Motorcycle trauma, Basic Life Support.

[Kermit]

Do you know how to administer first aid should a fellow mate injures himself coming off a bike?

If not and you would like to know read on.

The aim is not to shock people into taking action, however to make you aware there is a lot you can do to prevent death or improve the condition of the person, should you choose to engage in rending assistance following a trauma.

You don’t need to have a wealth of medical equipment nor be a doctor, nurse, ambo etc. to render basic life support. Just know that the contribution that you implement whilst you wait for an ambulance does make a difference.

Death as a result of trauma occurs during three time periods, we refer to them as peaks, and I will discuss the first two as they are most applicable to a trauma.

The first peak of death occurs at the time of injury. It may be instantaneous or within the first few minutes and is due to overwhelming primary injuries to major organs like the brain, heart or major vessels. In this situation there is not much can be done, although quick intervention may salvage the situation.

The second peak lasts from the end of this first period to several hours. In this peak we have the “golden hour”; research shows if basic life support is instigated within the first hour of injury then the outcome for the patient becomes a lot more favourable.

Basic life support prevents secondary injury occuring as a result of the primary injuries. The secondary injuries what we are trying to prevent is hypoxia (lack of oxygen in the body) and haemorrhage (loss of blood). We can temporarily correct hypoxia with CPR and haemorrhage with fluids, the use pressure to a wound & elevation of a limb as an example.

With this is mind we can now move onto assesing and instigating care in trauma situation.

There are multiple algorithms used on how to approach care, there is no set hard and fast rule in which algorithm you use, as long ABC is incorporated into the alogirthm your half way there.

Danger & Cervical Protection

In any trauma situation you want to do best not to endanger yourself or the injured person further, so if there is something obvious that will cause it then use your common sense to lessen or remove the danger.

[Kermit]

Cervical & spinal protection; I will answer the most obvious question before its asked .

Can I remove the riders motorcycle helmet after the accident?

Well that depends.

Are there any possible wounds to head that are bleeding?

Do you suspect an injury has occurred to the cervical spine?

If so, can I safely remove the injured riders helmet whilst maintaing head and neck in neutral alignment?

Am I attempting to remove the injured riders helmet alone?

If you answer yes to any of the above, then it is NOT safe to remove the injured riders helmet. However, if the injured rider is not breathing & or does not have a pulse then this takes precedence and the helmet comes off for CPR to be commenced.

Removing a injured riders helmet should be a two person task, one person maintains head and neck alignment, whilst other pulls on the straps of the cheek pads and lifts the helmet off at the same time.

Why are pulling on cheek pads straps? The same reason why we do it when we put a helmet on, to facilate cheek clearance to make fitting easier. In this instance not to cause non necessary head and neck movements, whilst being removed.

I’ve noticed with the top end ARAI & SHOEI helmets that they come with emergency release cheek tab straps, which is great and could possibly make the helmet removal a one person job.

However the majority of us don’t have these helmets and I think it will be a few years until this feature becomes standardised in all helmets. So always keep the premise that helmet removal is a two person job in a trauma situation.

From a saftey point of view I prefer not to explain generically how a helmet should be removed from an injured rider via a two person assist online. I am happy to explain & demonstrate in person with the assistance of one other person at PITS, EC track day or some other KSRC event.

That way you can practice the skill on each other if you want and I can go away feeling safe that you have adopted the correct technique and not endager a person cervical spine further necessarily.

Responce. Is the person awake or unconscious; if the person is awake try and determine whether they are orientated to time, place and what has occurred. You will quickly

[Kermit]

know whether the person is suffering from amnesia or possibly PTSD (post traumatic stress syndrome)

Abnormal answers as to who they are, what day it is and year may reveal a simple concussion to something more sinister like an intracranial haematoma. There isnt a lot you can do about this on scene but what you can do is try to make the injured person feel as safe as possible with reassurance.

Anxiety does not help the patient it leads to excessive breathing causing carbon dioxide build up in the body which does not have positive effects on circulation.

