1A Rider’s Been InjuredIn an Accident…

What should I do?

Don Arthur, MDEmergency Medicine PhysicianRider

2Keeping Things in Perspective

• No, you are not Superman.• You will not miraculously fix

injuries and be included in the next edition of the Bible.

But…• You can save a life or a limb!• You can lessen suffering.• You can bring calm to a

stressful situation

3Good Samaritan Laws

• Laws protect the general public when assisting a victim during a medical emergency.

• Assume no medically trained person is available to assist the victim.

• Protect a layperson if (s)he has good intentions to aid the victim.

• Some laws protect medically trained responders who follow normal procedures.

• Victim may sue if a responder acts with maliceor recklessness.

• Some states have penalties for those who do NOT assist.

4Good Samaritan Laws

• Four key elements:1.Care rendered is performed as the result of the emergency2.The initial emergency was not caused by the person invoking the law3.The emergency care is not delivered in a grossly negligent or reckless manner4.Aid is given with permission whenever possible to obtain it

• State laws vary widely… check them out at:http://www.heartsafeam.com/pages/faq_good_samaritan

5

• Blunt force trauma• Head and neck injuries• Chest and abdominal injuries• Musculo-skeletal injuries

• Penetrating injuries• Impacted objects• Road debris• Rider possessions

• Abrasions

Mechanisms of Injury

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T H E F A S T E R Y O U G O , T H E B I G G E R T H E M E S S

Speed and EnergyFO

RCE

OF

IMPA

CT

0 10 20 30 40 50 60 70 80 90 100

Kinetic Energy = ½ MV2

At 40 MPH

At 80 MPH

SPEED

7Scene Management

• Remain calm and others will join you!• Assess the scene for continuing hazards – traffic, fire risk• Safety Circle – protect yourself and others at the scene.• Control traffic and bystanders.• Best trained responder should attend to victim.• Approach victim and introduce yourself:

• Offer assistance to victim(s) and get a response.• Don’t argue with the victim.• Don’t move the victim.• Be careful what you say…

“You’ve been in a motorcycle accident and it’s important that you don’t move. An ambulance is on

its way. My name is Don and I’d like to help you.”

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• AIRWAY• Are there any obstructions to breathing?• Do not change head position unless

necessary.• BREATHING• Is the victim spontaneously breathing?• Are breaths regular and unlabored?

• CIRCULATION• Check for pulse on the side of the victim’s neck or at the wrist.• Assess pulse quality (use your own as a reference).• Count the number of pulses/minute.• Don’t use your thumb.

ABCC-911

IF RIDER IS INJUREDDO NOT

REMOVE HELMET

CAUTION

ONLY IF UNCONSCIOUS!

9Airway

• Must have an open and unobstructed airway• Open the victim’s mouth without moving head• Clear the airway of any foreign material• Move jaw forward to move tongue forward

10ABCC-911

• CERVICAL (NECK) SPINE• Assume there is a neck injury.• Anything you do can and will make it worse!• And the Good Samaritan Law may not apply if you do.

• HELMET REMOVAL• Only if necessary to establish an airway• Should only be performed by two trained people• Requires constant head support and immobilization

Tell the operator:• Motorcycle accident with injuries• Number of injured• Severity of injuries• Location (use your GPS)• You hang up last

I see a trauma center

in your future…

11Gather Essential Information

• Get as much pertinent information as possibleand write it down to give to ambulance crew• Name, address, phone number, age• Emergency information card?• Medical problems, medications, and allergies• Who should be contacted?• Vehicle insurance and towing preference

• Helps emergency personnel• Victim may not be able to respond if

medical condition worsens• Establishes rapport with the victim

IF VICTIM IS CONSCIOUS

12Accident Scene Facts

• Ask victim what (s)he remembers about the accident• Speed, weather, road conditions• Minutes leading up to accident• Traffic patterns as accident evolved• Position of other vehicles and objects

