Motorcycle accident first responder guidance

Report
A Rider’s Been Injured
In an Accident…
What should I do?
Don Arthur, MD
Emergency Medicine Physician
Rider
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Keeping 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
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Good 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 malice
or recklessness.
• Some states have penalties for those
who do NOT assist.
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Good Samaritan Laws
• Four key elements:
1. Care rendered is performed as the result of the emergency
2. The initial emergency was not caused by the person
invoking the law
3. The emergency care is not delivered in a grossly
negligent or reckless manner
4. 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
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Mechanisms of Injury
• Blunt force trauma
• Head and neck injuries
• Chest and abdominal injuries
• Musculo-skeletal injuries
• Penetrating injuries
• Impacted objects
• Road debris
• Rider possessions
• Abrasions
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Speed and Energy
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Kinetic Energy = ½ MV2
FORCE OF
IMPACT
At 80 MPH
At 40 MPH
SPEED
T H E
0
10
F A S T E R
20
30
Y O U
40
G O ,
50
T H E
60
70
B I G G E R
80
T H E
90
100
M E S S
Scene Management
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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:
“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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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…
ABCC-911
ONLY IF UNCONSCIOUS!
• AIRWAY
• Are there any obstructions to breathing?
• Do not change head position unless
necessary.
CAUTION
• BREATHING
IF RIDER IS INJURED
DO NOT
• Is the victim spontaneously breathing?
REMOVE HELMET
• 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.
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Airway
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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
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ABCC-911
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• 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:
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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…
Gather Essential Information
IF VICTIM IS CONSCIOUS
• Get as much pertinent information as possible
and write it down to give to ambulance crew
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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
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Accident Scene Facts
• Ask victim what (s)he remembers about
the accident
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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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Don’s Simple Categories
First, Do No Harm!
• 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
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Injuries You Can’t Do Anything About
But Could Make a Whole Lot Worse
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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
COUP INJURY
FIXED OBJECT
CONTRA-COUP
INJURY
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Injuries 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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Injuries You Can Do Something About
But Probably Shouldn’t
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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 nonemergency 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
Most 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
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ATGATT
Because walking away in disgust
beats riding away in an ambulance.
How Can You Prepare?
5½ hour First Aid/CPR/AED classroom course
23.4mB Smart Phone App
Contains videos and instructions
Carry it with you in your Smart Phone!
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First Aid Kit
Suggested Contents
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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
You don’t need a lot… just the basics.
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Common 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!
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Warning
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Courtesy: Donna Fousek, 2004
THE SURGEON GENERAL HAS DETERMINED THAT
MOTORCYCLE RIDING IS HABIT-FORMING!
“Dad went on a little ride this morning… to Ohio.”
Preparing for the Ride
• Carefully consider potential riding impact
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Chronic illnesses
Predisposing conditions
Family history
• Carry a card with emergency information
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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
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Dehydration
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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
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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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Rehydration
• 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)
• Avoid caffeine or alcohol for hydration
• Both cause water loss by increasing urination
• And this can accelerate dehydration
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For Diabetics
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• Carbohydrate (sugar) in solutions can be
dangerous for diabetics
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Can raise blood sugar level acutely
May result in rebound decreased blood sugar
May increase water output through urine
Most athlete supplements contain sugar
+ Sugar
No Sugar
• Contains necessary
electrolytes
• No carbohydrates/sugars
• Add to your water bottle
Cardiovascular
• History of heart disease
• Medications
• Physician consultation
• Deep vein thrombosis
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‘Sludging’ effect
Pain
Swelling
Redness
Numbness in feet
• Pulmonary embolism
• Anticoagulants (‘thinners’)
• Treatment:
• Leg exercises
• Support socks
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Deep Vein Clots
NORMAL
BLOOD FLOW
DEEP LEG VEINS
DEEP VEIN
THROMBOSIS
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EMBOLUS
TO LUNGS
Respiratory System
• Allergies – especially seasonal
• Upper respiratory infections
• Effects of smoking
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Nicotine effects on blood vessels
Nicotine effects on night vision
Nicotine withdrawal effects
Physical conditioning
• Medication effects
• Increased fatigue & sleepiness
• Dryness of mucous membranes
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Urinary 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
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Skin Conditions
• Heat rashes and “Monkey butt”
• Infections
• Worsening of chronic conditions
• Eczema
• Psoriasis
• Foot care
• Sunburn
• Preventive strategies
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Clothing fit
Clothing changes (especially socks)
Skull cap
Shaving
Lotions and lip balms
Powders
• Treatments
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Vibration and Overuse
• Causes and effects
SWOLLEN
TENDONS
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NERVE
COMPRESSION
• Excessive handlebar vibration
• Causes increased fatigue
• Causes swelling around
nerves in wrist and elbow
• Prevention
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Use grips with increased padding
Gel inserts for handlebars
Gel inserts in gloves
Relax your grip
Skier’s Thumb
Other Hazards
• 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
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ENVIRONMENATL
EFFECTS
Environmental Protection
• Sun
• Wind
• Dryness
• Moisture
• Temperature
• Vibration
• Noise
Courtesy: Paige Ortiz
• 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
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Be On The Lookout…
Distracted drivers
…are out to kill you!
You’re four times
It’s hard to
more likely to have
concentrate on
a road accident
two things
when you’re on
at the same time.
a mobile phone.
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Road Hazards
Be alert for subtle hazards…
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THE END
Enjoy the Road!
[email protected]
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