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This is a long document!...........best print it off for ease of
reading!
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I don't know who wrote this originally but I took it from a local
motorcycle site.
We all recognize that there are risks in this sport that we love,
and there are ways to help minimize the damage done if you or fellow
rider taste pavement. That being said, please take 10 minutes out of
your busy schedules, and please give this a read...it is simply a
"WHAT TO DO IF YOU ARE AT THE SCENE OF A BIKE ACCIDENT" post, and
hey, ya never know, it may just save someones life some day. I am
not trying to preach to anyone, I am just saying that it is better
to have this info and not need it rather than need this potentially
lifesaving info at the scene of an accident and not have it. In the
case of an accident scene, ignorance is definitely not bliss, so
although it is a long post, i think it is well worth the few minutes
it takes ya to read it.
ACCIDENT SCENE MANAGEMENT
The first hour of trauma is termed the ``Golden Hour'' by the
Emergency Medical Services (EMS). The idea is that trauma victims
have the best survival chance if they are in surgery within one hour
after the accident. Qualified medical personnel are really the
people who should be handling everything, but until they arrive
there are things that we, untrained motorcyclists, can do to help
the medical professionals before they arrive.
An extremely important point it ``Psychological Management''. At an
accident site, peoples' adrenaline will be going full-blast and the
most important thing is for at least one person to keep calm and to
think.
REMAIN CALM... THINK!
The first thing you need to do when arriving on an accident scene is
to stop, take two deep breaths to help you remain calm.
Anyway, the idea of psychological management is that all the other
people who are pumped and want to help will do whatever they are
told to do by a calm person who seems to be in control and knows
what he or she is doing. If you're excited and out of control as
well, everyone will run around
wasting precious time in an unorganized fashion (not to be confused
with everyone running around wasting precious time in an organized
fashion, mind you).
1) Get to victim, reassure, establish communication, first
evaluation of victim
2) Safety factors
3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
4) If breathing is taking place normally, LEAVE HELMET ON!
4a) helmet removal procedure if airway blocked or no respiratory
action.
5) After initial evaluation of seriousness of injuries, call for
ambulance
5a) Things to tell EMS operator
5b) Things that may be necessary for victim
6) Document personal information if possible (victim may pass out)
6a) AMPLE documentation
7) Wallets, purses, rings
8) Have person check pulse every 5 minutes & document it
8a) Have person check breathing every 5 minutes & document it
9) Watch for signs of person going into shock
10) Stop bleeding, using sterile bandages/dressings if available
11) In case of femur injuries (extremely common in moto accidents),
check for blood loss
12) When ambulance arrives
13) At the hospital
14) Dealing with law enforcement
15) Thank yous
16) Couple of miscellaneous notes
17) Four most important points to remember
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1) Get to victim, reassure, establish communication, first
evaluation of victim
After a person has gone down, they will be in a confused and scared
state. They probably don't know what happened when they went down.
They may be confused, frantic, etc., and often the only thing on
their mind will be their bike. It is important to reassure them and
to make sure they will not try to move or get to their bike. You can
tell them the following:
``You've been in a motorcycle accident. It is important that you do
not try to move. My name is Jason (whatever your name is).''
Tell them the ambulance is coming (assuming someone has been sent to
get one!) If your name is something like ``Chainsaw'' or
``Mega-death'', tell them your name is John.
Be careful what you say around the victim, even if they are
unconscious. Hearing works in the unconscious state and if you say
something like, ``Boy, is this dude messed up bad! Maybe we
shouldn't call an ambulance after all!'', it's going to register at
some level with the person and can
do nothing but harm. How you say things will be important as what
you say;
keep (or at least sound) calm and it will reduce the panic of
everyone else present.
