smene t hld the traffic back, as sme peple may lse patience and try t drive thrugh. Make sure there is enugh rm fr traffic t stp befre reaching the crash site, especially if it ccurs n a turn, were the line f site is shrt.
4 Next yu can attend t the injured. ALWAYS ASSUME INJURY TO THE SPINAL CORD OR HEAD HAS OCCURRED AND LIMIT THE AMOUNT OF MOVEMENT OF THE INJURED AS MUCH AS POSSIBLE, EVEN IF THEY INSIST THEY ARE FINE OR CAN WALK. THE SPINAL CORD CONTAINS NERVES THAT CONTROL BREATHING, SO SPINAL INJURY NOT ONLY COULD CAUSE PARALYSIS OF MUSCLES, BUT COULD ALSO BE LIFE THREATENING BY PREVENTING BREATHING. First actins are ABC911 = Airway, Breathing, Circulatin + call 911 ABC: Airway: Opening and clearing the airway. Breathing : Make sure that the victim is breathing; the brain can nly take 4 minutes f xygen deprivatin befre brain damage begins t ccur. Circulatin - applying direct pressure t uncntrlled bleeding and checking fr heartbeat and treating fr shck are imperative. Detailed directins are belw. Call 911: If yu are able, make the call and administer t ABC at the same time. Use yur cell phne r a clse land based phne. Give as much infrmatin abut yur lcatin as needed. Ask the dispatcher if they culd receive yur lcatin thrugh a GPS signal in yur phne. Observe fr clsed head injury: Details belw. Psitining and Spinal Supprt : Spinal injury can ccur but the injured may initially feel fine. Unnecessary mvement may make the injury wrse; it is best t leave the persn where they are unless they are in immediate danger. The mst stable psitin fr the spine is lying n the back. This als makes it easier t perfrm CPR if necessary and helps if they are in shck. If they try t walk arund, help them lay dwn. If they are laying dwn n their side, r face dwn, carefully rll them n t their back. This will require three peple. IF AT ANY TIME THE INJURED PERSON COMPLAINS OF PAIN OR LOSES SENSATIONS IN A PART OF THE BODY WHILE DOING THIS PROCEDURE, STOP IMMEDIATELY. Psitining : With as little mvement as pssible, psitin the injured persn's arms straight dwn at their side. Psitin their legs straight dwn which will keep their spine straight. Have ne persn, First Respnder 1 kneel abve their head facing their feet and hld their head r helmet. Hld their head r helmet with yur pinter finger just abve the spine in the back f the head and yur thumb tward their chin and ther fingers under their head. A secnd persn, Respnder 2 kneels t the injured persns side and hld their arms and chest while a third persn, Respnder 3 kneels t the same side and hlds their legs. In a single crdinated mve, rll the persn ver t their back while supprting their head keeping their neck straight and untilted and keeping their back straight and supprted. This is dne by Respnders 2 & 3 pulling n the far side f the injured persn's arms and legs tward them t rll them
5 ver nt their back, while the head is supprted by Respnder 1 and turned alng with the bdy t keep it aligned with the spine. If yu are the nly persn available, try t rll the persn ver keeping their head, neck and spine aligned by using a bard. Helmet Remval : Casualties shuld remve their wn helmets wherever pssible. Only remve the helmet if the injured are nt breathing r the airway is bstructed. This shuld be dne with extreme cautin and withut mvement f the neck (cervical spine). Remval f the helmet will always require tw first respnders. Respnder 1, the persn supprting the head stays where they are, and Respnder 2, the persn supprting the arms and chest mves up t the injured persn's neck, while still kneeling t their side. Respnder 1 takes hld f the helmet n the sides with their fingers ver the lwer edge f the helmet. Respnder 2 unbuckles the chin strap and puts ne hand under the injured persn's neck, with their pinter finger and thumb hlding the base f their head, with their ther hand hlding the jaw. Respnder 1 spreads the sides f the helmet as much as pssible and rtates the helmet, face side twards them, t clear the nse, then presses in n the sides f the helmet t supprt the head right befre fully remving the helmet. Respnder 2 mves the hand that is under the neck, up t psitin it under the head t trade ff with the respnder wh is supprting the head when the helmet is cmpletely taken ff. Respnder 1 then rtates the helmet the ther way t cmpletely remve it while Respnder 2 supprts the head. After the helmet is ff Respnder 2 places the head dwn n the grund s that it is aligned with the spine. Breathing : Check t see if the persn is breathing. Is their chest mving? Can yu hear them breathe? Can they talk r can yu feel their breath if yu put yur cheek in frnt f their face r n their chest? If they are breathing, then check fr bleeding. Uncnscius and Nt Breathing : Open their muth t see if they are chking n anything, like brken teeth r typically the tngue. Carefully remve any bjects by placing yur pinter finger in their muth and with a sweeping r hking mtin remve the bject. Yu may want t hld a slid bject between their teeth that is wider than yu finger in case they try t bite yu. If a persn vmits when they are n their back, use extreme cautin and rll the persn t the side t wipe ut the muth, keeping the head, neck and spine inline as yu rll them. If a chice has t be made life cannt be sustained withut xygen.
