Tony “Pan” Sanfelipo, retired EMT – Accident Investigator
Hupy & Abraham, S.C. – Motorcycle case specialist
Recent events at Waco brought a profound response from many in the motorcycle community. Likewise, motorcycle clubs and bikers’ gatherings at charity events have garnered more than their share of police scrutiny, profiling and interference. Some of the outcry proclaimed, “bikers’ lives matter.”
I couldn’t agree more, but I find myself considering another problem we face as bikers: prolonged response times to medical and trauma emergencies.
The American Heart Association developed a “Chain of Survival” when considering responses to emergencies, especially cardiac in nature. That chain has distinct links, each adding to the overall strength and effectiveness of the entire chain. The four links are early access, early intervention, early EMS (Emergency Medical Service) and early advanced life support.
Reports and studies have applauded the improvement of the EMS, starting with large dispatch centers, better-trained and equipped technicians, new and advanced ambulances and the increased availability of medical air-transport helicopter services. These improvements and advancements continue to be extolled in the studies, resulting in more monies becoming available to purchase the latest innovations in emergency medicine.
The problem I have with studies is the fact they can be manipulated to portray a certain desired outcome. For instance, reporting a dramatic improvement in outcomes in emergency situations, then equating those outcomes to the above advancements, could be misleading if the studies are conducted in major metropolitan areas. Larger cities can afford highly trained paramedic services, level one trauma centers and enjoy a 5-to 8-minute response time to get that help to an injured person. Couple that with a 5- to-10 minute transport to the trauma center and outcomes can be anticipated to be the best that could be expected.
My concern is, outside of the motorcycle commuter using his or her bike to travel to work and back or take a trip to a neighborhood business, most bikers who enjoy riding, enjoy doing it away from urban centers. In the event of a serious crash in a rural area, several concerns come to mind. First, it’s more likely that first responders or EMT basics might be responding to your emergency instead of the highly trained paramedics you find in metropolitan areas. This is not intended to belittle the first responders or EMTs, but they are not trained or licensed to administer many lifesaving drugs, and many cannot administer IV therapy. Paramedics can perform some surgical techniques in the field like tracheotomies and chest taps, high level skills that save lives when coupled with short response times. Small rural communities with longer response times seldom have paramedics in their emergency medical system.
Unlike major cities with a 5-minute response time, a crash in rural America can have response times of anywhere from 5 to 55 minutes, depending on where the incident occurred and the terrain leading to the crash site. How does this relate to the chain of survival? The chain is only as strong as its weakest link. In the case of a rural crash, 30 miles from the nearest small town, early intervention is the link I’m most concerned with. Who will perform this early intervention? Typically, bikers ride with a companion, or even in a group, when taking a trip outside of the city. Those riding companions ultimately become the first responder/early interveners. If they are trained in basic lifesaving skills, the outcome could be good. If a rider is alone, he may be left up to the skills and education of a passerby.
Bikers’ lives matter and it is my hope that the weak link in the chain of survival, the early intervention link, is addressed in conversations among medical professionals in the emergency medicine field. Training bystanders in life-sustaining care is essential to improving outcomes of trauma victims in rural settings. Even if the best-trained medical professionals are dispatched to a crash scene, if the response time is greater than 5 minutes, a critically injured, nonbreathing patient may not be alive when paramedics arrive. This is a concern in all traumatic injuries, but I’m especially concerned about bikers, since that’s who I am.
I am also a retired National Registry Emergency Medical Technician (NREMT) and a lead instructor for Accident Scene Management (ASM). ASM is the only nationally accredited bystander assistance training course in the country dealing with motorcycle trauma. Some myths about helping the injured persist today like not getting involved because of the threat of lawsuits. Anyone can try to sue anyone for almost any reason, but that’s not to say those suits will ever see a courtroom. State legislatures have seen the light and many years ago passed some form or another of a Good Samaritan Law. Basically, if a person tries to help someone and does not act grossly negligent, the chance of being sued for trying to help someone is almost nonexistent.
