Similar to spending time in the backcountry, roadways are often another form of austere environment where, in the case of accident and injury, being prepared can make the difference between life and death. Still, I’ve seen more than one surprised face when I talk about having an emergency preparedness kit in my car. Having a “go bag” and/or medical kit prepared is recommended by the CDC, FEMA, and the National Weather Service.
The CDC recommends keeping a variety of kits—separate ones for the different situations that could arise. In California, one may want to focus on earthquakes. In Louisiana, prepare for hurricanes. However, there are some situations that everyone needs to be ready for. Traveling by motor vehicle is nearly universal, and road traffic deaths are the number one cause of death worldwide for people between the age of 15 and 29 and are the overall 9th leading cause of death. One may be fortunate enough to never be part of or witness a wreck in their lifetime, but with 3,287 deaths occurring per day due to road crashes, it’s worth it to be prepared.
Fortunately, I was prepared when in July of 2019 I watched in shock as a motorcyclist over-corrected on the interstate. The adjacent car seemed to barely clip the motorcyclist’s fender before the biker was thrown forward into the cement. I quickly stopped, threw on the emergency lights, and ran to the back of the car to grab my medical kit. I scanned through what I had in my bag and the steps I wanted to go through in assessing the situation. Was the area safe? Were other cars going to come sliding into me as I went to help?
Coming up to the scene I saw a woman roughly in her 40s sitting on the ground bleeding, her knees pulled up to her chest. Her motorcycle helmet was still on. She was wearing shorts and had large abrasions from the asphalt. I explained that I was a physician and asked if I could treat her. As an intern fresh out of medical school I still wasn’t entirely comfortable telling people I was a doctor, but clear communication is essential, especially in letting those around know you are a medical professional.
I fought the urge to reach out and immediately start treating her and put on the gloves from my pack. I had, just the day before, repacked my medical kit, and I felt grateful for this as I knew where everything was going to be. I gave the woman a quick once over. She was sitting up, she was responding and breathing on her own. There were two deeper wounds, one on her forearm and the other on the thigh.
When we come across someone injured, it is instinctual to be drawn to bleeding. After confirming this isn’t life-threatening, it is important to remember that blunt force trauma is common in motor vehicle accidents and can hide fatal injuries if not found and treated quickly. This is especially true for motorcycle crashes where there is nothing to limit the ejection of the rider. In riders wearing helmets, thoracic and abdominal trauma are a significant culprit of morbidity, most notably in individuals over 40 and those with BMIs over 30.
As I had no experience in proper procedure for helmet removal and the patient was without cervical or respiratory symptoms, I decided to leave it. I later learned this was the incorrect decision. Removing her helmet would have allowed me to better assess her airway, visualize potential injuries, and provide better stabilization of the cervical spine. Laying the patient down with the helmet can cause increased forward flexion and strain on the neck. Furthermore, helmets limit access to airway management when rapid intubation may be necessary. The only time to not remove the helmet would be if this caused significant pain. In this case, guidelines recommend laying the person down and stabilizing their neck with the helmet. Here is the proper way to remove a helmet with the least amount of neck movement.
I started my primary survey, starting from the top and working down. As she was still sitting up, I took the opportunity to check for any areas of tenderness along her back. I looked for areas of bruising and pushed on her abdomen while asking questions. She thought her ankle was broken, but her injuries appeared otherwise minimal. I cleaned and applied pressure and bandages to the two areas of bleeding.
It wasn’t until this moment that I really looked away from the woman and standing only twenty feet away was a man leaning casually against the guardrail, blood running down his arms and legs. When I had rushed onto the scene I had thought about the security of our location, about utilizing bystanders, and had looked for injured individuals already on the ground. I had somehow mistaken this man, who turned out to be the driver of the motorcycle, for a bystander. I quickly assessed him as well, and he fortunately only had superficial scrapes and bruising. It was about this time that EMS arrived, and I handed the patients off to them.
In any emergency situation, having an organized and established team dynamic allows for efficiency and prevents errors, such as missing major injuries or injured parties. Typically, the group leader will stand back, assign roles, and direct the team. This provides a broad overview of the situation, which is necessary for proper treatment and coordination of care. While I had utilized bystanders who were eager to offer assistance for smaller tasks, I also could have assigned more in depth roles. Requesting someone to record when the wreck occurred, having someone make sure there were no other injured individuals, and another to control traffic and make way for EMS personnel are all examples of ways others could assist. Do not underestimate the capabilities of non-medical bystanders.
Obviously, different situations will call for different supplies. As we were on the interstate and not off some back country road, help was coming quickly. Sometimes, you have to be innovative with what you have. Linked here is an article where a group of EM residents and attendings had their bus overturned coming back from a tubing trip and managed the situation extremely well with limited resources.
Fortunately, neither rider was seriously injured that day, but I felt encouraged knowing I was prepared and had set myself up to be able to help. We never know what is going to happen in our day-to-day life and even if one isn’t looking to assist others on the road, emergency situations happen to us all. Once EMS arrived I handed the driver and passenger off to them, gave a police report and was quickly on my way. I even made it to the wedding on time.