6 Once yu are sure they are nt chking, gently lift their chin, which mves the jaw frward and tilts the head backward. This is dne by kneeling abve their head and putting yur index finger at the base f their jaw, near where it jins t the skull and place yur thumb next t the ridge f their eye and lift their jaw upward. D nt push the frehead t tilt the head, as this culd cause mre injury t the neck, head r spine. If the persn has a severe injury t the muth, then ventilate thrugh the nse while keeping the injured persn's muth sealed shut. If they d nt start breathing n their wn, start ventilatin. Pinch their nse clsed, then blw slwly twice in their muth, making sure t have an airtight seal. Check t see if their chest rises as yu blw int their muth and that air cmes ut when yu stp blwing. If air des nt g in, repsitin and try again. Still nt, check fr mre bstructins. Keep repeating until the air successfully fills the chest. Next check fr a heartbeat. Check the cartid artery in the neck. Place yur index and middle finger n tp f the hard trachea in the middle f the neck, then mve yur fingers t the far side f the trachea, there will be a band f muscle n the side. Slide yur fingers up alng the junctin f the hard trachea and the band f muscle tward the jaw, stp when yu run int tissue under the jaw and feel t a pulse in the area where the trachea, band f muscle and tissue under the jaw meet. Check fr pulse fr at least 15 secnds. CHECKING FOR A HEART BEAT MUST BE DONE QUICKLY TO DETERMINE IF THE CHEST COMPRESSION PART OF CPR IS NEEDED. If a heartbeat is fund, just cntinue blwing air int their muth (ventilating) as befre until they start t breath n their wn. If n heartbeat is fund, d chest cmpressins. Expse the chest, using yur middle and index fingers, find the bttm f the ribs n bth sides. Fllw the ribs up tward the head t the pint where the ribs jin the breastbne. This pint is called the Xiphid Prcess. With yur middle finger n this pint, place yur index finger n the sternum itself. Slide the heel f yur ther hand dwn the sternum until it reaches yur index finger. This shuld be the middle f the lwer half f the sternum. The secnd hand is psitined ver the first and the fingers f the secnd hand entwine r interlck the first. Ensure that pressure is nt applied ver the casualty's ribs and that there is n pressure exerted ver the upper abdmen r bttm tip f the sternum. Psitin yur bdy directly abve the casualty's chest and, arms straight, press dwn n the sternum with tw hands between 4-5 cm. Release all the pressure withut lsing cntact between the hand and sternum. Cmpress at a rate f abut tw cmpressins a secnd, 15 times in a rw. Then check t see if the injured persn is breathing, if nt, then blw 2 times int their muth, Repeat the chest cmpressins and blwing in the muth until help arrives r the injured persn starts t breath n their wn, checking their breathing between each cycle. Current CPR guidelines fr 1 persn CPR suggest a 15:2 rati fr cmpressin t ventilatins.
