Roadside First Aid

Article printed in American Iron Magazine.  Click here to see PDF article.

accident-scene

Are you prepared if things go wrong out on the road?

Normally, I commute about 35 minutes to work in my car. However, on a particular day when I heard that freeway traffic was already snarled at 7 am, I grabbed my iron steed so I could use the car pool lane. The freeway was more gridlocked than normal as I merged over to the car pool lane. But something else was going on up the road. I could see traffic grinding to a halt only 100 yards ahead. Strewn across the road at weird angles were maybe four or five cars. As I approached the accident scene, lanes one and two were nearly blocked on this five-lane freeway, with traffic easing around on the right. Air bags had been deployed in at least two cars, and one car was perpendicular to the normal flow of traffic. A motorcyclist was also sitting on the shoulder next to his dropped sportbike. As the tangle of traffic crept for-ward, I watched a young lady step out of her crashed car and promptly go limp, falling backwards onto the roadway. I was shocked that no one had stopped to help, even though many cars had already squeezed by the wreckage on the right.

I pulled my bike in front of the young lady lying on the road, hoping to block any additional traffic from easing up on her, putting on my flashers, and running to her side. She struggled to get up and mumbled something. Her eyes were rolling around in her head. I placed my hand on her shoulder to keep her flat on the road and braced her head against my thigh to immobilize her head and neck and said in a loud voice, “Hi, I’m Allan. You’ve been in an accident. You’ve also fallen and hit your head. Please don’t move. Just rest for a minute and let’s find out if you’re okay. I’ll be right here. Everything is going to be okay.”

I realized that she was one of several drivers that could be seriously hurt. The motorcyclist was still sitting on the ground about 20′ away, his helmet still on, studying his once beautiful bike and shaking his head in disgust. It also dawned on me that it had been over 20 years since I’d used any of my basic first aid training as a lifeguard during my college days. I was thankful that I didn’t need to deal with breathing issues, CPR, or extensive bleeding with the young girl I was with, but what about the other drivers? Was someone in worse condi-tion than her?

Time seemed to slow down. I’d been there for about five minutes and no one else had stopped to help. The young lady was breathing fine, she had color in her face, and she was following my command to lie still until we could assess her injuries. Had someone called 911? I did not know. My phone was back in my bike. Then someone tapped me on the shoulder. It was an Emergency Medical Technician (EMT) and his partner with emergency equipment. He said, “Thanks, buddy, we’ve got this.” I was relieved to be off the hook for that woman’s safety, and I quickly debriefed the EMT (what I saw and actions I had taken). Realizing that the Highway Patrol and Fire Department had arrived, I was out of there. I’ve reflected on this situation many times. My reoccurring thought is that I tried to help the best I could, but I wasn’t sure if I did the right things in the right sequence. My epiphany was that I needed training, something more than just first aid, because I participate in activities that bring inherent risk: hang gliding, scuba diving, rock climbing, dirt biking, clearing land with a chain saw, and, yes, riding a street bike. And, I think as a motorcyclist, there’s a higher probability that I will witness an accident (motorcycle, car, pedestrian, what-ever) because I’m using the road for recreation as well as for transportation. I’m likely out on the road more than the average person, especially in isolated places. So, I think I have a responsibility to myself, my riding buddies, my family, and even total strangers, to be ready if and when the need arises. I refer to these as Moments of Truth. By that I mean, when something unexpected happens, do I respond in a capable, helpful way?And, let me tell you a secret that I learned from lifeguarding that you won’t likely find emphasized in many first aid training materials: many people don’t react well in emergency situations. I’m not talking about those that are hurt. I’m talking about those that witness or come upon an accident. Some people even react by going into shock. Others deliberately avoid the situation because it’s too overwhelming for them. And still others that want to be helpful are not ready (skill and knowledge) to provide the necessary assistance – like I did in the aforementioned accident.

Enough drama, let’s talk reality. It turns out there’s a nonprofit organization that’s dedicated solely to preparing riders, EMTs, and paramedics to be capable first responders, especially for the unique needs of motorcycle accident victims. It’s called Accident Scene Management (ASM); it was founded by Vicki Roberts-Sanfelipo, a registered nurse, who is also the executive director. Vicki’s motivation to start ASM came when she realized: “As a nurse, I was not trained in roadside trauma, yet my friends [fellow motorcyclists] looked to me in the event something happened. I heard their comments and thought I should figure out just what my response should be.”

What To Do

AFTER JUST A FEW MINUTES TALKING with Vicki, I realized that my Good Samaritan actions were not necessarily the best actions to take nor were they done in the right order. Bottom line: I kind of failed my moment of truth due to a lack of knowledge. According to Vicki, my first mistake was parking my motorcycle in front of the victim. A car could hit my bike and knock it into both you and the victim lying on the road. According to the California Highway Patrol [CHIPS], this has occurred in the past killing both the victim and first responder.Vicki stated, “In fact, in accident scene management we teach first responders to keep vehicles 100 feet back from the accident scene. That way, emergency services — ambulances, police cars, and fire trucks — have immediate access to the site.”

When you’re the first person to stop at an accident scene, the common mistake is to immediately focus on an obvious victim lying on the ground. However, there could have been other victims with worse injuries in need of urgent help like CPR or controlling severe bleeding. Accident Scene Management trains first responders to approach and take action using the acronym: PACT. P is for prevent further injury, also called scene safety. A stands for assessing the situation, which entails gathering the needed information for a 911 call. C is contact the EMS. Don’t delay this important step. In fact, do this while doing the first two steps if you have a cell phone signal and do not need to leave the scene to call for help. The T stands for treating the injured with life-sustaining care using the ABCSS of Trauma, which we’ll get into next, to prioritize your actions. In my situation, I went to the aid of the first obvious victim without performing the PAC of PACT. Maybe all of the people driving by thought someone else had called 911, delaying their response time. I didn’t assess the full scene and it’s possible that other victims needed urgent help.

