A Rider’s B een Injured In an Accident… What should I do?

1. A Rider’s Been Injured In an Accident… What should I do? Don Arthur, MD Emergency Medicine Physician Rider

2. 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

3. 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.

4. Good Samaritan Laws • Four key elements: • Care rendered is performed as the result of the emergency • The initial emergency was not caused by the person • invoking the law • The emergency care is not delivered in a grossly • negligent or reckless manner • 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

5. 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

6. Speed and Energy • Kinetic Energy = ½ MV2 At 80 MPH FORCE OF IMPACT At 40 MPH SPEED 0 10 20 30 40 50 60 70 90 100 80 THE FASTER YOU GO, THE BIGGER THE MESS

7. Scene Management • 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 trafficand bystanders. • Best trained responder should attend to victim. • Approach victim and introduce yourself: • 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… “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.”

8. ABCC-911 ONLY IF UNCONSCIOUS! • AIRWAY • Are there any obstructions to breathing? • Do not change head position unless • necessary. • BREATHING • Is the victim spontaneously breathing? • 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. CAUTION IF RIDER IS INJURED DO NOT REMOVE HELMET

9. Airway • 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

10. ABCC-911 • 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: • 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…

11. Gather Essential Information IF VICTIM IS CONSCIOUS • Get as much pertinent information as possible • and write it down to give to ambulance crew • 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

12. Accident Scene Facts • Ask victim what (s)he remembers about the accident • 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

13. 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

14. Injuries You Can’t Do Anything About But Could Make a Whole Lot Worse • 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 CONTRA-COUP INJURY FIXED OBJECT

15. 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

16. Injuries You Can Do Something About But Probably Shouldn’t • 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 non-emergency 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

17. Most Common Injuries ATGATT • 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

18. ATGATT Because walking away in disgust beats riding away in an ambulance.

19. 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!

20. First Aid Kit Suggested Contents • 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.

21. 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!

22. Warning THE SURGEON GENERAL HAS DETERMINED THAT MOTORCYCLE RIDING IS HABIT-FORMING! Courtesy: Donna Fousek, 2004 “Dad went on a little ride this morning… to Ohio.”

23. Preparing for the Ride • Carefully consider potential riding impact • Chronic illnesses • Predisposing conditions • Family history • Carry a card with emergency information • 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

24. Dehydration • 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 • 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

25. 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

26. For Diabetics • Carbohydrate (sugar) in solutions can be dangerous for diabetics • 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

27. Cardiovascular • History of heart disease • Medications • Physician consultation • Deep vein thrombosis • ‘Sludging’ effect • Pain • Swelling • Redness • Numbness in feet • Pulmonary embolism • Anticoagulants (‘thinners’) • Treatment: • Leg exercises • Support socks

28. Deep Vein Clots EMBOLUS TO LUNGS NORMAL BLOOD FLOW DEEP VEIN THROMBOSIS DEEP LEG VEINS

29. Respiratory System • Allergies – especially seasonal • Upper respiratory infections • Effects of smoking • Nicotine effects on blood vessels • Nicotine effects on night vision • Nicotine withdrawal effects • Physical conditioning • Medication effects • Increased fatigue & sleepiness • Dryness of mucous membranes

30. Urinary System • 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

31. Skin Conditions • Heat rashes and “Monkey butt” • Infections • Worsening of chronic conditions • Eczema • Psoriasis • Foot care • Sunburn • Preventive strategies • Clothing fit • Clothing changes (especially socks) • Skull cap • Shaving • Lotions and lip balms • Powders • Treatments

32. SWOLLEN TENDONS NERVE COMPRESSION Vibration and Overuse • Causes and effects • Excessive handlebar vibration • Causes increased fatigue • Causes swelling around • nerves in wrist and elbow • Prevention • Use grips with increased padding • Gel inserts for handlebars • Gel inserts in gloves • Relax your grip Skier’s Thumb

33. 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

34. Courtesy: Paige Ortiz Environmental Protection • 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 • Sun • Wind • Dryness • Moisture • Temperature • Vibration • Noise ENVIRONMENATL EFFECTS

35. 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. Be On The Lookout… Distracted drivers …are out to kill you!

36. Road Hazards Be alert for subtle hazards…

37. THE END Enjoy the Road! donald.arthur@comcast.net