By Jerry Cummins, FF/EMT-P, PHTLS & ACLS Instructor
You are on a morning ride with your motorcycle club when one member is involved in an accident with a car. What should you do? What are your next steps? Do you stop and run to your motionless buddy lying on the pavement? Do you call 911 first? Where do you park your motorcycle? Do you remove his helmet? Does he need any first aid care while you are waiting on EMS? Do you chew out the driver of the car? All are good questions. Let me try to answer them, starting with your approach to the scene.
Consider your safety first as you approach the accident. It is best to pull your vehicle off to the side of the road, away from traffic, out of harm’s way and in a place so you don’t hinder the approach of emergency vehicles. Get off of your bike, and look carefully at the scene. Look for any dangers that could cause you harm, and that could turn you into the next victim! Power lines are often knocked off poles due to accidents. These lines carry a great deal of electricity. Touching one of them could turn an accident that involves one victim into an accident involving two. Watch for automotive fluids on the road. Stepping into anti-freeze could cause you to slip and fall, possibly injuring you.
At this point, someone should make an effort to alert approaching traffic of the situation. This must be done with care. The best method may be to wave down approaching cars from the side of the road--the safest place to stand. While placing your bike between moving traffic and the accident may seem logical, is not a good idea. Drivers may perceive it as a moving vehicle (even without a rider visible), and not be prepared to stop or avoid it. Many police officers are injured every year due to drivers plowing into the backs of their cars while they are sitting on the side of the road on a traffic stop (with their emergency lights flashing). Drivers see the back of the police car and “follow it.” As a safety measure, it is the policy of many fire departments to park their fire trucks sideways, or at an angle, when working an accident. This eliminates the possibility of drivers mistaking it for a moving vehicle; and the large trucks provide additional safety for everyone at the scene.
If you can approach your friend safely, your immediate concern should be to see if he is breathing. Approach him so that he can look at you without moving his head, and then speak to him. If he responds, you have answered this key question. Without moving him, if you are in a safe location, you should then check to see what his injuries are. Call 911 and relay the injury information to EMS.
If your friend is lying in a dangerous spot, such as in the middle of a very busy roadway, and visibility is limited, move him! If gasoline is leaking and beginning to pool around him, move him! Don’t waste time! Move the victim out of danger! You cannot effectively tend to a victim in a dangerous situation! You run the risk of getting injured yourself, and the added danger of leaving him in harm’s way might actually cause him more harm than the accident itself.
To move your victim, if he is unconscious, or conscious but complaining of back or neck injuries, use as many people as you can to move him in a way so as to not compromise his spine. In other words, keep his back flat, in a natural position, and his neck in a neutral position relative to the rest of his body (imagine a person lying down on a bed, without a pillow). Three or four people could easily reach their arms under the person, while one holds his head, with everyone lifting at the same time. A blanket could be used to drag the person over level ground. You need at least two people to log roll him onto the blanket, and one to hold his head so it moves with the body as you roll it. If you are by yourself, drag him by his legs. The goal is to prevent bending of the neck or back. If you don’t have time for these precautions because the situation is very dangerous, just move him any way you can!
Once your friend is out of harm’s way, you must consider his condition. If he’s unconscious, it is crucial to find out if he’s breathing or not. If not, you must begin artificial breathing for him, by doing CPR. In order to do this, you must remove his helmet. If you do not begin breathing for him as soon as possible, he will, and I repeat, will, die!
In removing the helmet, have someone hold his head from the bottom, trying to keep the neck in a neutral position, thereby avoiding further damage to his spine. (You must assume that anyone who is unconscious due to trauma has suffered head, neck and/or spinal injuries.) Unfasten the chin strap, then grasp the bottom edges of the helmet at the jaw under each ear. Pull outwards on the helmet to widen it at the base, and gently, but very quickly, pull it straight off the head. Sometimes the helmet alone is enough to cut off breathing. While the victim is lying on the ground, the shape of the helmet may cause his head to tip forward. This can cause the airway of an unconscious person to close off due to the bend in the neck. In taking the helmet off, and by straightening out the neck, the person might begin breathing on his own.
Once you have the helmet off, continue to hold the head with the neck in a neutral position. If the person is not breathing, you must then make sure that nothing obvious is closing off his airway, and then begin CPR. Continue CPR until he begins breathing on his own, or until EMS arrives. I’m not going to get into CPR here. If enough people in the club want me to put on a class with actual CPR manikins, I can do that. (For those of you who are knowledgeable in CPR, chest compressions begin immediately for all non-breathing victims, based on the new AHA guidelines.)
If your friend is lying in a fairly comfortable position, alert, and talking, it is best to leave him in the position he is in, pending the arrival of EMS. Do whatever you can to keep him comfortable and warm. Unless the helmet is causing problems in managing his care, leave it on. Caution him not to move his head or back. You might use clothing or whatever is available to pad around his head and under his neck (without lifting the head or neck) to help him keep his neck in a neutral position. Make sure the shield is open and that you can monitor his breathing. If he is bleeding, apply pressure to the wound in an effort to stop the bleeding. If his arm or leg appears broken, splint it in the position you find it – don’t try to straighten broken bones. Do not give your friend any fluids or food. Fluids or food can cause him to choke.
The key thing to remember is that you must consider your safety first, prior to attempting to care for your friend. You cannot give him much care if you are lying beside him after slipping on anti-freeze or after getting knocked to the ground from 20,000 volts of electricity. The single most important first aid consideration is to keep him breathing! The full-face helmet can stand in the way of this objective. You must be ready to remove it quickly, should the need arise. If anyone wants me to show them the accepted method that EMS and emergency room professionals use for helmet removal, let me know.
One last thought: most states have Good Samaritan Laws which protect you from being sued by anyone for your actions while trying to help an accident victim as long as your actions are taken with good intentions. Don’t be afraid to act and provide life saving assistance.
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02/17/01