Motorcyclist down on a dark November road, no mobile coverage
It is 16:40 in late November, –3 °C and already dark. You are driving on a rural two-lane road with a 70 km/h limit. Rounding a long right-hand bend you find a motorcycle on its side in your lane, and 15 metres beyond it a rider lying on his side with his back to you. A car has stopped on the opposite shoulder with its hazard lights on; that driver is standing beside it with her phone in the air, shouting that there is no coverage. The rider's visor is scratched, he is breathing noisily with a gurgling sound, and a dark pool is spreading from the motorcycle towards him. Two cars have already passed without slowing. In your boot you have a warning triangle, a reflective vest, a first-aid kit and a small fire extinguisher. The bend behind you is blind for about 80 metres.
1. What do you do in the first 60 seconds, in what order, and how do you deal with the missing mobile coverage?
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The order is: stop the traffic, then treat the casualty, then get help.
- Hazard lights on and stop before the scene, on your own side, at an angle that shields the rider if you can do it without blocking the road.
- Reflective vest on before you open the door.
- Warning triangle about 100 metres back, placed before the bend where an approaching driver will actually see it in time - a triangle sitting inside a blind bend is decoration.
- Send the other driver up the road to wave traffic down. Two passing cars without slowing tells you the sight line is the real problem tonight.
- Call 113. No bars on a phone does not mean no emergency call: in Norway emergency numbers route over any operator's network that is available, so keep trying 113, or 112 (police) if that fails. If it truly will not connect, flag down a car and ask the driver to drive to the nearest house or place with coverage and call from there - and to come back and confirm.
- Only now go to the rider: check response, airway, breathing and major bleeding.
Sixteen-forty on an unlit 70 road with a dark-clothed rider down is a scene that will be hit again within minutes if you do not own the traffic first.
2. The rider is breathing noisily with a gurgling sound. Do you remove the helmet?
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The gurgling is the finding that decides this. It means fluid or blood is partly obstructing the airway, and an obstructed airway kills faster than a spinal injury. Airway beats spine.
- Do not remove the helmet routinely. It is not a first reflex; done badly by one untrained person it can turn a neck injury into a worse one.
- First try to manage the airway with the helmet on: support the head in line with the spine, use a jaw thrust or gentle chin lift, and see whether the noise stops and the breathing becomes quiet and regular.
- If you cannot clear it, the helmet comes off - ideally two people, one holding the head steady and the other easing the helmet off by widening it at the sides, keeping the neck in line. A scratched visor should be lifted or removed first if it is in the way.
- If he is unconscious but breathing, put him in the recovery position even with a suspected spinal injury. A casualty who is breathing but unprotected will aspirate; the recovery position is the lesser risk.
Keep him warm - a blanket or jacket over and under him - monitor breathing continuously, and be ready to start CPR if it stops.
3. Fuel is spreading towards the rider, and the ambulance is 25 minutes away. What do you do about the fuel, the cold and the handover?
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Fuel: the pool is not yet a fire, but it will be if anyone smokes or if there is a spark. Keep everyone back, ask people to put cigarettes out, do not start any engine unnecessarily, and keep your extinguisher ready but do not spray it at nothing. If the fuel reaches him or the bike starts to burn, move him - drag him by the shoulders along the long axis of the body, away and upwind. The rule against moving casualties is about spinal risk; it does not survive an immediate threat to life.
Cold: at –3 °C on the ground, hypothermia will set in while you wait, and it worsens bleeding and shock. Insulate him from the road surface, cover him, and shelter him from the wind with a car door or blanket. Do not give food or drink - he may need surgery.
Handover to the ambulance: give a short, structured report - what you found, when, whether he was conscious, whether the airway was noisy and what you did, whether he has moved or been moved, how long he has been down, and any bleeding you controlled. Then stay available: they may need you to hold a torch or a blanket.