First aid question on a scenario

[devon deer stalker]

OK, i know what i would do, but what would you do?
Here is the scenario, you are the first person to come across an incident involving a motor bike on a main road.
The biker is face down on the road, in full leathers and crash helmet with full face visor, clearly from the angle of his leg and blood he has a serious leg injury, he is also non responsive and unconscious, in addition he is not breathing, so what would you do?
Thought provoking isn't it.
Cheers
​Richard

 

[Archer]

Top of my head?
First person to arrive so you are working alone,
Situation assessed and called in as you approach
Helmet stays on
Full leathers on so leg is secondary
Main problem is lack of breathing

Commence artificial respiration as for a drowned man- compression of the chest by pushing down on his back type action
10 compressions/squeezes then check for spontaneous breathing
Full set of leathers will minimize extra lung damage from compressions
Basically any biker who comes off and has these injuries in need of professional care and anything I do is better than nothing

 

[Grand Slam]

Check immediate area for any other dangers.

Call for help or get someone in vicinity to do so.

Obviously without knowing the full extent of the injuries moving the casualty is a very sore subject but get enough people to support the head/neck/back and i would consider rolling casualty onto back.

I am not a biker but i assume a full face visor can be lifted up so reveal the full face.

Lift Visor gently while ensuring someone is completely supporting head/neck.

Commence Airway check (looking in mouth for any obstructions ie broken teeth/vomit etc)

Check for breathing (Feel for breath on cheek, look for chest movement) (OP States Not breathing)

Check Pulse for circulation.

Start BLS and dont stop until Emergency Services arrive or you physical cant do it anymore or he begins breathing again.

Depending on severity of leg injury i would be getting someone to either apply pressure to affected area or fashion a torniquet to stem the bleeding.


Obviously every situation is different and each persons perception of what to do is different so before you slate my opinions.


Adam

 

[Mr B]

Depending on how much the leg is bleeding, i'd try to stem it, either by using a dressing, clothing, or a make shift tourniquet. Whilst he's on his back, have a quick look for any other big bleeds. We're talking about pools of blood forming. The blood loss could kill him.
If he's unconscious and not breathing, then that could be because of a blocked airway, which you cant tell with his lid on. The helmet needs to come off.people are extremely wary of c spine injury and are totally against taking a helmet off. If theres two of you, you can remove it carefully enough to protect the spine. If not, then it needs t be removed. If you leave it on, you'll take a corpse to hospital, safe in the knowledge that you didn't damage his spine. When you remove the helmet have a good look for damage too. To roll him over, try to position his body into the normal anatomical line, ie straight, with hands by sides. With you kneeling by his hips, roll him over, trying to control his head- quite a challenge with only two hands!
once the helmet is off, check his airway is clear, if it isn't, try to clear if, but only as far as you can see- don't stick your fingers down his throat... To maintain the airway, you could perform a head tilt, or a chin lift/jaw thrust manoeuvre, but the jaw thrust needs to be manned constantly. No good if you're alone.
if he isn't breathing (a 30 second check) then commence cpr. 30 compressions, to 2 breaths, at a rate of 80-120 compressions a minute, roughly one third the depth of his chest.
Another thing to check is whether or not the leg is still bleeding. He could have stopped breathing due to cardiac arrest, caused by hypovolaemia (low circulating volume). Cpr needs to continue until an ambulance arrives and takes over. They'll be giving him fluids, some cardiac drugs possibly, and defibrillation. Bottom line is that he need defib, but your good quality CPR is allowing the brain in particular to be perfused and remain alive, long enou for the ambulance to get there.
there are differing opinions on when to phone for help. Id probably give 2 breaths and 30 compressions before phoning. You can always pause the call periodically to continue cpr- the operator isn't going anywhere. Failing that, talk clearly and fast before hanging up- they can replay the call to get the info.
if a fire crew arrives first, dont neccessarily expect them to take over from you. If it looks like youre doing a good job, they may leave you to it, unless you ask for help!
i think posts like this are very useful. I regularly run through "what ifs" and I think it better prepares you for the day something actually happens.
​hope this helps

 

[widu13]

Just throw something in the mix (and this is a judgment call).

