First Aid at a Motorcycle Collision with a Fuel Leak
At 18:40 you are the first car to stop at a collision on a two-lane bypass near Islamabad. A motorcycle has hit the side of a small car. The rider, a young man, is lying on his back in the left lane. He is breathing noisily and has a bleeding cut on the side of his head, but he does not respond when you speak. His helmet is still on, but the visor is cracked. The car driver is standing beside the car, holding his wrist and shouting. A strong smell of petrol comes from the motorcycle, which is on its side with fuel dripping. Traffic is passing on the right at 70-80 km/h, and it is getting dark. You have a first-aid kit, a mobile phone, a warning triangle and a reflective jacket.
1. What are your first actions before approaching the rider, and why?
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Protect the scene first. Park well before the collision, off the traffic lane if possible, switch on hazard lights and put on the reflective jacket. Place the warning triangle behind your car and, if safe, behind the collision to give traffic warning; do not walk into the fast lane. Call Rescue 1122 and the police, giving the location, number of casualties and the fuel leak. If you can do so without risk, switch off the motorcycle's ignition and the car's ignition to reduce fire risk, but do not smoke or create sparks. Keep bystanders back. Only then approach the rider. A second collision or a petrol fire would create more casualties and would prevent you from helping.
2. How should you assess the rider's airway and bleeding without moving him unnecessarily?
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Speak to him and check for response; look at the chest for breathing and listen for normal breath sounds. Noisy breathing suggests the airway is partly obstructed, but do not remove the helmet or tilt the head sharply, because a neck injury is possible. If he is breathing and there is no immediate fire, leave him in the position found and monitor. Control the scalp bleeding with a sterile dressing or clean cloth and direct pressure around the wound, not by pressing on a suspected skull fracture. Do not give him food or water. Keep him warm, reassure him, and be ready to turn him into the recovery position only if he vomits or his breathing becomes obstructed and you have help.
3. The car driver insists you move the rider to the side of the road. How do you respond, and when would moving him be justified?
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Explain that moving an unconscious collision casualty can worsen a spinal injury and should be avoided unless there is an immediate danger, such as fire or another vehicle about to hit him. The fuel leak is a real risk, so keep sparks away and monitor it; if the fuel ignites or a vehicle is bearing down, then move him, but use a log-roll with several helpers supporting the head and neck, and only as far as necessary. Otherwise wait for the ambulance crew. Ask the car driver to sit down, keep his wrist supported, and stay clear of traffic while you monitor the rider's breathing.