As just stated, the T in PACT is for treatment or ABCSS. The A in ABCSS stand for airway. The first thing to do is determine if the person is breathing. If you don’t think the person is breathing, perform a jaw thrust by lifting the jaw while keeping the neck straight. This will lift the tongue from the back of the throat. The B is for breathing. If the per-son is not breathing by himself, keep the jaw lifted and, using a breathing barrier, give two breaths initially, then one every six seconds. C stands for circulation. In trauma, a loss of circulation comes from bleeding. Look for and treat obvious ex-ternal bleeding using direct pressure, el-evation, and a hemostatic dressing or tourniquet on limbs only and only if ab-solutely necessary. The S is for shock. Consider internal bleeding, elevate legs, cover the person for warmth, and stay calm. Do not give him anything to drink even if he asks. The second S is for spinal motion restriction. Hold the person’s neck still until the emergency workers arrive and take over for you.

Training & Gear

SO WHAT DOES ACCIDENT SCENE MAN-agement teach in first responder train-ing? Vicki replied, “As noted earlier, we teach first responders how to apply PACT and ABCSS. I would like to add that we train bystanders to help. It really takes some time to teach the topic prop-erly. This training goes beyond CPR and first aid.” In Vicki’s opinion, the mini-mum amount of training that a motor -cyclist should have is ASM’s 100 Series class, which is just one day long and typ-ically taught from 9 am to 4:30 pm with a lunch break. However, it can also be given in two 3-1/2 hour sessions. ASM has a website (RoadGuardians.org) that shows where and when classes are held as well as its instructors. ASM trainers are located around the country, but, un-fortunately, not in every state. If you can’t find a class near you, contact ASM and ask about how to get something going so you and your friends can be trained. Many times, ASM will send an instructor to your location for the train-ing. Hopefully, more instructors will step up and get trained, so they can teach this information correctly and maintain its in-tegrity. All ASM instructors go through certification and a lead instructor must be present at every class. A lead instruc-tor has EMT or higher training or is an experienced ASM trainer.

My next question to Vicki was con-cerning what first aid equipment should/can we carry on our bikes? Her reply was that at a minimum you’ll need nitrile gloves, 7-1/2″ paramedic shears, 4 x 4 gauze, roll gauze, tape, something to write on, a pen or marker, and a rescue breathing barrier. ASM builds trauma packs for motorcyclists since most packs that are commercially available don’t have what we’ll need in them, and space is an issue and water resistance is impor-tant. You can see exactly what’s recom-mended, as well as prebuilt kits, by checking out the First Aid Trauma Prod-ucts link at RGcompound.com.

Two Scenarios

OKAY, LET’S RUN THROUGH TWO POSSIble scenarios and see how the PACT guide-lines are applied.

Scenario #1: you’re riding solo in a remote area and hit a deer. You go down and think you have a broken leg. It could be hours before help arrives. What do you do? Vicki: First, prevent further injury (P): Be sure you’re in a safe location, like the side of the road. Then assess your sit-uation (A): You think you have a broken leg, but is there anything else going on?Is there any external bleeding? Next, contact the EMS (C): Find your phone and call 911. If you have a bad signal, try texting 911. Sometimes a text will go through when a call will not. Also try yelling for help. If a car does come by, flag it down and ask the driver to call for help. While you’re waiting for help, treat your injuries (T): If the broken leg in-volves a break in the skin, cover it up to prevent infection. Use sterile gauze if you have it. If there’s severe bleeding, apply a tourniquet 2″ above the break until all bleeding has stopped. You can use a belt but avoid shoelaces. Write the time the tourniquet was applied on the skin next to the tourniquet. If there’s no break in the skin or bleeding, consider splinting your leg to prevent movement of the bones to reduce pain. Put a cold pack on the wound if you have one.

Scenario #2: a rider in your group is sideswiped by a reckless driver. The rider is semiconscious, not bleeding, but you don’t know what injuries, if any, have occurred. It could be at least 30 minutes before help arrives.

Vicki: Prevent (P) further injuries by making sure the person and rescuers are in a safe location. Then assess (A) the sit-uation by doing a head to toe assessment of the injured person to check for in-juries. Gather information (his full name, a person you can call, where does he hurt, any allergies, does he take any med-ications, pertinent medical history, when did he last eat or drink and how much) from the injured person right away. Then have him tell you what happened in his continued on page 42 own words. This conversation also helps you assess their level of consciousness and gives you information that might be hard for the EMTs to get when they arrive if the person’s condition has deteriorated. While you’re assessing the injured rider, have someone in your group contact EMS (C). Then treat their in-juries (T), and be sure to cover the person to keep him warm while giving spinal motion restriction (SMR). I could talk for six hours on this topic, but that’s why our class is six to seven hours long! We teach critical skills such as how to move some-one if necessary, Jaw Thrust rescue breathing, and Helmet Re-moval. Those skills are also practiced during the class. You can get advice but the best thing is to get trained!

Conclusion

LAST WEEK I ROLLED UP ON ANOTHER accident on the highway. Police, fire, and EMTs were already on the scene. Whew! But I can tell you that after writing this article and having an in-depth conversation with Vicki, I’ll never look at an accident scene the same way. I’m not ready for my next moment of truth just yet. Thank-fully, ASM has an instructor near me in the San Francisco Bay Area. I’ve also contacted my local Harley-Davidson dealer to see if he would be interested in sponsoring a one-day, basic program in the near future. ASM would help coordinate the effort. Is that great or what? Will you be ready for your moment of truth? AIM

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