On and Off Road: Caring for victims of motorcycle accidents

You and I know the risks; but, we ride anyway!  Or maybe one of your family members does.  And we’ve lost count of the number of times we’ve heard, “Those things are dangerous.” As a healthcare provider you also probably know the statistics.  In 2007, there were 3,821 motorcycle crashes in Michigan, which was up 12.8% from the previous year.  The number of bikers injured in 2007 totaled 3,026, again up almost 12% from 2006.  Motorcycles were involved in 1.2 percent of all traffic crashes in Michigan in 2007 and injuries suffered by bikers in these accidents were often more severe than in regular motor vehicle accidents.  Keep in mind, these statistics do not include off road cycles and ATV’s.

The hazards associated with riding motorcycles are obvious, given the lack of external protection.  We can’t ride in a bubble, right? Protective clothing, safety equipment and a sharp mind can help (see sidebar “Quick Tips”), but once an accident occurs, it’s up to all of us, at the scene, to move quickly for the best patient outcome.  Here’s a quick refresher on responding to MCCs.  Your training and quick-thinking can help save my fellow rider’s life.

Be Aware of Common Motorcycle Injury Patterns
Motorcycle accidents often involve contact with another vehicle, trees and /or good’ol mother earth.  Collisions with shifty woodland creatures like deer are surprisingly frequent and fatalities occur from this type of accident as well.  A victim of a serious motorcycle accident is almost always thrown off the bike and can land on a variety of surfaces such as pavement, dirt, gravel or the hood/windshield of a car.  During this airborne period, the patient is essentially a projectile. They can sustain loss of limbs, or other significant bodily injury, if they encounter stationary objects like signs, telephone poles, trees, etc.   In a head-on or ejection-type of motorcycle crash, head, chest, abdomen, pelvic and femur fractures can result dependant on where the rider’s impact point is. If the motorcycle collides with an object at an angle, the resulting crushing mechanism can cause injuries to the upper or lower extremities and the abdominal organs as a result of energy exchange.  Internal injuries should often be suspected given the kinematics of the event and can be rapidly fatal, especially in the case of an aortic tear or other arterial bleeding.  “Road rash”, or abraded skin from sliding to a stop on pavement or gravel can often be prevented with protective clothing.  Burns are also possible if fuel leaks ignite or if the patient’s skin contacts a hot tail pipe or parts of the engine.

Rapid Rescue
Once the scene is safe, a primary survey should be done to quickly rule out immediate life-threatening injuries.  This includes the ABCs: Airway, Breathing and Circulation and examples of life threats can include airway obstruction from facial trauma, inadequate breathing, pneumothorax, and internal or external bleeding.  Once these are either managed or ruled out, a more thorough secondary survey should be done.  This can sometimes be complicated due to the rider’s personal protective equipment, which hopefully they are wearing. In addition, be aware that with this equipment, the rider may or may not have superficial damage to the skin. But a keen assessor is always suspicious of underlying injuries due to the blunt force trauma sustained. The patient can be fully immobilized during this assessment and individual extremity circulation should be assessed and managed as well.  Individual injuries that are not life-threatening can be addressed after the patient is stabilized, but transport to an appropriate trauma center should not be delayed for this.  Splinting and pain management should be addressed throughout care.  

Do I Have to Remove Their Helmet?
Patients who are wearing full face helmets must have the helmet removed early in the assessment process.  Two providers are required for this maneuver to protect the patient’s cervical spine.  Removal of the helmet provides immediate access to assess and manage the patient’s airway and ventilatory status.  It also ensures that hidden bleeding is not occurring into the posterior helmet and prevents the c-spine from assuming a flexed position instead of neutral alignment during immobilization efforts. In an additional note, cervical spine braces are becoming very popular in motorcycling, especially in the off road arena. These devices offer unique challenges with regards to assessment/treatment and immobilization. I encourage heathcare providers to take a moment and familiarize themselves with those products via the internet.  Especially with regards to function and removal.

Final Word
Motorcycling is an ever growing activity (sort of like taxes). More and more individuals experience the thrills each year. It only stands to reason that we will likely see the accident rates climb as well. Especially with the onslaught of gadgets taking our focus off driving (side note: did you know there are a number of motorcycle helmets that are Bluetooth capable? No comment.) Manufactures also continue to develop new and technologically advanced safety equipment to better protect the riders. Again, I highly recommend that we keep abreast of these and enhance your already outstanding care for your patients. Take care and to my fellow motorcyclists’, Ride with a sharp mind and keep the rubber side down.

By Darby Brauning, Flight Nurse, RN, NREMT-P

Reprintable safety tips sidebar by MSF: