Tatonka
03-15-2007, 10:40 PM
I've seen this post before and while it in no way is meant to take the place of expert care it just might get you motivated to seek some training of your own. Most of this is targeted at a road crash but lot's of the advice will still apply. Remember, at any accident scene...Do No Harm!
http://www.molenda.com/accident.html#three
Accident Scene Management
a talk by: Slider Gilmore, given at a motorcycle safety instructor conference in Rochester, MN
10/11/92
Notes taken by Jason Molenda with copious notes, edits, and suggestions shamelessly plagiarized from Bruce Leung and Stacy Heinrich. These are the notes as best as I can remember them; if something in here is incorrect or misleading and it worsens a trauma victim, don't come crying to me. I am NOT a medical professional and have NO medical training. This is a summary of what Slider talked about as best as I could understand/remember. It is well worth catching Slider's talk if he is ever in your area. I cannot guarantee the accuracy of my notes.
The first hour of trauma is termed the "Golden Hour'' by the Emergency Medical Services (EMS). The idea is that trauma victims have the best survival chance if they are in surgery within one hour after the accident. Qualified medical personnel are really the people who should be handling everything, but until they arrive there are things that we, untrained motorcyclists, can do to help the medical professionals before they arrive.
Slider talked a lot about "Psychological Management''. At an accident site, peoples' adrenaline will be going full-blast and the most important thing is for at least one person to keep calm and to think. He emphasized this a lot; he had a whole slide for REMAIN CALM... THINK!
The first thing you need to do when arriving on an accident scene is to stop, take two deep breaths to help you remain calm. This was especially important for Slider as he fit the `bad biker' image well; the sight of him being overly excited would not be terribly reassuring to anyone.
Anyway, the idea of psychological management is that all the other people who are pumped and want to help will do whatever they are told to do by a calm person who seems to be in control and knows what he or she is doing. If you're excited and out of control as well, everyone will run around wasting precious time in an unorganized fashion (not to be confused with everyone running around wasting precious time in an organized fashion, mind you).
This seminar was designed to give us the basic background and some guidelines to follow so that we can be the calm person who has some idea of what needs to be done without overreacting. All of this should be regarded as ``guidelines''; real situations may require adaptation in the field.
The following items were covered in the presentation:
1) Get to victim, reassure, establish communication
2) Safety factors
3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
4) The three questions
5a) If breathing is taking place normally, LEAVE HELMET ON !
5b) helmet removal procedure if airway blocked or no respiratory action.
6a) After initial evaluation of seriousness of injuries, call for ambulance
6b) Things to tell EMS operator
6c) Things that may be necessary for victim
7a) Document personal information if possible (victim may pass out)
7b) AMPLE documentation
8) Wallets, purses, rings
9a) Have person check pulse every 5 minutes & document it
9b) Have person check breathing every 5 minutes & document it
10) Watch for signs of person going into shock
11) Stop bleeding, using sterile bandages/dressings if available
12) In case of femur injuries (extremely common in moto accidents), check for blood loss
13) When ambulance arrives
14) At the hospital
15) Dealing with law enforcement
16) Thank yous
17) Couple of miscellaneous notes
18) Four most important points from talk
1) Get to victim, reassure, establish communication
After a person has gone down, they will be in a confused and scared state. They probably don't know what happened when they went down. They may be confused, frantic, etc., and often the only thing on their mind will be their bike. It is important to reassure them and to make sure they will not try to move or get to their bike. One thing is to not call out to the injured party from a position where they would have to move their head to see where you are (ie, off to one side, behind them) - if someone calls out to you, you tend to look where the sound is coming from. Address them from their feet end initially, not one side or behind the head.
Slider suggests something on the order of, ``You've been in a motorcycle accident. It is important that you do not try to move. My name is Jason '' Tell them the ambulance is coming (assuming someone has been sent to get one!) If your name is something like ``Chainsaw'' or ``Mega-death'' ......... tell them your name is John.
Be careful what you say around the victim, even if they are unconscious. Hearing works in the unconscious state and if you say something like, ``Boy, is this dude messed up bad! Maybe we shouldn't call an ambulance after all!'', it's going to register at some level with the person and can do nothing but harm. How you say things will be important as what you say; keep (or at least sound ) calm and it will reduce the panic of everyone else present.