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2) Safety factors
An accident scene can be a hectic place with a lot of things going
on at once. It is important to keep safety in mind; if you are
helping someone lying in the middle of the road and a semi comes
barrelling down on both of you, you aren't going to do that person
much good.
a) Traffic If people are available, get someone uproad and downroad
to wave down traffic. This is especially important in tight twisties
where they may not have time to stop after seeing the accident site.
b) Hazardous material spills (gas, oil, brake fluid) People and
vehicles will slip on this stuff. If ambulance personnel slip on oil
while carrying the victim, it is bad. Either clean it off the road
or indicate to everyone where it is.
c) Power lines If power lines are down around or near the victim,
ambulance crews may not be able to get near the person until they
are shut off. It is important to call the local utility company to
get these live wires turned off at the same time an ambulance is
called. If the ambulance arrives and
they are still live, they will have to call the utility company and
wait for them to come out, wasting a lot of precious time in the
Golden Hour.
d) Fire People who smoke tend to light up under stress. Ask these
people to either extinguish their smokes or move away from the
flammable materials and/or bikes. It is easy to forget something
obvious like this in a stressful situation like an accident scene.
e) Safety circle Establish a few people around the immediate
accident scene to help direct traffic, to point out fluid spills,
and to warn people who may want to light up (see (d)).
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3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
The person with the most training (first aid, CPR, etc.) attends
directly to the victim. Assuming the victim is lying on the ground,
this person should sit behind their head and should stabilize his or
her head to avoid unnecessary movement (i.e. hold their head still).
Assume the person has a back/neck injury and any unnecessary
movement could risk paralysis.
This person should be doing ``U-ABCC'' at the arrival on the scene
and every 5 minutes thereafter:
U Unresponsiveness (?) Ask the victim three questions and
document their responses;
Who are you? Where are you? What time of day is it? (Or asking what
day of
week it is would be fine also. Many people do not know what time of
day it
is without a watch even in a normal state.)
A Airway Is there something to impede their airway? Gravel in
the helmet,
something down the throat? This needs to be cleared immediately,
without
helmet removal if at all possible.
B Breathing Is the person breathing? Determined by listening,
watching
their chest, feeling for breath, etc.
C Circulation Check the pulse on the throat initially and
subsequently on
their wrist. This is the carotid artery, right next to the wind
pipe/adam's
apple on either side. If pulse is not present, remove helmet if
necessary
and begin CPR immediately. When checking pulse on their wrist, do
not check
with thumb; use the two fingers next to the thumb.
C Cervical Spine Immobilization Support the victim's head and
make sure
they don't move it. CONSIDER EVERY MOTORCYCLE ACCIDENT A HEAD
INJURY, CONSIDER EVERY MOTORCYCLE ACCIDENT A CERVICAL/BACK INJURY!
This is important even if they feel they can move their head
normally! When you talk to the victim initially, add on a short bit
to reassure them;
``You've been in a motorcycle accident. It is important that you
don't
move. My name is Jason. Answer me without moving your head. We don't
know
if you have a neck injury or not. An ambulance is on the way.''
Again, make sure that the victim does not move at all, their head or
any other part.
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4) If breathing is taking place normally, LEAVE HELMET ON!
It is very dangerous to remove someone's helmet if they have some
type of cervical/back injury. The only time it should be removed is
if the airway is blocked and cannot be cleared with the helmet on or
if it is necessary to perform CPR.
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4a) helmet removal procedure if airway blocked or no respiratory
action.
This is the method recommended by the American College of Orthopedic
Surgeons. It requires two people.
Remove glasses and unbuckle the chinstrap. One person should be to
the side of the head of the victim and the other person should be
directly behind the head of the victim, stabilizing the head to
avoid excess movement (as seen in (3)).
The person on the side puts one hand behind the victim's head
supporting at the base of the skull (not on helmet). They put their
other hand on the jaw bone/chin (again, not on helmet). They will be
supporting the head, so it is important to get a good solid grip.
Keep some tension in the arms so
that if the person pulling the helmet slips the victim's head won't
drop.