If a person is unconscious then we need to determine whether ABC is being maintained, if not then we intiate the ABC protocol. (see below)

Send for help. Before sending away someone for help, provided you have a helper; determine whether you can adequately provide ABC to the injured rider alone should it be required.
Having done CPR on numerous patients I can tell you it is a very difficult task to sustain for more than 5 min alone. Your technique does deteroriate with time & therefore does your ability to resusitate the person properly.

Airway

In order to ensure that a person airway is patent, we observe if it is clear and not obstructed by either a foreign body, vomitus, blood or their tongue. If breathing is laboured or or noisy then it safe to assume that is something obstructing the airway.

If we can physically see something in the mouth or the back of the mouth then remove it manually, avoid using your fingers as you might loose them if the person happens to bite. If it is the tongue that has happened to roll back on itself obstructing the airway, move it back to its natural position.

Sometimes a simple chin lift jaw thrust will prevent an unconsicous patient from further obstructing there airway. Be mindful when inserting or manipulating objects in the back of an injured patients mouth as it might induce a gag reflex and cause the person to vomit.

If a person is vomiting whether it is abdominal contents or blood, can we turn the injured person on there side? In most traumatic bike accident it is safe to assume there is possible spinal injuries, if you need to put a person on their side, then this should be done with the assistance of an additional two people via a LOG roll.

A properly performed log roll ensures that spinal alignment is maintained at all times when the injured person is being turned, the person who controls the head, controls the the timing of the turn.

When the injured person is tuned on there side, it gives the opportunity for another person remove vomitus from the mouth & to check the back of the injured person for any obvious injuries.

[Kermit]

Again, I will refrain from discussing the log roll technique turn further online, it something that should be taught and assessed pratically and happy to demonstrate in person.

Breathing, if your remember the adds look, listen and feel, then that’s exactly what you should be doing when assessing if the injured person is breathing.

Watch the chest for rises and falls, don’t feel weird by placing you ear on the injured person chest to determine whether air is actually moving into and out of the lungs. If you hear air only moving into only one of the two lungs, the lung with demished air entry is injured, such as an pneumothorax.

A pneumothorax is basically a punctured lung, once a lung is punctured it looses it's vacuum to remain open and therfore the ability to transfer oxygen and carbon dioxide dimished or lost altogether.

If the lung is punctured via a pentrating injury you can help restore some of that vacuum lost by simply applying an occlusive dressing, if you don’t have an occlusing dressing then apply something that maintains an air tight seel over the lung wound, get creative and pull a macguiver if you know who he is.

A normal respiratory rate is 12-20 breaths per minute, if its raised and you can see stomach muscles being used to breath, then you know that the injured patient is struggling for breath.

Provided the person is conscious and a spinal injury is not suspected, sitting a person up and keeping there head up improves oxygenation and makes breathing easier. Mass clutter of people around the injured rider does not help, its not a specatator sport.

If the injured person is not breathing then pulmonary resusitation is started, these days mouth to mouth resusitation is only used as the last resort. Masks and breathable plastic sheets are used as a barrier to protect the user when pulmonary resusitation is started on the non breathing person, these kits are only a few dollars and very small if you worried about package space.

It’s a small price to pay in not having another person vomit back in your mouth and help the cessation of transmisible mouth diseases when doing pulmonary resusitation.

Circulation & Haemorrhage control

When assessing the injured person's circulation we are looking at the person extremities for normal colour & determing whether the person has a pulse, in traumatic injuries where haemorrhage is involved, our bodies naturally divert blood from the extremities and shunts it to vital organs eg brain and heart.

With this is mind when assessing the injured rider for a pulse and or rate, we assess from large arteries eg the jugular or femoral arteries. Assessing someone femoral

[Kermit]

artery can be seen as appropriate to some as its near the genitals, so it should only be used if you can’t palpate the jugular.

A normal pulse rate is 60-100 pulsations per minute, pulsations from the jugular should be feel strong in a person who is not bleeding. As a rule of thumb if you fracture your humerus (arm), you can loose upto 800mls of blood, if you fracture your femur (thigh); you can loose upto 2000mls and pelvis, upto 3000mls. The later two injuries can be potentially fatal and do require sooner rather later urgent intervention.