2) Safety factors
An accident scene can be a hectic place with a lot of things going on at once. It is important to keep safety in mind; if you are helping someone lying in the middle of the road and a semi comes barrelling down on both of you, you aren't going to do that person much good.
a. Traffic
If people are available, get someone uproad and downroad to wave down traffic. This is especially important in tight twisties where they may not have time to stop after seeing the accident site.
b. Hazardous material spills (gas, oil, brake fluid)
People and vehicles will slip on this stuff. If ambulance personnel slip on oil while carrying the victim, it is bad. Either clean it off the road or indicate to everyone where it is.
c. Power lines
If power lines are down around or near the victim, ambulance crews may not be able to get near the person until they are shut off. It is important to call the local utility company to get these live wires turned off at the same time an ambulance is called. If the ambulance arrives and they are still live, they will have to call the utility company and wait for them to come out, wasting a lot of precious time in the Golden Hour.
d. Fire
People who smoke tend to light up under stress. Ask these people to either extinguish their smokes or move away from the flammable materials and/or bikes. It is easy to forget something obvious like this in a stressful situation like an accident scene.
e. Safety circle
Establish a few people around the immediate accident scene to help direct traffic, to point out fluid spills, and to warn people who may want to light up (see d).
3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
The person with the most training (first aid, CPR, etc.) attends directly to the victim. Assuming the victim is lying on the ground, this person should sit behind their head and should stabilize his or her head to avoid unnecessary movement (i.e. hold their head still). Assume the person has a back/neck injury and any unnecessary movement could risk paralysis.
This person should be doing ``U-ABCC'' at the arrival on the scene and every 5 minutes thereafter
U Urgency
Try to determine if the person's injuries are (a) minor or (b) major, i.e. urgent. If unsure, it is urgent. See (6) on trying to diagnose injuries.
A Airway
Is there something to impede their airway? Gravel in the helmet, something down the throat? This needs to be cleared immediately, without helmet removal if at all possible.
B Breathing
Is the person breathing? Determined by listening, watching their chest, feeling for breath, etc.
C Circulation
Check the pulse on the throat initially and subsequently on their wrist. This is the carotid artery, right next to the wind pipe/adam's apple on either side. If pulse is not present, remove helmet if necessary and begin CPR immediately. When checking pulse on their wrist, do not check with thumb; use the two fingers next to the thumb..
C Cervical Spine Immobilization
Support the victim's head and make sure they don't move it. CONSIDER EVERY MOTORCYCLE ACCIDENT A HEAD INJURY, CONSIDER EVERY MOTORCYCLE ACCIDENT A CERVICAL/BACK INJURY! This is important even if they feel they can move their head normally! When you talk to the victim initially, add on a short bit to reassure them;
``You've been in a motorcycle accident. It is important that you don't move. My name is Jason. Answer me without moving your head. We don't know if you have a neck injury or not. An ambulance is on the way.''
Again, make sure that the victim does not move at all, their head or any other part.
4) The three questions
Ask the victim three questions and document their responses;
? Who are you?
? Where are you?
? What time of day is it?
(Or asking what day of week it is would be fine also. Many people do not know what time of day it is without a watch even in a normal state.)
5a) If breathing is taking place normally, LEAVE HELMET ON !
It is very dangerous to remove someone's helmet if they have some type of cervical/back injury. The only time it should be removed is if the airway is blocked and cannot be cleared with the helmet on or if it is necessary to perform CPR.
5b) helmet removal procedure if airway blocked or no respiratory action.
This is the method recommended by the American College of Orthopedic Surgeons. It requires two people.
Remove glasses and unbuckle the chinstrap. One person should be to the side of the head of the victim and the other person should be directly behind the head of the victim, stabilizing the head to avoid excess movement (as seen in (3)).
The person on the side puts one hand behind the victim's head supporting at the base of the skull (not on helmet). They put their other hand on the jaw bone/chin (again, not on helmet). They will be supporting the head, so it is important to get a good solid grip. Keep some tension in the arms so that if the person pulling the helmet slips the victim's head won't drop.
The person sitting behind the head will then slowly pull the helmet directly back and off of the head. Watch out for catching the nose on the chin-guard on full-face helmets, as well as ears and earrings.
After the helmet is off, put a leather jacket or something under the head of the victim! If the person supporting their head lets go, their head will drop a good 4 inches or so. This would not be good. If possible, it would be best to have a third person ready with something to place under the victim's head once the helmet is off.
After the helmet is off, the person behind the head should again hold the victim's head to promote cervical immobilization.