He will die without air. If he has positional asphyxia or an obstructed airway, no amount of compressions are going to bring him back.

Adam's answer is comprehensive, but being a biker I would physically assess him and make a judgement call as to whether or not to remove the helmet in addition.

 

[tackb]

check his wallet for a doner card whilst lecturing him on the dangers of motorcycles ! (all said very tongue in cheek!)

 

[paul o']

+ 1
YOU should never remove the helmet it may be holding a injury from becoming worse keep up comp's and deal with his leg as a 2nd unless its a fem bleed then unless you can reach it his not goner last long anyway

Check immediate area for any other dangers.

Call for help or get someone in vicinity to do so.

Obviously without knowing the full extent of the injuries moving the casualty is a very sore subject but get enough people to support the head/neck/back and i would consider rolling casualty onto back.

I am not a biker but i assume a full face visor can be lifted up so reveal the full face.

Lift Visor gently while ensuring someone is completely supporting head/neck.

Commence Airway check (looking in mouth for any obstructions ie broken teeth/vomit etc)

Check for breathing (Feel for breath on cheek, look for chest movement) (OP States Not breathing)

Check Pulse for circulation.

Start BLS and dont stop until Emergency Services arrive or you physical cant do it anymore or he begins breathing again.

Depending on severity of leg injury i would be getting someone to either apply pressure to affected area or fashion a torniquet to stem the bleeding.


Obviously every situation is different and each persons perception of what to do is different so before you slate my opinions.


Adam

 

[triggersqueezer]

look around and if no one else is about see how much cash he has in his wallet ?
or if im feeling kind if he is not breathing so going to die i would probably wrongly move him and give mouth to mouth was my first thought all goes against the advice i have heard but my thinking was he is going to die if i dont and pushing on his back to give cpr would be as bad as moving .mouth to mouth because he may have broken ribs /internal injuries.oh and call an ambulance might be an idea.

 

[Mr B]

If you don't remove the helmet he will die. If you do remove the helmet, worst case he will die. Either way the odds aren't good, but leaving his helmet on means you cant clear any obstruction and cant administer rescue breaths, which are the only thing that will keep his organs partially perfused.
the likely issues caused by removing a helmet could be antagonising a cervical spine injury, or possibly worsening a very serious head injury, which the helmet is effectively splinting. Chances are, if the biker has a head injury, the intercranial pressure will be rising. Theres nothing you can do at the roadside for this. If the skull is so badly fractured that his helmet is the only thing splinting it, then it really isn't his day and the helmet would be in bits anyway. The only thing that you can fix at the roadside is his lack of breathing and lack of a pulse. You cant do that with his helmet on, unless you want to try mouth to nose through the front of it.

 

[ths84]

Well its a tough one for todays first aiders as when I renewed my ticket earlier this year I was told never to do more than the absolute minimum to keep them alive till the ambulance/ doctor arrives on the scene as anything extra you do which is wrong opens you up for a huge amount of ball ache being dragged through the courts especially if they die and even then getting the basics wrong could land you in court!

But OT first off is don't move the helmet just yet, check if there are any obstructions in the front of the lid which is stopping him from breathing, second if their are by standers get them to help roll them on to their back by supporting all parts of the body, next if there is still no breathing then the helmet must be removed, life take precedence over spine damage, check pulse again and then start chest compressions, depending on skill and your confidence you either do about 100 (if memory serves me) a minute and no breaths until paramedics arrive or if you know what you are doing 30 compressions to 2 breaths.

The way CPR is looked at today is there is a few minutes of oxygen stored in your blood so mouth to mouth is kind of a last resort and just the compressions are enough to keep someone alive.

That being said I'm sure it will change next year!

Whilst this is going on get someone else to sort the leg out

 

[Pheasant Feeder]

Survey the safety of the scene, is there a risk of oncoming traffic, that could injure me, is the road full of diesel that could cause traffic to loose control colliding with me.
Assess the scene is it just a single person or is there someone else involved. What is the status of the casualty or casualties, is he conscious and breathing.
Disseminate the following information to the emergency services, (it might only take eight minutes for an ambulance to get there but it will be one of the longest eight minutes of your life.)

