Thursday, May 13, 2010

Rider Down! First-Aid For Motorcyclists

(photo courtesy of Aerostich)

Let's face it—no matter what we tell our spouses, or our neighbors, or our bosses, motorcycling is a dangerous sport. You can minimize the danger by riding safely and wearing the right gear, but no amount of preparation can protect you from drunk drivers, or leaping deer, or just plain bad luck. That's when preparation of another kind comes in—knowing what to do in case of an accident—that can literally mean the difference between life and death.

Dr. Harry Wong, a.k.a Doc Wong, is a chiropractor based in Redwood City, California. He's also a motorcycle rider who confesses to being "a bit wild" in his younger days, racking up eight moving citations in his first 12 weeks on a bike—at barely more than 15 years old. Since then Doc has calmed down a bit, and in the mid-1990s, seeing his young self in many new riders, he began organizing riding clinics in the San Francisco Bay Area. Realizing that not all accidents are avoidable, he later added first-aid clinics to his schedule.

The turning point was a ride Wong was on when a rider went down. Amid the confusion, none of the riders who stopped to help secured the accident scene. As a result the law enforcement officer responding to the call came roaring around a blind corner and almost plowed into the group. That's when Wong realized there was a need for a clinic that addressed accidents and how to deal with them.

Rule number one of accident avoidance, Wong says, is don’t have an accident in the first place. "Most of the accidents I see involve riders who aren’t skilled enough and who get in trouble because of it. That's why you should work at improving your skill level no matter what you ride or how you ride." Recognize when your skills aren't at their fullest, too. "Some days you're on, some days you're off. If you're a little bit off on a given day, slow down."

Still, stuff happens, and one day you might be out riding with a group of buddies when you see one of them go down, or you might see a cloud of dust up ahead or in your mirrors indicating someone has gone off the road. "First," Wong says, "safely stop or turn around. Next, secure the scene. With luck you have more than one buddy with you so someone can run up the road and control traffic, waving people down and cautioning them to the fact that they're coming up on an accident scene."

Next, assess the downed rider's injuries. "If the downed rider is really concerned about his motorcycle, that's a good sign, because it means he's conscious, awake, and knows he's been in an accident. Most motorcycle accidents don't involve injuries. The rider gets up and takes off his helmet before anybody gets to him. The instances where the rider is unconscious or in pain are kind of easy to assess, too, because you know this guy's in trouble and you need to apply immediate first aid."

An injured rider falls into one of three categories—not hurt, partially hurt, or badly hurt. "The in-between is a harder state to figure out," Wong says. "A rider could fracture his neck or back and he may not feel it for the first half-hour because swelling hasn't taken place. He might say, 'My neck feels a little tight,' but he'll get up and move around. But when the swelling begins, and the fracture starts to open up a bit, now you can have some serious problems."

If you witness the fall, and see the rider tumble and twist, try to keep him still. "If you suspect the possibility of a spinal injury," Wong says, "it's better to be safe than sorry. I've been at the scene of an accident where the guy wanted to get up, but just looking at how he'd tumbled, and hit his head, and twisted his neck, we had him lie down. Sure enough, within a few minutes, we started to see some spinal symptoms. We got ice on him—if you suspect a spinal fracture get some ice on it. That will minimize the swelling. It turned out that he did fracture his neck, and was in a halo for a while."

One of the most common motorcycle injuries is road rash, which in itself isn't usually that serious. But what comes right after can be. "If the rider's covered with road rash, typically the bleeding won't be severe. It'll look pretty bloody, but with road rash you don't typically break major arteries. What you really need to watch out for shock." Wong says any injury can lead to shock. "Shock is when you go into a state where the body tightens up. It's the body's reaction to trauma. The eyes may seem glazed, and the skin will seem ashen-colored or pale.  Blood vessels can close down, and you might start to feel clammy. Assuming you're not in the desert and dehydrated, don't give the victim any fluids, just keep him warm and calm. If it's a hot day try to make some shade around him to keep him cool. The idea is to neutralize the body temperature back to the ideal temperature."

In case of bleeding, Wong says, "what you want to do is put direct pressure on the wound to see if you can get some coagulation going to stop the bleeding. If it's a major artery there are certain pressure points to hit, which we go over in the first-aid class." Broken bones can often best be treated on the scene by leaving them alone. "If the rider has broken his foot, leave the boot on. Once you take it off the foot will balloon up and you won't be able to get the boot back on. And the boot itself makes a good splint. If he's broken his leg, leave the leathers on." In the case of a compound fracture, however, where the end of the bone penetrates the skin resulting in bleeding, cut off the clothing and do what you can to stop the bleeding.

If a downed rider isn't breathing, forget any other injuries and concentrate on getting him breathing again. "This is one scenario where you might suspect spinal injury but you're going to take his helmet off anyway," Wong says. "If he's not breathing you have four minutes until he's dead. Ideally, removing the helmet is done by two people, one to support the neck and the other to take the straps of the helmet and pull them apart and gently take the helmet off."

After the helmet has been removed, check the ABCs—airway, breathing, and circulation. "You want to make sure the airway is clear. You might get him breathing just by clearing the airway. Then you check for breathing. You can look at the chest to see if there's any motion, or you can put your hand or cheek near the mouth to see if you can feel any air going in and out. Finally, if you have breathing you're going to have circulation, which you can check by feeling for a pulse in the carotid artery."

The point of first-aid is not to cure whatever injuries might result from an accident, but rather to stabilize the victim until professional help arrives. At least one member of every riding group should carry a cell phone, or barring that a CB radio, which can be used to notify passing traffic that an accident has occurred so word can be passed up and down the road that emergency personnel are needed on the scene. Bottled water will come in handy for rinsing wounds. But the most essential piece of first-aid equipment is the first-aid kit.

You can get a good first-aid kit from drug stores, camping supply stores, and a few motorcycle accessory outfits. At minimum a kit should contain four-inch-square gauze bandages, sometimes called four-by-fours; a CPR mask for giving mouth-to-mouth without skin contact; latex gloves; alcohol pads; and adhesive tape. To any basic kit you can add a space blanket for shock victims; antimicrobial hand wipes; an assortment of band-aids and other adhesive bandages; large-area gauze pads; scissors; pain relievers like aspirin, ibuprofen, or acetaminophen; and a flashlight, which can be used to look in a victim's mouth if you suspect an airway obstruction. Wong also suggests adding Kotex-type sanitary pads, which are good for soaking up blood.

A first-aid kit should be as essential a part of your riding gear as protective clothing. But it’s not much use without the knowledge to use it. If you live near the San Francisco area, go here for a schedule of Doc Wong's CPR and First-Aid for Motorcyclists classes. In other parts of the country go to the Red Cross website where you can sign up for first-aid courses at your local Red Cross chapter. Take a class, and take your riding buddies with you. Because while motorcycling can be hazardous to your health, ignorance can be fatal. —Jerry Smith


  1. Excellent write up Jerry. Every motorcyclist should read this and be prepared.


  2. This is all good.
    Especially fix it so nobody else gets hurt as in secure the scene.
    I differ in the point about breathing etc.
    If the trauma is bad enough so that that the patient needs CPR, there is a something like a 95%
    chance he's a goner. I would not start CPR in a case of trauma like a bike wreck.
    You have to continue until the guy is pronounced dead. You will get all kinds of yuck into your mouth. And he's going to die anyhow. OK ensure the airway, but there comes a time when it's over. For me, that's pretty much when the breathing stops, except with heart attacks and electricity. With luck you will never have to deal with any of this. Choose your riding friends with care.