Moped rider down in a live lane: first sixty seconds
Midday, dry, on a busy two-lane urban street. A scooter rider, a man of about 20, has hit an opened car door and is lying in the right-hand lane, on his side. A line of cars is braking behind him. He is wearing a full-face helmet with the visor up. He is conscious, shouting in pain, and trying to push himself up. His left forearm is bleeding heavily through a torn jacket and the blood is pooling on the asphalt; his right lower leg lies at an odd angle. The car driver who opened the door is standing in the lane with his hands in the air, and his car has no hazard lights on. You smell petrol. You are alone, in your own car, with a first-aid kit and a reflective vest, and there is no one else stopping yet.
1. Give your actions for the first 60 seconds, in order, with the reason for each.
Read the worked answer
- Stop and protect. Pull in before the scene or just past it, hazards on, reflective vest on before you open the door. Position your car so it shields the rider from traffic behind but leaves you an exit. A second collision would make you the second casualty, and there would then be nobody competent to help the first.
- Stop the traffic, not the bleeding, first. The rider is lying in a live lane with cars braking behind. Wave traffic down, use the other driver to block the lane, get his hazard lights on. This is the one situation where moving a casualty becomes arguable - but stopping the traffic achieves the same protection with far less risk to a spine and a fractured leg.
- Delegate. Point at the car driver: 'You - call 101, tell them one rider, conscious, heavy arm bleeding, leg deformed, petrol on the road.' Specific person, specific task.
- Kill the ignition source if it is safe - the scooter's ignition, if you can reach it without entering the traffic lane.
- Approach from the front, crouch so you are at his eye level, tell him who you are and that help is coming, and tell him not to try to stand. He is talking, so his airway is clear - leave the helmet on.
2. How do you control the arm bleeding, and what must you not do?
Read the worked answer
Control:
- Put on gloves from the kit if you have them.
- Apply direct pressure with the heel of your hand on the wound, over a sterile pad or the cleanest cloth available. Press hard and keep pressing - a dressing that is not pressed is decoration.
- If blood soaks through, add another layer on top. Do not lift the soaked pad off to look; that disturbs the clot you are trying to build.
- If there is no obvious fracture in the arm, raise it above the level of his heart while you keep pressure on.
- Keep talking to him, keep him still and warm, and do not stop pressing until the ambulance crew takes over.
- If bleeding is catastrophic and pressure is failing, a tourniquet high and tight on the upper arm, with the time written on his skin or your hand, is the last resort - and it is a decision, not a reflex.
Must not do:
- Do not remove the helmet. He is conscious and talking; taking a full-face helmet off a trauma patient risks the cervical spine for no gain.
- Do not straighten the deformed leg or try to splint it yourself in the road.
- Do not give him food or drink.
- Do not let him stand up and walk to the pavement because he is embarrassed about the traffic.
3. What do you tell the emergency operator, and should the rider be moved?
Read the worked answer
To the operator (101 for Magen David Adom; 100 for police if traffic control is needed):
- Exact location with landmarks and the direction of travel - street, junction, nearest shop or number.
- Number of casualties: one rider.
- Conscious and breathing, shouting in pain - and what that means: airway is open, he can speak.
- Injuries: heavy bleeding from the left forearm, right lower leg deformed, possible spinal involvement from the impact with the car door.
- Hazards on scene: petrol spill, live traffic lane, a second vehicle involved, drivers standing in the road.
- Your name and mobile number, and stay on the line until released.
Should he be moved? No, not by you, as long as the lane can be made safe by stopping traffic - which it can, in daylight, with several drivers available. Moving him is justified only when staying put is more dangerous than moving: fire, or traffic that cannot be stopped. The petrol smell is a reason to keep everyone from smoking and to get the ignition off, not yet a reason to drag a man with a deformed leg and a possible spinal injury across the asphalt.
Your legal duty is to stop, give aid and identify yourself - all of which you have done by staying on scene.