When ASM talks about bystander training, it’s not talking about first aid or CPR, but rather motorcycle specific trauma training. First aid is for Boy Scouts and hikers out in the woods. CPR is for cardiac problems. ASM deals with roadside emergencies like breathing issues, head and neck injuries, severe bleeding, internal injuries, shock and broken bones. There are things a bystander can be trained to do that will keep a person alive until help arrives. Airway is a priority, and it’s the first thing first responders or EMTs will check when they arrive on scene. One concern I have is the recent change in CPR training, calling for 30 chest compressions before any rescue breaths in a nonbreathing patient. That’s all well and good for a cardiac patient, but someone involved in a motorcycle crash may have serious internal injuries, and pressing on a chest too soon might just ensure that person is dead before the professionals arrive. In the case of a nonbreathing crash victim, it is recommended that the rescuer use the jaw-thrust method, which is a way of opening the airway while providing cervical spine (neck) immobilization. Airway takes precedent over everything else, and if breathing cannot be restored or rescue breaths are inadequate, the traditional chin-lift/head-tilt method may have to be employed. I’m just suggesting that you don’t go there first without trying the jaw-thrust method.
We’ve found through conversations with many EMTs that motorcycle specific crash scenarios are not covered in most training modules, and that full-face helmet removal is another skill not well taught in many EMT classes. Thanks in part to my wife Vicki “Spitfire” Sanfelipo, Founder and Director of Accident Scene Management, her attendance at numerous committee meetings in Washington, D.C. with the National Highway Traffic Safety Administration (NHTSA), and meetings with local medical directors has initiated some motorcycle training in some curriculums and changed EMT Basic training in 2012 to include a 15-minute module on helmet removal. There is much more to do.
She is also actively working on changing some protocols in Emergency Medical Dispatch (EMD). She learned of a local dispatcher in an EMD training facility who was threatened with dismissal for advising a caller to remove the full-face helmet of a nonbreathing motorcycle crash victim. That biker died despite CPR efforts to revive him. The problem the dispatcher had was there was no protocol to deal with a helmeted nonbreather. Dispatchers have flipcards for various situations. When the caller advised it was a motorcycle crash, the dispatcher flipped to the motor vehicle crash cards. When he asked if the person was breathing (remember airway takes precedent over everything else), a negative response caused him to flip to the card dealing with CPR. When advised the caller couldn’t perform CPR because of the helmet, the dispatcher told him to remove the helmet and proceed. That split-second decision, even though it was the proper advice, was not covered in his protocols and almost got him fired. When asked what he should have done, we were advised that he should have left the helmet on, tipped the head back and pressed on the chest.
After arranging a meeting, Vicki met with the EMD supervisor, the county executive, several fire chiefs, the medical director for the county, our state motorcycle-safety program coordinator and a board of directors’ member of our local ABATE chapter. After explaining the problem with the protocol, the local dispatch supervisor changed the protocol and they now advise to remove a full-face helmet on a nonbreathing crash victim. A small but important step that may help save a life, but there is much more to do.
Vicki is also trying to change the protocols to recognize that one-person helmet removal is attainable and can be taught to nonprofessional bystanders. To effect that change, a study must be conducted at a state-of-the-art facility with an estimated cost of $50,000. Suffice it to say that the study is on hold as we look for financial sponsors and wait for the actual study to be written before it can be tested.
The reason for me writing this article is to light a fire under the motorcycle rights community. Bikers’ lives do matter, and along with the problems of profiling, motorcycle-only checkpoints, enhanced enforcement targeting and other problems that bikers complain about, there should be an outcry to improve the chances for survival of motorcycle crash victims by exploring and implementing some of the things ASM has been trying to bring to the attention of NHTSA, the DOT and medical directors across the country.
Happily, various ABATE chapters have engaged in providing ASM training and securing ASM instructors for their state. More needs to be done. Motorcycle rider coaches should be trained in ASM, including Advanced ASM which deals with the additional problem of medical emergencies, something they could very easily be confronted with on the training range. Motorcycle clubs and organizations like H.O.G., Goldwing Riders Association and others should encourage this training for their members.
The more people we can train, the stronger the chain of survival becomes. Bystanders are the weak link, but together, we can change that. More information about ASM, who its instructors are and where classes are scheduled can be found at Road Guardians Schedule
Tony “Pan” Sanfelipo is a 24-year accident investigator for Hupy and Abraham, S.C. He is also a retired NREMT, a lead instructor for Accident Scene Management and a member of Wisconsin/Illinois Roaddocs RC. He founded ABATE of Wisconsin in 1974 and BOLT in 1992 and has been riding motorcycles since 1964.