Casualties inform the emergency services of the type of incident and more importantly your location, the status of the casualty or casualties.
Hazards look again at any hazards are you still safe, is there fuel leaking from the motorcycle onto the hot exhaust.
Access is the way to the incident clear or have you left your car across the only access point is the road blocked by something.
Location be as precise as you know to be accurate, are you after or before the junction, are you heading north or south etc.
Emergency services required, is there a need for the fire brigade.
Type of incident in this case a Road Traffic Accident
Safety is there any concerns for the safety of the scene, has he collided with a road sign leaving live wires exposed etc.


Then;
Is he conscious? Yes reassure him keep him talking, have a look at the leg that's look not touch at this point is it spurting blood if so you need to apply pressure above the bleed.
No check his breathing is he breathing if so place him in the recovery position.
If he's not breathing then and only at this point would I think of removing his helmet.
Place the casualty on his back ideally an extra pair of hands is needed and support his head as you roll him.
Your then into the ABC, Airway is it clear look for obstructions.
Breathing ensure a clear unobstructed airway by tilting the head back by lifting the chin.
Circulation if there is no pulse then its time for the compressions, feel for the sternum, place the heel of your hand two fingers up from the sternum and press hard and fast to Nelly the elephant, or staying alive depending on your choice of music.

But get comfortable because now you've started the compressions your doing it until help arrives and you'll realise the eight minutes i mentioned earlier will feel like an hour.

Reasons, for my answer. If he's not breathing he is going to at the very least suffer brain damage if you don't intervene and probably die. If there's no pulse then he's almost dead if you don't intervene. The associated risks of spinal damage of removing the helmet are paramount and it is only because he is about to die through no pulse or airway that I would consider taking the helmet off. If there is any way of opening the airway without removing the helmet then I would try.

I encountered a very similar situation 15 years ago but thankfully the casualty was conscious and breathing so we had a conversation through an open visor. It was the first time I had come across an RTC and had received only basic first aid training working on building sites.

The above pneumonic SAD CHALETS is one of the principles of incident management taught to many of the emergency services. It is designed to give a structure to the thought process, and the communications to a control room.

 

[Mr B]

Pheasant Feeder, today people aren't even taught to check for a pulse. A survey was conducted of about 1000 doctors, paramedics and nurses and a large proportion of them couldn't find a radial pulse!
The Joint Resuscitation Council decided to remove the need to check. If the casualty is unresponsive, airway clear and no breathing, then commence CPR.
Ive been to quite a few RTCs with my job, first on scene for probably a third of them, removed helmets on two motorbike crashes, once, in agreement with an on scene doctor, once in total disagreement with an on scene fireman.

 

[willie_gunn]

An interesting scenario.

I'm with Mr B on this. If I was the first to arrive and the biker is unconscious and not breathing then clearing the airway and initiating CPR would be the priority. The biker is lying face down but is not breathing, so as he's already in a safe airway position he clearly isn't going to breath unassisted. If he has a spinal injury then turning him into the recovery position is going to exacerbate things anyway, so might as well turn him over completely and try to get some oxygen through him, as otherwise he has zero chance. I'd be looking to remove the helmet, as I wouldn't feel confident doing mouth to nose and would worry that any air I breath in through his nose would be escaping through his mouth anyway.

Interestingly I was reading about helmet removal in a new book, "Outdoor First Aid", only the other day. They have a section on helmets (climbing, off road biking, etc) and include examples of how to remove the helmet whilst stabilising the head and neck. Ideally it's a two person job. They do also point out that it's a contentious issue. They also make the suggestion of sending the helmet with the patient to the hospital, as it can help in terms of identifying points of impact, etc.

willie_gunn

 

[willie_gunn]

Disseminate the following information to the emergency services, (it might only take eight minutes for an ambulance to get there but it will be one of the longest eight minutes of your life.)

Casualties inform the emergency services of the type of incident and more importantly your location, the status of the casualty or casualties.

You raise a very interesting point.