The person sitting behind the head will then slowly pull the helmet
directly back and off of the head. Watch out for catching the nose
on the chin-guard on full-face helmets, as well as ears and
earrings.
After the helmet is off, put a leather jacket or something under the
head of the victim! If the person supporting their head lets go,
their head will drop a good 4 inches or so. This would not be good.
If possible, it would be best to have a third person ready with
something to place under the victim's head once the helmet is off.
After the helmet is off, the person behind the head should again
hold the victim's head to promote cervical immobilization.
AGAIN, THIS IS ONLY TO BE USED IN SITUATIONS WHERE THERE IS NO OTHER
OPTION! Leave the helmet on until the ambulance personnel arrive if
at all possible!
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5) After initial evaluation of seriousness of injuries, call for
ambulance
After there has been a quick evaluation of the number of injured
people and just the most preliminary guess of seriousness, someone
has to be sent to get an ambulance. Remember that an ambulance can
only support one truly injured person.
It is important to remember that a lot of the injuries that don't
look serious to us could very well be life-threatening and injuries
that look fatal are relatively minor. Don't get fancy with the
initial seriousness evaluation. If you can't tell, assume it's
Urgent!
Send one or two bikes to the nearest house.
When you go to the door, REMAIN CALM... THINK! Take a second and a
couple of deep breaths. It will not help to have this biker person
in a very excited state on the doorstep of some person's home. The
people will be far more receptive to someone who looks like they
have a grip on themselves.
Do not ask directly for entry into their house; something like
``There has been an accident. Please call 911.'' There is no need to
specify that it was a motorcycle accident to them (it is important
to let the Emergency Medical Services dispatcher know that it was a
motorcycle accident, however). It is less threatening to ask to call
911 than it is to ask to come in and use their phone.
5a) Things to tell Emergency Medical Services dispatcher
General tips/things to cover when talking to the EMS dispatcher:
a) there has been a motorcycle accident
b) need an ambulance
c) the # of injured people (and how badly injured they are). A
severely traumatized person will require an entire ambulance to
themselves, so it is important to give the EMS dispatcher some idea
of the scope of the accident. If they only send one ambulance and
there are two people who need one immediately, it will be a problem.
d) location of accident (get help from the people whose phone you're
using, they should know how to describe their location best)
e) You (the caller) hangs up last! The EMS dispatchers are
well-trained and will get all the information they need from you
before hanging up. Stay on the line until they do.
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5b) Things that may be necessary for victim
It is helpful if you know some special equipment is going to be
necessary
to tell the dispatcher;
a) Helicopter: Most rural areas cannot handle severe trauma and they
may need to get the victim to a trauma center via helicopter. If
they know there may be a need, they can get the helicopter ready to
leave for the rural hospital when a doctor establishes the extent of
the injuries.
b) fire: Should the fire department be called in?
c) Jaws of life
d) Utilities See (2-C) about downed power lines above.
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6) Document personal information if possible (victim may pass
out)
Before the ambulance arrives, if possible, document information
about the victim. They may become unconscious and it will be helpful
to have information like:
Full name Next of kin (plus phone number) Age, date of birth Doctor
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6b) AMPLE documentation
Remember that ``There is AMPLE time to document this before the
ambulance arrives.'' Again, this will be very helpful to the
paramedics if the victim passes out.
A Are you allergic to anything?
M Are you on any medications? Street
drugs?
P What's your past medical history?
L Last meal - when did you eat last?
(will help anesthesiologist if one is necessary)
E What were the events leading up to the
injury? Document the mechanisms of injury. If the doctors and
paramedics have some idea how accident occurred, it will give them
better ideas on what kind of injuries to look for. Did the person
low-side and slide for a while on one of their sides? Did they go
over the bars? Did they head-butt a solid object, such as a car? If
they went over the bars, is there any obvious damage to the tank/handlbars
which might indicate they hit the lower abdomen/groin area? This
kind of stuff could help the doctors/paramedics.
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7) Wallets, purses, rings
Do not go rooting through personal effects of the person. There
should be no need to go through their wallet or purse for insurance
information; the hospital personnel will deal with all of that. If
there is some important reason that you need something from their
wallet or purse, make sure you
have at the very least a witness! Preferably a law enforcement
officer if possible. If the person is conscious, ask first and if
they say ``no'' then don't push it.
If the person has rings on, the fingers may swell up and it is
important to get them off. Consent is paramount if the person is
conscious. Make sure there is at least one witness when removing
them.
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8) Have person check pulse every 5 minutes & document it
Every 5 minutes the pulse should be checked at the wrist. If the
pulse goes away at the wrist, check at the throat. This is a late
sign of shock (see 9).
Write down the number of beats per minute and the time you took the
measurement.
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8a) Have person check breathing every 5 minutes & document it
Just like the pulse, check number of breaths per minute, the most
reliable method being by placing your hand on the person's chest.
Obviously if the victim is female it would be best to have another
lady do this if at all possible.
Try to check their breathing rate without their knowing it. If they
know you are counting their respirations, they may unconsciously
alter their breathing rate.
Record this number along with the pulse every 5 minutes. Also note
the type of breathing; fast, shallow, yodelling, gurgling, labored,
easy, whatever. Even in layman's terms it may be useful to the
paramedics.
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9) Watch for signs of person going into shock
Signs of shock:
a) Inability to answer the 3 questions coherently (Who are you,
etc.)
b) Pale, cool, clammy skin
c) Delayed capillary refill press your fingernail so that it turns
white. It should turn back to pink in less than 2 seconds. If it
takes longer, that is not a good sign.
d) Radial pulse (pulse at the wrist) goes away but there is still a
pulse on the neck
There isn't much we can do once someone starts going into shock, but
a few minor things that may help:
a) Assure adequate breathing. This really comes with the AB of U-ABCC.
b) Loosen restrictive clothing.
c) Reassure victim.
d) Keep the person warm (not too hot though).
e) Elevate the feet ~6 in. This is actually a judgement call since
you shouldn't really do that with suspected spinal injuries.
f) Control bleeding. This is probably obvious but if you don't
realize the victim is bleeding and they are rapidly going into
shock, this should tell you something.
g) Immobilize fractures. This helps relieve pain and control
bleeding.
Stop bleeding, using sterile bandages/dressings if available
Two important things here are to
(a) stop any bleeding as soon as possible and
(b) keep the wounds sanitary as much as possible. Peripheral limbs
are commonly lost to infection, but given the choice between
stopping bleeding and using a nonsanitary cover, using the
nonsanitary wrapping is preferred. Blood loss is bad.
If sterile dressings are not immediately available, women in the
group may be carrying sanitary tampons, or Kotex napkins. Either can
be used as a sterile dressing, although obviously the sanitary
napkins would be superior.
EXCEPTION: If there are cuts anywhere on the head, do NOT apply
pressure. If there is a bone chip it is possible to push it into the
brain. It is also possible that stopping the flow of blood or
cerebral spinal fluid can lead to a buildup of pressure on the brain
which is not good. You should still bandage the cuts loosely.
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11) In case of femur injuries (extremely common in moto
accidents), check
for blood loss
80% of motorcycle accidents involve someone going over the top of
their motorcycle. Femur (the ``thigh bone'') injuries are very
frequent. There are huge arteries that run along the inner thigh; if
these are compromised the person can bleed to death in a very short
amount of time. It is important to minimize bleeding in this region!
Use a pressure point above the cut to control blood flow out of the
femur artery.
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12) When ambulance arrives
Before the ambulance arrives, send people to the intersections in
all directions to watch for/direct the ambulance.
