Motorcyclist Down: Scene Safety, a Helmet, and Fifteen Breaths a Minute

The order is chosen so that the number of casualties does not go up.

1. Stop before the scene, not at it - 20–30 m back, hazards on, wheels turned away from the impact. Your car becomes a shield between the live lane and the casualty.
2. Do not add a third casualty. Traffic is still running in lane 3 at 50 km/h on a greasy surface with fuel on it. Before anything clinical, get the scene stopped: position yourself where you are visible, get the car driver out of lane 2, and get the two bystanders to stop walking into a live lane.
3. Kill the ignition of the bike if it can be reached without going into the traffic lane - a running engine next to a petrol spill is a fire risk, and a spinning rear wheel is an injury risk. If reaching it means standing in lane 2, don't; the fuel is a slow hazard, the traffic is a fast one.
4. Call for help now, not after the assessment - unified emergency number 911, or ambulance 997 and traffic police 999. Say: three-lane road, one rider down, fuel leaking, rider unconscious but breathing, and give the nearest landmark. If you are the only trained person, put the phone on speaker and leave the line open.
5. Then go to the casualty and confirm breathing yourself: look, listen, feel, and count.

The sequencing principle being tested: the casualty's clock and the scene's clock run at different speeds. A fire takes minutes; a car in lane 3 takes two seconds. Secure the fast hazard first, and never let bystander enthusiasm pull you into a lane that is still live.

Stop him - politely, firmly, immediately.

Why: a full-face helmet comes off over the face and the back of the skull. Removing it requires rotating and lifting the head, which in an unconscious rider after a high-energy impact is exactly the movement that converts a stable spinal injury into a cord injury. He is breathing, which means the airway is not currently obstructed, which means there is no emergency that justifies the risk.

The exceptions - when the helmet comes off despite the risk:

• The airway cannot be maintained with the helmet on - vomit, blood, or a jaw that cannot be opened. A casualty who is not breathing is a casualty with no brain in four minutes; the spinal risk becomes secondary.
• CPR is required - you cannot ventilate or manage a full-face helmet effectively during resuscitation.
• There is an immediate life threat that forces movement - a fire, or the casualty lying in a live traffic lane that cannot be closed.

How to manage the airway without removing the helmet:

• Remove the visor or open it fully, and remove glasses if worn.
• Use a jaw thrust rather than a head-tilt chin-lift, so the neck is not extended.
• Keep the head supported in the position you found it; if you must move the casualty, move the head and body together as one unit, with someone holding the head.
• Keep talking to the casualty even if he does not respond.

Fifteen breaths per minute is a normal adult rate (roughly 12–20). The man is ventilating adequately on his own. That is the single most reassuring finding available to you at the roadside, and it changes your job from resuscitation to protection and monitoring.

What you do with that finding:

• Keep him still, keep him warm (a blanket or coats - wet clothes on a greasy road at 18:20 will chill him fast), and keep monitoring the breathing.
• Do not give him anything to eat or drink; he is unconscious and cannot protect his airway.
• Do not move him to 'make him comfortable'. Comfort is not the objective; an intact spine is.
• Recheck breathing continuously. A casualty who is breathing now can stop. A rate that climbs above about 28 or falls below about 10, or becomes noisy or irregular, is a deterioration sign and means help needs to be there.

If the breathing stops:

1. Recheck using head-positioning that respects the neck - jaw thrust, no tilt if you can avoid it.
2. Start CPR: 30 compressions to 2 breaths, compressions at 100–120 per minute, about 5–6 cm deep, on a hard surface.
3. At that point the helmet comes off, because ventilation is impossible with it on and a casualty in cardiac arrest has no time left for spinal precautions.
4. Send someone to meet the ambulance and keep the compressions going until you are relieved.

The judgement this case is testing: the instinct to do something dramatic is the enemy. The bystander reaching for the helmet and the bystander wanting to drag the rider to the pavement are both trying to help and both making the injury worse. The correct first-aid action here is largely preventing other people's actions, then watching a chest rise every four seconds.