I have fortunately not been in the situation described in the OP, but earlier this summer whilst fishing on the North Tyne one of our party slipped and broke her ankle. Having taken the first aid course with AviatingJoe earlier this year I tried to recall his excellent instruction .

I didn't move the patient - she was conscious, lucid and in no great pain. As it was her ankle that was broken I couldn't "raise her tail" but I did make sure she was warm and comfortable and had another of the party keep talking to her whilst I got on the phone to the emergency services.

I had a ten-figure OS grid reference but was surprised when the operator told me that they couldn't actually do anything with a grid reference . She asked me where I was but I had to explain that we were on a beat down by the river and I had no idea of the nearest village. I knew the beat was off the road to Wark, and that there was a quarry on the opposite side of the road, but that was it. The operator was reciting village names and road numbers that meant nothing to me. After a couple of minutes of this I grabbed my iPad from the car and fired up one of the map Apps that I had. From this I could then center on our exact location and the rest was easy. The ambulance turned up a few minutes later and the patient was taken away to Hexham hospital.

What I learned from this is that having a grid reference is not really sufficient - in future I would look up on an App on my iPhone to be able to describe the exact location (nearest road name/junction, farms, landmarks, etc) as well as having the grid reference. In my case the delay was frustrating but not life threatening, in the scenario described in the OP it would potentially be the reverse.

willie_gunn

 

[widu13]

+ 1
YOU should never remove the helmet it may be holding a injury from becoming worse keep up comp's and deal with his leg as a 2nd unless its a fem bleed then unless you can reach it his not goner last long anyway

It's really extremely rare for any fracture to be held together by the helmet. The none removal of the helmet echoes back to people untrained to recognise neck injuries and a damn good job was done of educating basic first aiders never to remove the helmet. However, many people do have experience with neck injuries- take lifeguards for instance, neck injuries are not uncommon. Do you suggest leaving the person in the water?

They are taught that in the event of a obvious neck injury and the casualty stops breathing then then must be removed from the water and CPR commenced. It is recognised that the spinal injury may be exacerbated. In some circumstances, public services etc NOT doing everything to resus the casualty may land you in court on criminal charges.

On the civil front, a jury is not going to convict someone for recognising that there is a possibility of further injury when faced with the prospect of the casualty dying. They will of course take a dim view of someone whose first effort is to remove a helmet.

Now, if you are told the ambulance is 2 mins away you would be a fool to remove the helmet unless you can see obvious signs of airway distress. Being face down does not mean that they are safe in the "recovery" position. The airways does also need to be checked whether visually or mechanically. Positional asphyxia is a real concern unless they are lying correctly on their front, not only that but many people do not realise/are not taught that the casualty should also be rotated every 15min to prevent the lung on the "down" side filling with fluid.

 

[widu13]

the operator told me that they couldn't actually do anything with a grid reference .

​They can but the operator has to know how to work the GIS. Lat/Long is now the standard.

 

[willie_gunn]

​They can but the operator has to know how to work the GIS. Lat/Long is now the standard.

Useful to know, thank you.

Is that because most car SatNav's can give Lat/Long position but not an OS grid ref?

willie_gunn

 

[widu13]

Useful to know, thank you.

Is that because most car SatNav's can give Lat/Long position but not an OS grid ref?

willie_gunn

Mainly because most GIS systems used by the emergency services are US created systems. My local force used grids as the first point of call until about 5 yrs ago and now lat/long is the standard but the operators have trained to work in grid for us die hards! I'm often amazed by peoples inability to use grids- I find it far easier than deciphering the 6 0r 7 different GPS standards!

 

[bewsher500]

I learned D-R-A-B-C
might be out of date or non PC but even crap First Aid is better than none!

Danger - are you or he going to be killed by oncoming traffic? if yes, Move!
Response - concious? responsive?
Airway - I would never remove a helmet from a motorbike accident victim unless they are unable to breath as result. even with a full face helmet you can still do nasal ventilation
Breathing - are they?
Circulation - Pulse?

 

[splash]

ABC
Would not hesitate in helmet removal in that situation, Without AIR all other action is pointless

Oh and I am a biker and know risks of helmet removal, But as a Mammal I know the RESULTS of not breathing