AGAIN, THIS IS ONLY TO BE USED IN SITUATIONS WHERE THERE IS NO OTHER OPTION! Leave the helmet on until the ambulance personnel arrive if at all possible!
http://www.molenda.com/accident.html#three
Accident Scene Management
a talk by: Slider Gilmore, given at a motorcycle safety instructor conference in Rochester, MN
10/11/92
Notes taken by Jason Molenda with copious notes, edits, and suggestions shamelessly plagiarized from Bruce Leung and Stacy Heinrich. These are the notes as best as I can remember them; if something in here is incorrect or misleading and it worsens a trauma victim, don't come crying to me. I am NOT a medical professional and have NO medical training. This is a summary of what Slider talked about as best as I could understand/remember. It is well worth catching Slider's talk if he is ever in your area. I cannot guarantee the accuracy of my notes.
The first hour of trauma is termed the "Golden Hour'' by the Emergency Medical Services (EMS). The idea is that trauma victims have the best survival chance if they are in surgery within one hour after the accident. Qualified medical personnel are really the people who should be handling everything, but until they arrive there are things that we, untrained motorcyclists, can do to help the medical professionals before they arrive.
Slider talked a lot about "Psychological Management''. At an accident site, peoples' adrenaline will be going full-blast and the most important thing is for at least one person to keep calm and to think. He emphasized this a lot; he had a whole slide for REMAIN CALM... THINK!
The first thing you need to do when arriving on an accident scene is to stop, take two deep breaths to help you remain calm. This was especially important for Slider as he fit the `bad biker' image well; the sight of him being overly excited would not be terribly reassuring to anyone.
Anyway, the idea of psychological management is that all the other people who are pumped and want to help will do whatever they are told to do by a calm person who seems to be in control and knows what he or she is doing. If you're excited and out of control as well, everyone will run around wasting precious time in an unorganized fashion (not to be confused with everyone running around wasting precious time in an organized fashion, mind you).
This seminar was designed to give us the basic background and some guidelines to follow so that we can be the calm person who has some idea of what needs to be done without overreacting. All of this should be regarded as ``guidelines''; real situations may require adaptation in the field.
The following items were covered in the presentation:
1) Get to victim, reassure, establish communication
2) Safety factors
3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
4) The three questions
5a) If breathing is taking place normally, LEAVE HELMET ON !
5b) helmet removal procedure if airway blocked or no respiratory action.
6a) After initial evaluation of seriousness of injuries, call for ambulance
6b) Things to tell EMS operator
6c) Things that may be necessary for victim
7a) Document personal information if possible (victim may pass out)
7b) AMPLE documentation
8) Wallets, purses, rings
9a) Have person check pulse every 5 minutes & document it
9b) Have person check breathing every 5 minutes & document it
10) Watch for signs of person going into shock
11) Stop bleeding, using sterile bandages/dressings if available
12) In case of femur injuries (extremely common in moto accidents), check for blood loss
13) When ambulance arrives
14) At the hospital
15) Dealing with law enforcement
16) Thank yous
17) Couple of miscellaneous notes
18) Four most important points from talk
1) Get to victim, reassure, establish communication
After a person has gone down, they will be in a confused and scared state. They probably don't know what happened when they went down. They may be confused, frantic, etc., and often the only thing on their mind will be their bike. It is important to reassure them and to make sure they will not try to move or get to their bike. One thing is to not call out to the injured party from a position where they would have to move their head to see where you are (ie, off to one side, behind them) - if someone calls out to you, you tend to look where the sound is coming from. Address them from their feet end initially, not one side or behind the head.
Slider suggests something on the order of, ``You've been in a motorcycle accident. It is important that you do not try to move. My name is Jason '' Tell them the ambulance is coming (assuming someone has been sent to get one!) If your name is something like ``Chainsaw'' or ``Mega-death'' ......... tell them your name is John.
Be careful what you say around the victim, even if they are unconscious. Hearing works in the unconscious state and if you say something like, ``Boy, is this dude messed up bad! Maybe we shouldn't call an ambulance after all!'', it's going to register at some level with the person and can do nothing but harm. How you say things will be important as what you say; keep (or at least sound ) calm and it will reduce the panic of everyone else present.
