Motorcycle Crash at Dusk: First Aid and Scene Control
At dusk you are the first driver to reach a rural bend where a motorcycle has left the road and hit a low stone wall. The rider, a man in his twenties, is lying on his side on the asphalt. His helmet is still on and the visor is cracked. He is breathing, but he does not respond when you speak loudly and shake his shoulder gently. Blood is running from a deep cut on his right forearm and pooling on the road. The motorcycle's headlight is still on and the rear wheel is spinning slowly. Two bystanders arrive and one reaches for the helmet to 'let him breathe'. The road is a narrow two-lane road with a blind curve 30 metres uphill; traffic is still moving past. Your mobile phone shows a weak signal. It is getting dark and you are alone with the two bystanders.
1. What are your first three actions, in order?
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First, protect the scene: switch on hazard lights, park your car before the bend if possible, uphill of the casualty, to warn traffic, and keep your own engine off. Second, call emergency services, give the road, direction, number of casualties and the fact that the rider is breathing but unresponsive; if the signal is weak, send a bystander to a higher point or flag down another driver. Third, approach the rider and take charge: tell the bystander not to remove the helmet, keep the crowd back, and check danger from the spinning wheel and traffic. You cannot help if you become a second casualty, and a warning vehicle before a blind bend prevents a second collision.
2. How do you manage the airway and the helmet?
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The rider is breathing but unresponsive, so the priority is to keep the airway open while protecting the neck. Do not pull the helmet off; the bystander's instinct to 'let him breathe' can turn a stable neck injury into a worse one. Kneel at the head, keep the head in line with the spine, and monitor breathing and response. If there is no sign of vomiting or airway obstruction, leave the helmet on until trained help arrives. If breathing stops, or if vomit blocks the airway, you may have to remove the helmet, but only with a second trained person holding the head and neck, using a proper two-person technique. The helmet is not the airway problem; uncontrolled movement is the danger.
3. How do you control the bleeding from the forearm?
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Put on gloves if available, then press firmly on the wound with a clean pad or cloth and keep continuous direct pressure. If there is no sign of a fracture, raise the arm gently while maintaining pressure. Bandage over the pad firmly enough to control the bleeding, but not so tight that the fingers turn white or blue; check the fingers for colour and warmth. Do not keep lifting the pad to look. A tourniquet is only for life-threatening bleeding that direct pressure cannot control, and if used, note the time. Continue monitoring breathing and keep the rider warm until help arrives. Direct pressure controls most bleeding and leaves the limb viable.