First on Scene: Motorcyclist Down at Dusk
You are the first person to arrive at a two-vehicle collision on a single carriageway with a 100 km/h limit, at dusk in dry weather. A motorcycle has struck the rear corner of a small hatchback that was turning right. The rider, a man in his thirties wearing a full-face helmet and a textile jacket, is lying on his back in the nearside lane. He is unresponsive but breathing noisily, and there is blood around his mouth. His right thigh is bleeding heavily through torn jeans from a wound about 8 cm long, and his left forearm is visibly deformed. The hatchback driver is standing beside her car, dazed but walking. Traffic is still passing the scene at speed in the opposite lane, and there is no hard shoulder. You have gloves, a first aid kit with dressings and a triangular bandage, and a torch; you have no manufactured tourniquet. Two bystanders have stopped. The ambulance service estimates 12 minutes.
1. Set out your actions in order for the first minute, and justify why treatment is not first on the list.
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Scene safety comes before any treatment. Stop your car before the collision rather than past it, switch on hazard lights and side lights, and send one bystander up the road to slow the passing traffic; at 100 km/h a driver covers about 28 m per second and may not see the scene until it is too late. Keep your gloves on.
Call the emergency number, giving the road number and direction, the number of casualties, and the fact that one is unconscious but breathing and bleeding heavily. Only then approach. Do not move the rider: a deformed forearm and a helmeted head injury mean possible spinal injury, and the only reasons to move him are fire, an immediate traffic threat, or an airway you cannot keep open. A rescuer who becomes a second casualty makes the scene worse for everyone.
2. The rider is breathing noisily with blood around the mouth. Do you remove the helmet?
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Noisy breathing with blood at the mouth is an airway problem, but helmet removal is a two-person, trained manoeuvre: one person supports the head and neck while another steadies the helmet and eases it off without dragging the chin or rotating the neck. If you are alone and untrained, leave it on.
Instead, kneel at the head, support the helmet with both hands to keep the neck neutral, clear what you can actually see from the mouth, and watch the chest and listen to the breathing continuously. If he vomits, or stops breathing, the balance changes: an airway you cannot maintain kills faster than a possible spinal injury. With a bystander's help, remove the helmet then and begin CPR if he stops breathing.
3. How do you deal with the thigh wound with the equipment you have, and what do you do while waiting?
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The thigh wound is the most time-critical injury. Put a trauma dressing directly on the wound and press hard with both hands, using your body weight, without lifting to check. If it soaks through, add a second dressing on top rather than removing the first.
Do not use the triangular bandage as a tourniquet: improvised tourniquets are wide, slip, and often fail to stop arterial bleeding. If a manufactured tourniquet arrives from another kit, apply it 5-7 cm above the wound and never over the knee, and record the time. Keep him warm and flat to limit shock, reassess breathing every minute, and give nothing by mouth. Send a bystander to guide the ambulance in and keep the hatchback driver sitting down and warm.