2) Safety factors
An accident scene can be a hectic place with a lot of things going on at once. It is important to keep safety in mind; if you are helping someone lying in the middle of the road and a semi comes barrelling down on both of you, you aren't going to do that person much good.
a. Traffic
If people are available, get someone uproad and downroad to wave down traffic. This is especially important in tight twisties where they may not have time to stop after seeing the accident site.
b. Hazardous material spills (gas, oil, brake fluid)
People and vehicles will slip on this stuff. If ambulance personnel slip on oil while carrying the victim, it is bad. Either clean it off the road or indicate to everyone where it is.
c. Power lines
If power lines are down around or near the victim, ambulance crews may not be able to get near the person until they are shut off. It is important to call the local utility company to get these live wires turned off at the same time an ambulance is called. If the ambulance arrives and they are still live, they will have to call the utility company and wait for them to come out, wasting a lot of precious time in the Golden Hour.
d. Fire
People who smoke tend to light up under stress. Ask these people to either extinguish their smokes or move away from the flammable materials and/or bikes. It is easy to forget something obvious like this in a stressful situation like an accident scene.
e. Safety circle
Establish a few people around the immediate accident scene to help direct traffic, to point out fluid spills, and to warn people who may want to light up (see d).
3) Best-trained individual (medically-wise) attends to victim (U-ABCC)
The person with the most training (first aid, CPR, etc.) attends directly to the victim. Assuming the victim is lying on the ground, this person should sit behind their head and should stabilize his or her head to avoid unnecessary movement (i.e. hold their head still). Assume the person has a back/neck injury and any unnecessary movement could risk paralysis.
This person should be doing ``U-ABCC'' at the arrival on the scene and every 5 minutes thereafter
U Urgency
Try to determine if the person's injuries are (a) minor or (b) major, i.e. urgent. If unsure, it is urgent. See (6) on trying to diagnose injuries.
A Airway
Is there something to impede their airway? Gravel in the helmet, something down the throat? This needs to be cleared immediately, without helmet removal if at all possible.
B Breathing
Is the person breathing? Determined by listening, watching their chest, feeling for breath, etc.
C Circulation
Check the pulse on the throat initially and subsequently on their wrist. This is the carotid artery, right next to the wind pipe/adam's apple on either side. If pulse is not present, remove helmet if necessary and begin CPR immediately. When checking pulse on their wrist, do not check with thumb; use the two fingers next to the thumb..
C Cervical Spine Immobilization
Support the victim's head and make sure they don't move it. CONSIDER EVERY MOTORCYCLE ACCIDENT A HEAD INJURY, CONSIDER EVERY MOTORCYCLE ACCIDENT A CERVICAL/BACK INJURY! This is important even if they feel they can move their head normally! When you talk to the victim initially, add on a short bit to reassure them;
``You've been in a motorcycle accident. It is important that you don't move. My name is Jason. Answer me without moving your head. We don't know if you have a neck injury or not. An ambulance is on the way.''
Again, make sure that the victim does not move at all, their head or any other part.
4) The three questions
Ask the victim three questions and document their responses;
? Who are you?
? Where are you?
? What time of day is it?
(Or asking what day of week it is would be fine also. Many people do not know what time of day it is without a watch even in a normal state.)
5a) If breathing is taking place normally, LEAVE HELMET ON !
It is very dangerous to remove someone's helmet if they have some type of cervical/back injury. The only time it should be removed is if the airway is blocked and cannot be cleared with the helmet on or if it is necessary to perform CPR.
5b) helmet removal procedure if airway blocked or no respiratory action.
This is the method recommended by the American College of Orthopedic Surgeons. It requires two people.
Remove glasses and unbuckle the chinstrap. One person should be to the side of the head of the victim and the other person should be directly behind the head of the victim, stabilizing the head to avoid excess movement (as seen in (3)).
The person on the side puts one hand behind the victim's head supporting at the base of the skull (not on helmet). They put their other hand on the jaw bone/chin (again, not on helmet). They will be supporting the head, so it is important to get a good solid grip. Keep some tension in the arms so that if the person pulling the helmet slips the victim's head won't drop.
The person sitting behind the head will then slowly pull the helmet directly back and off of the head. Watch out for catching the nose on the chin-guard on full-face helmets, as well as ears and earrings.
After the helmet is off, put a leather jacket or something under the head of the victim! If the person supporting their head lets go, their head will drop a good 4 inches or so. This would not be good. If possible, it would be best to have a third person ready with something to place under the victim's head once the helmet is off.
After the helmet is off, the person behind the head should again hold the victim's head to promote cervical immobilization.
AGAIN, THIS IS ONLY TO BE USED IN SITUATIONS WHERE THERE IS NO OTHER OPTION! Leave the helmet on until the ambulance personnel arrive if at all possible!