7 If it will be a lng time befre help arrives, get smene t help take ver when yu get tired. Als, if it is cld ut, have smene else cver the injured persn as much as pssible withut interfering with yur CPR. Bleeding : if the injured persn is breathing, then check fr bleeding. If any bvius bleeding is seen, use a sterile bandage if pssible t cver the area bleeding and apply direct pressure t the bleeding wund (ice in a plastic bag r a chemical ice pack that is activated by crushing, may als be applied t small wunds t help stp bleeding, especially fr a nse bleed). If yu suspect a skull fracture, DO NOT apply direct pressure t the bleeding face r head. If bleeding is ccurring in an arm r leg, try t elevate it abve the chest by placing a blanket r clthing under it. The nly applies if the limb is nt fractured. Keep pressure n until help arrives. If there are multiple bleeding wunds, have ther peple help, r tape bandages r cmpressin gauze dwn t the wund wrapping the tape/gauze arund the bdy t make it as tight as pssible. YOU SHOULD HAVE VINYL GLOVES TO KEEP THE INJURED PERSON'S BLOOD FROM CONTACTING YOU, IF THAT IS NOT POSSIBLE, LEATHER GLOVES OR CLOTHS MAY OFFER SOME PROTECTION. Abrasins - try t clean as much as pssible and bandage Punctures - clean and apply bandage if n friegn bject is inside - D nt remve bjects! Avulsins - lss f a bdy part - stp bleeding and find missing bdy part. Try t clean carefully and either put n ice in a plastic bag r keep next t persn's skin. Incisins - stp bleeding with cmpress bandages, pressure r pressure bandages Laceratins - stp bleeding with cmpress bandages, pressure r pressure bandages Shck : Treat fr shck befre checking fr shck and even if the victim is nt shwing signs f shck. Shck is life threatening. SHOCK COULD BE CAUSED BY A LOSS OF BLOOD NESSECITATING REPLACMENT OF LOST FLUIDS, THIS MUST BE DONE INTRAVENIOUSLY BY A PARAMEDIC DO NOT TRY TO REPLACE LOST FLUIDS BY HAVING THE INJURED PERSON DRINK WATER, THIS DOES NOT WORK FAST ENOUGH AND MAY CAUSE CHOKING. Cver them with a blanket; clthing, yur rain gear, jacket, etc can be used. If pssible, gently elevate their feet by placing clthing r a blanket underneath them, if pssible, d the same t their hands, s that their feet and hands are higher than their chest. IF ELEVATING THEIR FEET AND HANDS WILL CAUSE MOVMENT OF THEIR SPINE OR CAUSES PAIN IN THEIR BACK OR NECK, STOP IMMEDIATELY AND RETURN THEM TO THEIR STRAIGHTENED POSITION. DO NOT ELEVATE THEIR HEAD. DO NOT ELEVATE THE INJURED PERSON'S LEGS IF YOU SUSPECT A SPINAL OR HEAD INJURY. T check fr shck: Ntice if the skin is pale lking and may feel cld and clammy. If their heartbeat feels weak, and breathing shallw and irregular, they may be in shck. Lastly, ntice the clr the skin under their thumbnail. Press the thumb s that skin becmes pale and cunt
8 hw lng it takes t return t nrmal clr. If it takes ver 2 secnds t return t nrmal clr they may be in shck. Sucking Chest Wund: If there is a puncture wund in the chest that is making a gurgling nise when the injured persn breathes in, they are at great risk f ne r mre lungs cllapsing (tensin peunmthrax). Tape dwn n three sides an airtight material ver the wund. Preferable use a sterile impervius bandage, but a latex glve r piece f leather may wrk if needed. By taping nly three sides air might escape ut f the chest when the injured persn breathes ut, but air is preventing frm entering when they breathe in. Brken Bne: Brken bnes are less life threatening than the injuries addressed abve. Severely brken bnes can be seen by an abnrmal shape f the bdy r bne prtruding ut f the skin. Less severe brken bnes may be nticed by bleeding under the skin and pain. Splinting the brken bne may help alleviate pain and prevent further damage. As a general rule, dn't mve a brken bne; splint it in the psitin it was fund. Hwever, if an arm r leg is brken and the rest f the limb further away frm the bdy feels numb r a heartbeat may nt be felt (as felt n the wrist r ankle) then it might be better t straighten it. If a bne is sticking ut f the skin hwever, never try t push it back in. When warranted, yu may try t gently align the brken bne, but, if pain ccurs while straightening stp immediately and splint in the psitin it is in. If part f the bne is sticking ut f the skin, cver it with a damp (with sterile water r the injured persn's wn bld) sterile gauze. Splinting is dne by taping a semi sturdy bject alng the axis f the bne that is brken. A stick, r rlled up blanket culd be used. Fr fingers and tes, tape the brken finger t a neighbring unbrken finger. If an elbw r knee is brken, yu may splint with the jint bent and the supprting bject laid acrss the bnes abve and belw the break as t make an A with the bne making the sides and splint making the middle. Ice in a plastic bag shuld als be applied t the brken area t prevent swelling and pain. Eye Injury: An injured eye is nt usually life threatening, but may cause blindness. If the eye lks injured, r there is bruising arund the eye r bleeding frm the nse and eye pain, cver bth eyes with a sterile gauze and a light blcking material (like a piece f leather) t prevent the injured persn frm mving their eyes arund which culd cause further damage.
