Night crash on the Ring Road: crowd, fuel and a neck injury
8:10 p.m., dark, on the Ring Road near Koteshwor. A motorcycle has hit the back of a parked truck and the rider is on the road. You stop about 20 m before the scene, on the shoulder, and switch on your hazard lamps. The rider, a man in his twenties, is lying on his side, breathing and talking, wearing a full-face helmet. He says his neck hurts and that his fingers feel 'pins and needles'; his left forearm is bleeding through a torn jacket and blood is pooling on the tarmac. The motorcycle is on its side, the engine is still running and petrol is dripping. Traffic is passing at about 50 km/h within 3 m of him. A crowd of about 15 people has gathered and two men are pulling at his arms to lift him up. Your phone shows 8% battery, and there is a police checkpoint about 400 m ahead.
1. Set out your actions in order for the first 60 seconds.
Read the worked answer
Scene safety before patient care-you are useless as a second casualty.
- Stop the traffic. Send two or three bystanders up the road with torches or phones to wave vehicles around the scene, and get someone to move the parked truck's warning position if possible. Traffic passing at 50 km/h three metres away is the most immediate threat to everyone.
- Kill the engine and the fuel risk. Ask someone to switch off the motorcycle's ignition and, if it is safe, right it or at least move it away from the spill. No smoking, no one lighting anything near the petrol.
- Stop the crowd moving him. Two men pulling his arms is the single most dangerous thing happening to the patient. Speak loudly and specifically: 'Don't lift him, his neck is injured-leave him still.' Put one calm person in charge of the patient's head.
- Call for help on 100 (police) or 102 (ambulance) while your battery lasts; give location, number of patients, and the neck and bleeding findings. Ask a bystander with a fuller battery to call as backup, and send someone to the checkpoint 400 m ahead.
- Only then start first aid.
2. Should you remove the helmet? Justify your answer and describe what you do instead.
Read the worked answer
No-leave the helmet on. Neck pain plus pins and needles in the fingers is a red flag for a spinal injury, and the helmet is currently acting as a splint holding the head in line with the spine. Removing it requires rotating and lifting the head, which can turn a recoverable injury into permanent paralysis. The general rule is that a helmet comes off only when it blocks the airway, when vomiting threatens the airway, or when trained help needs it off to resuscitate-and even then, ideally by two people maintaining in-line stabilisation.
Instead:
- Kneel at the head and hold the helmet steady between your hands, forearms resting on the ground, so his head cannot roll.
- Tell him not to nod or turn to look at you, and keep him talking-his answers also tell you whether his consciousness is deteriorating.
- If he vomits or stops breathing, that is the moment to remove it, using a two-person log-roll technique with one person holding the head in line.
- Hand over clearly to the ambulance crew: mechanism, neck pain, pins and needles, time of the crash, and that the helmet was left on.
3. How do you control the forearm bleeding and manage the patient until the ambulance arrives?
Read the worked answer
Bleeding: the blood is pooling, so apply firm direct pressure with the cleanest cloth available-a folded shirt, a gauze pad if someone has a first-aid kit. Press directly on the wound, not on a random point up the arm, and keep pressing without lifting to 'check' every 30 seconds; check around the edges instead. If the cloth soaks through, add another on top rather than removing the first. A tourniquet is for catastrophic bleeding that direct pressure cannot control and for someone trained to use one; this does not yet look like that case. Do not straighten or pull at the arm, which may be fractured as well as cut.
Meanwhile: keep him warm-a space blanket or jacket over him, because cold and shock worsen each other-keep his head still, monitor breathing and responsiveness, and give nothing by mouth, not even water. Note the time. When the police arrive, give a short factual account and your contact details before you leave; a witness account of the crowd lifting him and of the truck's parking position may matter later.