We can roughly estimate a person heamorrhagic state just by monitoring a person breathing, pulse rate and there mental alertness.

< 750 mls of blood loss Pulse 60-100, RR (respiratory rate) 12-20, Alert
750-1500 mls Pulse 100-120, RR >20, Anxious
1500-2000 mls Pulse > 120 feels thready or week, RR > 20, Confused
2000 > mls Pulse > 120 feels very thready or week, RR> 20, Unconscious

If any major haemorrhage is visible it should be controlled by applying direct pressure to the wound. If an foreigh object is causing the haemorrhage, it should be not be removed and pressure around the object should be applied to prevent further blood loss. Tourniquets should never used to prevent bleeding from a limb, as it can cause tissue destruction to any thing beyond it by way of artery occlusion.

Simple things like elevating the haemorrhagic limb will help with the cessation of blood loss.

If long bones are fractured and you are competent in splinting then you should attempt to splint, just bear in mind this will cause excrutiating pain without analgesia.

In the initial stages of trauma pretty much every person experience an adrenaline discharge, in this stage the effects of pain may not be felt, however the experience is very short lived.

In the situation where no pulse is present (asystole) CPR should be commenced. 2 breaths for every 30 compressions. I think there is enough information online that is freely available for you to learn and adjust your CPR technique, I’ll leave it to you to search for it.

Exposure – For a person to be assessed and treated properly on scene, they should be undressed (undies and or bra should be left on unless injury are suspected to those areas).

It is an appropriate action. From a rider point view I dislike ambo’s who go straight for shearing everything off. You can salvage a lot of the injured riders gear without shearing everything off provided its not a multi trauma.

[Kermit]

Just bear in mind if you undress a person an leave them exposed to a cold climate for too long this causes shivering which is not good from haemorrhagic point of view. Cover the patient where appropriate with a space blanket, blankets or just there own gear that you have removed to maintain core body temperature.

Thanks for reading, if you have questions fire away.

[dickfaber]

here, here!
this is a very important part of riding and being a rider that is never discussed.
is very important, personally i've been on both ends of this sort of need, and the best thing anyone can do is do a first aid emergency care course - and most employers will pay for it!

and keep up the practice and retraining!

[philbo]

good topic blackster!!
will def be reading over these a couple of times

[TyM2Go]

It's a good read indeed. Will keep it in mind. Thanks blackster

[Kwakked Up]

Blackster

Good read, yep been both sides of this myself, although I got more losses than victories. Understood everything and you set it out well.

Important thing is that everyone needs to get trained properly, whether it is for fellow riders or family.

[Kermit]

Cheat sheet, handy in those times when you're put on the spot & forget.

[D]anger = Eliminate any potential danger to yourself & the injured person.

[R]esponse = Orientate & alleviate anxiety. Not Awake, evaluate ABC.

[A]irway = Look & listen. Clear or obstructed (prolonged obstruction, they will turn blue).

If labored or obstructed, remove contents.

If Obstructed, not breathing & no pulse. Helmet comes off, airway cleared, BC commenced, gear comes off!

[B]reathing = Chest rises or falls, can you see or hear air moving out of there nose or mouth?

Normal RR (respiratory rate) 12-20 breaths per minute (count in 30 sec increments then X 2 = bps (breaths per minute)

Not breathing, give two quick breaths

[C]irculation, palpate jugular for pulse (normal) 60-100 pulsation per minute, Count in 30 sec increments then X 2 = PSM (pulsation per minute)

No pulse, start compressions (aim is 100 per minute followed by two breaths)

[H]aemorrhage

Bleeder? Apply pressure & elevate limb.

Internal bleeder?, Count pulse, RR & watch level of agitation. If all raised from norm, hypovolemic shock has started .

[S]end, other person goes for help (no phone reception) when we are satisfied ABC is being maintained.

[tim]

Cheat sheet, handy in those times when you're put on the spot & forget.....

that's great, I'll put that in the under-seat storage and in the car, thanks for this thread Phil!