• Draw the scene• Note vehicle positions and directions of travel

• Photograph scene• Don’t photograph victim without permission

• This will assist medical personnel in assessing mechanisms of injuries and possible extent of unseen injuries

• Victim may not later remember details essential for insurance claims

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• Injuries you can’t do anything about (but can always make worse)• Head injury• Neck injury• Internal chest and abdominal injuries• Open fractures (bone has broken through the skin)• Penetrating injuries

• Injuries you can do something about… and should• Open chest wound• External bleeding• Eye injury• Closed fractures

• Injuries you can do something about… but probably shouldn’t

• Positioning for comfort• Abrasions

Don’s Simple CategoriesFirst, Do No Harm!

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• Head injury – usually caused by striking a fixed object• Neck injury – can result in paralysis and death• Internal chest and abdominal injuries• Open fractures (bone has broken through the skin)• Penetrating injuries

Injuries You Can’t Do Anything AboutBut Could Make a Whole Lot Worse

FIXED OBJECT

COUP INJURY CONTRA-COUPINJURY

15Injuries You Can Do Something About

And Should

• Open chest wound• Air entering chest cavity will collapse lung• Apply occlusive dressing over wound• Tape in place only on three sides

• External bleeding• Apply direct pressure at the site of bleeding• If severe, apply pressure at pulse point• No pressure to skull if fracture is suspected

• Eye injury• Protect the eye from further injury

• Closed fractures• Splint in place to avoid further injury

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• Positioning for comfort• Victim may ask you to move him to ease pain from injuries• Movement may make the injury worse and do nothing for the pain• You may not be covered by Good Samaritan Law for non-

emergency or unnecessary treatment• Let the professionals perform all victim movement

• Abrasions• Field treatment won’t improve eventual healing• May further contaminate the wound• Protect from further contamination• Do not put anything directly onto the

wounds except to stop significant bleeding

Injuries You Can Do Something AboutBut Probably Shouldn’t

17Most Common Injuries

• Bone Fractures – Open or Closed• Legs and feet• Arms and shoulders• Hands• Pelvis and hips• Back and neck

• Road Rash• Head Injury• Internal Abdominal Injuries• Internal Chest Injuries• Bleeding from Injuries• Nerve Damage

ATGATT

18

ATGATTBecause walking away in disgust

beats riding away in an ambulance.

19

23.4mB Smart Phone AppContains videos and instructions

Carry it with you in your Smart Phone!

How Can You Prepare?

5½ hour First Aid/CPR/AED classroom course

20First Aid Kit

• Triple antibiotic ointment packet • Antiseptic cleansing wipes• Plastic adhesive bandages (Band Aids)• Instant cold compress• Triangular sling/bandage• Gauze dressing pads• First aid tape• Gauze roll bandage• Latex-free exam-quality vinyl gloves• Hand sanitizer• Scissors• Plastic tweezers

Suggested Contents

You don’t need a lot… just the basics.

21Common Medical Problems

• General thoughts• Dehydration• Cardiovascular conditions• Deep vein thrombosis (DVT)• Respiratory conditions• Urinary conditions• Skin conditions• Other riding effects• Surgeon General’s warning…

Nothing gets better during a ride!

22Warning

“Dad went on a little ride this morning… to Ohio.”

THE SURGEON GENERAL HAS DETERMINED THAT MOTORCYCLE RIDING IS HABIT-FORMING!