9 Pressure Bandage fr Bleeding Wunds The first thing t d is clean the area as well as yu can. Apply a cmpress, applying pressure with yur hands. If the wund cntinues t bleed thrugh the cmpress, apply mre n tp f the cmpress yu are using. D NOT remve the first cmpress. If the wund cntinues t bleed and yu cannt put cntinuus pressure n it, apply a pressure bandage. Find a lng narrw strip f clth. Yu may have t rip a piece f clthing. Start by placing the center f the clth directly ver the cmpress n the wund. Pull the bandage t keep the cmpress in place, wrap it arund the bdy part and tie a knt in the bandage directly ver the cmpress. Majr Clsed Head Injury If the victim has a majr clsed head injury, swelling f the brain may start t ccur which may r may nt always ccur immediately. If help is delayed, it may result in prlnged r nnreversible brain damage. The prblem is that the swelling and bleeding will nt be able t expand within the skull. Since the skull cannt stretch t relieve the pressure, the fluid and swelling ends up cmpressing the brain, cmpunding any initial damage in the riginal trauma. This pressure is called inter-cranial pressure "ICP." Symptms f a ICP : Lss f cnsciusness, cnfusin, r drwsiness* Lw breathing rate r drp in bld pressure Cnvulsins Fracture in the skull r face, facial bruising, swelling at the site f the injury, r scalp wund Fluid drainage frm nse, muth, r ears (may be clear r bldy) Severe headache Initial imprvement fllwed by wrsening symptms Restlessness, clumsiness, lack f crdinatin Slurred speech r blurred visin Inability t mve ne r mre limbs Stiff neck r vmiting Pupil changes** Inability t hear, see, taste, r smell Irritability (especially in children), persnality changes, r unusual behavir
10 * Ask the persn their name, age, address, r the date. If they are unsure r incrrect, they are cnfused. **If yu shine a light int their eyes and their pupils (black center f eye) d nt get smaller in respnse t the light, they may have swelling f the brain (if it is bright ut, their pupils may be a small as they can get, try shading their eyes fr a minute and test again). If the injured persn is cnscius, try t get them t hyperventilate (breathing abut breaths per minute) fr nly a shrt amunt f time. These prcedures are primarily fr life threatening injuries that can be treated withut much equipment. Mre sphisticated treatments are pssible by paramedics and at hspitals. N treatment shuld be dne t delay r substitute transprting the injured persn t a hspital. The best chance f surviving a crash is t rapidly get t a hspital. Even if the injured persn feels alright and seems uninjured, get them t a hspital. There are many types f injuries which are nt bvius r nticeable immediately, but may cause death if undetected and untreated. Equipment List: Cell phne GPS mapping system Emergency radside reflectrs r flares Sterile bandages Sterile water Medical tape Vinyl glves Blankets (extra clths yur jacket/chaps/shirt/rain gear, etc.) Ice in plastic bags (Instant Ice packs activated by squeezing) Impervius bandages (leather pieces (leather clthing and scissrs)) Flash light Cmpressin gauze
11 Surce: Msby's Paramedic Textbk, Mick Sanders, Msby Lifeline, St. Luis, 1994 Abut the authr: Andrew Ewens, Ph.D., DABT Andrew Ewens received his Ph.D. in Mlecular Pharmaclgy and Cancer Therapeutics frm the Rswell Park Cancer Institute Divisin f the State University f New Yrk at Buffal in During his time in Buffal he helped develp a curative treatment fr breast cancer in mice. He has wrked as a txiclgist fr six years n varius cntracts with several federal gvernment agencies, including the Natinal Txiclgy Prgram, Natinal Cancer Institute, Natinal Institute fr Envirnmental Health Sciences, Natinal Library f Medicine, Envirnmental Prtectin Agency, and Centers fr Disease Cntrl and Preventin. Currently, he edits the 12th Reprt n Carcingens fr the Natinal Txiclgy Prgram/Natinal Institute fr Envirnmental Health Sciences. In 2009, Dr. Ewens received his bard certified frm the American Bard f Txiclgy. Dr. Ewens is als a member f the Cary Nrth Carlina Citizen's Emergency Respnse Team and teaches classes n terrrism and respnse t hazardus materials incidences. He is certified in hazardus materials respnse t the peratins/terrrism level by the Nrth Carlina Office f the State Fire Marshal.