When the ambulance arrives, it is important to stay out of their way
as much as possible. Meet them and identify yourself as being ``in
charge'' and to be the person to contact if they need anything
(bikes moved, people moved, whatever). Make sure you
a) Provide accessable parking for ambulance
b) Let EMT's know who's in charge
c) Give factual account of accident (``And then the car comes along
at 154 feet per second and hits our buddy here!'' is probably not
going to help anything). At 40 MPH, there are 60,000 units of
kenetic energy. At 50MPH, there are 120,000. It is IMPORTANT for
medical personnel to have an
HONEST estimate of the speed and circumstances at the time of the
accident.
d) Give them all of the information that has been written down
(periodic vital signs and the three questions from U-ABCC at 5
minute intervals, personal information about the victim, etc.)
e) Give EMT's an honest evaluation of patient's drug/alcohol
consumption
f) Stay back or leave if told g) give EMT's time to work
It is important to give the ambulance people the most accurate
information possible! If the person just had 10 beers in the past
hour, tell them! They are not the law enforcement officials and
their only immediate concern is the safety of the patient. By
underestimating, trying to cover up, or not
telling the whole truth, you are only keeping important information
away from them which may be necessary for the safety of the patient.
If the helmet was removed, send it along in the ambulance. The
doctors may use the visible damage to the helmet to assist them in
what to look for in terms of injuries.
If there were leaking fluids, let the medical personnel know. The
fluids may have gotten on the patient and they need to know if there
was oil, gas, brake fluid or something like that on an open wound.
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13) At the hospital
Only have one or two people in the Emergency Room at a time. If the
doctors have questions and neither of the people in the ER know the
answer, send one of them out to the other people to find out the
answer. Crowding everyone into the ER will only make it more
stressful and difficult for the ER staff to do their jobs.
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14) Dealing with law enforcement
As with the the ambulance, when law enforcement arrives identify
yourself as being ``in charge''. Let them know that if there is
anything they need, such as bikes moved or people moved, you are the
person to talk to.
For them, walking on to a scene of bikers who are all in a very
excited state is intimidating and this will help calm them and give
them some easy way to control the bike people.
It is obviously important to do whatever the law enforcement
officials ask.
Before the officers do arrive, try to not move motorcycle parts any
more than necessary! They may need to take accident scene notes and
by moving things around you may confuse the situation for them.
Parts will need to be moved off the road to avoid further accidents,
but move them directly to
the side so the law enforcement officials can determine roughly
where it stopped if necessary. Try not to distrub the bike any more
than necessary. (Petcock should be shut off, electrics turned off,
bike propped up vertically, etc.)
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15) Thank yous
Officers often get little or no recognition for helping out on the
scene. It will cheer all of them up to no end to receive some kind
of thanks for their help; any of the following are appropriate
1: cards 2: in newspaper 3: in person
It will improve our image as bikers and rewards all those people who
take time out of their own lives to help others. It is important!
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16) Couple of miscellaneous notes
Leathers will have to be cut off by medical personnel. Be mentally
prepared for it. If they do not cut off your clothes, they will not
be able to do a proper assessment of the wounds and you are not
being treated properly! If you are conscious and insist that they do
not cut your leathers, they cannot by law. If you are unconscious,
it is implied consent and they will remove them if in doubt.
Over 50% of fatalities are alcohol related. I know it's a cliche'
but don't let friends drink and ride unless you're prepared to lose
that friend.
Like I said earlier, in 80% of the accidents involve going over the
handlebars. If your bladder is full, the extreme pressure can easily
cause it to break. Make a pitstop by the bathroom before you leave.
In an emergency situation, psychological management is important. If
a central person takes charge and is remaining calm, this will
transfer to all of the other people on the scene and will help the
victim far more than if everyone is overly excited and pumped with
adrenaline. Take two deep
breaths when you feel yourself losing it.
Take basic first aid and CPR courses! They are offered through the
Red Cross and several other organizations periodically. Go with some
riding buddies or get your club to have a class!
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17) Four most important points from this:
The four most important things were
a) Stay calm
b) U-ABCC
c) AMPLE
d) Who are you/Where are you/What time of day is it?
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