Cour

tesy

: Don

na F

ouse

k, 2

004

23Preparing for the Ride• Carefully consider potential riding impact

• Chronic illnesses• Predisposing conditions• Family history

• Carry a card with emergency information• Name, address, phone numbers• Next of kin and how to contact• Significant health history• Medications and allergies• Health insurance information• Vehicle insurance and towing information

• Make an ICE entry in your cell phone contacts• Put a sticker on the back of your driver’s license• Take extra medication (in safe and dry place)• Prevention is better than treatment• When in doubt, talk with your primary care provider

24Dehydration

• Water loss from heat exposure – primarily sweating• Normal vapor loss from lungs• Normal ‘insensible’ water loss from skin• Increased water loss during heat exposure• Keep skin covered• Use cooling methods

• Significantly affects mental and physical functions• Can accelerate development of fatigue• Accentuates fatigue effects• Many symptoms mimic fatigue• Dry mouth, headache nausea, muscle weakness

• Increases risk for heart and circulation problems• Especially when taking some medications

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• Stay ahead… DRINK before you need to

• Water AND electrolyte (salt) solution• Sweating causes loss of water and electrolytes• Need to replenish BOTH• Low salt levels can be harmful

• Read the labels• Amounts of electrolytes vary• May contain carbohydrates (sugar)

Rehydration

• Avoid caffeine or alcohol for hydration• Both cause water loss by increasing urination• And this can accelerate dehydration

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• Carbohydrate (sugar) in solutions can be dangerous for diabetics• Can raise blood sugar level acutely• May result in rebound decreased blood sugar• May increase water output through urine• Most athlete supplements contain sugar

For Diabetics

+ Sugar No Sugar

• Contains necessary electrolytes

• No carbohydrates/sugars• Add to your water bottle

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• History of heart disease• Medications• Physician consultation

• Deep vein thrombosis• ‘Sludging’ effect• Pain• Swelling• Redness• Numbness in feet

• Pulmonary embolism• Anticoagulants (‘thinners’)• Treatment:

• Leg exercises• Support socks

Cardiovascular

28

DEEP LEG VEINS

NORMALBLOOD FLOW

DEEP VEINTHROMBOSIS

EMBOLUSTO LUNGS

Deep Vein Clots

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• Allergies – especially seasonal• Upper respiratory infections• Effects of smoking• Nicotine effects on blood vessels• Nicotine effects on night vision• Nicotine withdrawal effects• Physical conditioning

• Medication effects• Increased fatigue & sleepiness• Dryness of mucous membranes

Respiratory System

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• Kidney disorders can hasten dehydration• Kidney stones can be caused by dehydration• Bladder infections and prevention• Risks associated with ‘endurance extenders’

• Bladder infection• External skin irritation and infection• Loss of friends

Urinary System

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• Heat rashes and “Monkey butt”• Infections• Worsening of chronic conditions

• Eczema• Psoriasis

• Foot care• Sunburn• Preventive strategies

• Clothing fit• Clothing changes (especially socks)• Skull cap• Shaving• Lotions and lip balms• Powders

• Treatments

Skin Conditions

32

NERVECOMPRESSION

SWOLLENTENDONS

Vibration and Overuse

• Causes and effects• Excessive handlebar vibration• Causes increased fatigue• Causes swelling around

nerves in wrist and elbow

• Prevention• Use grips with increased padding• Gel inserts for handlebars• Gel inserts in gloves• Relax your grip

Skier’s Thumb

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• Stings and bites• Be careful where you rest!• Examine your boots and helmet

• Eye protection• Flying objects• Ultraviolet effects• Dryness

• External ear infections• Extended ear plug use• Swimmer’s ear solution

Other Hazards

34Environmental Protection

• Helmet – proper fit, full face, liner• Windshield – laminar flow• Eye protection• UV filtering sunglasses• Prescription lenses/bifocal inserts

• Hearing protection• Skin and lip protection• Powder to prevent chaffing

Courtesy: Paige Ortiz

• Sun• Wind• Dryness• Moisture• Temperature• Vibration• NoiseEN

VIRO

NM

ENAT

LEF

FECT

S

35

You’re four timesIt’s hard to

more likely to haveconcentrate ona road accident

two thingswhen you’re on

at the same time.a mobile phone.

Distracted drivers …are out to kill you!

Be On The Lookout…

36

Be alert for subtle hazards…

Road Hazards

37Enjoy the Road!THE END

donald.arthur@comcast.net