When I was vacationing in British Columbia recently, I happened upon a motorcyclist who had crashed into a ditch. Purely by coincidence, so did another physician. With two doctors and a paramedic on site within moments, we waited, keeping the rider comfortable and alert, carefully stabilizing his neck until the ambulance arrived with a backboard, neck brace and other equipment. Then we got him out of the ditch, put his leg back where it belonged and looked for other injuries.
How should one approach such a situation? First, don’t become a casualty. Assess your own safety. Can you pull over safely? Can you get to the downed rider without breaking your leg? Is a semi-truck about to run over both of you? If possible, have someone else handle traffic and call emergency services.
Next, assess the whole situation. Does he have a helmet on? If so, don’t remove it! Is he responsive? Is he breathing? Are there any obvious limb deformities? Is there bleeding?
One reassuring voice goes a long way toward settling down an injured person. Thrashing around, from pain or panic, is likely to do further harm. So talk to the person, calmly, throughout the time you are there. Let him know what you are doing and why. Tell him help is on the way.
Removing a helmet moves the neck and can injure the spinal cord if the neck is broken. Don’t remove the helmet until a rigid neck brace is in place. Twenty percent of motorcycle crashes involve head or neck injuries, which can be catastrophic. So unless he isn’t breathing and you need to remove the helmet to breathe for him, don’t remove it. Assign a helper to hold the rider’s head so he doesn’t move his neck. All it takes is a hand on each side of the head. If the rider is unresponsive, check his pulse at the neck and make sure he is breathing. CPR is a reason to remove a helmet. No one worries about being paralyzed if they’re dead. This situation arises very rarely.
Look for bleeding. Unless there is a pool of blood underneath, don’t roll him over. If you see bleeding, put pressure on it. If you have a first-aid kit, use a sterile gauze to cover the wound and stop the bleeding; otherwise, use whatever you have and as much pressure as it takes.
Are there obvious limb deformities, such as one leg taking a right angle at the middle of the shin? If so, don’t move it! That is more likely to cause harm than improve the outcome. Just stabilize it to keep movement from causing additional injury. Having a helper hold the limb in place is helpful. If you must move the rider, stabilize the injured limb by strapping something rigid to it on either side in the position it is in at the time. Tire irons are handy.
Once medical personnel arrive, follow their instructions and don’t get in their way. Tell them everything you have seen and done. This becomes especially important if the downed rider’s mental status has changed. Has he become more responsive or confused? Is he in more pain or less? If he could remember his phone number when you got to the scene and now can’t, it could indicate worsening brain damage or other complications.
When it’s all over, give yourself a pat on the back. You might have saved a life.