# Motorcycle down on the Freeway



## Jim37F (Nov 10, 2016)

So you're working a BLS ambulance (dual EMT.....though if you happen to work 1+1 Medic/Basic or dual Medic I wouldn't mind hearing how that changes from the dual EMT in the scenario!). It's evening rush hour in a big city. You get dispatched to a reported motorcyclist down on the Freeway (think Los Angeles area freeway, 4 lanes jammed with rush hour traffic all inpatient to get home). As you pull onto the freeway at the entrance before the reported location, just as you're in the gore point just before the onramp actually meets freeway lane you see the crash off to your left almost immediately perpendicular to you....and there's a small curb in the gore point (and the curb ends passed the crash location). The crash is in the far left lane, and from where you are at you can see one person is down on the pavement underneath a pickup truck. There's at least one Police car parked on scene but down stream of the accident....you do have ALS fire department responding on initial dispatch but a) they are nowhere in sight yet, and b) due to the unexpected location it's actually in another department's jurisdiction....and go!


----------



## VentMonkey (Nov 10, 2016)

Is the patient pinned underneath the truck? If so, wait for the FD to arrive and do their thing.

While I wait (P/B), my partner can set my stuff up in the back while I try and get a primary on the patient, make base, and tell them we'll be coming in with a (most likely) Step1 Trauma soon as fire frees them, and that I will recontact as needed, and/ or once en route.

FFWD to fire arriving, freeing said patient, do a rapid trauma, enlist proper airway management (BLS is fine for now), cut clothes, look for any major "kill zone" injuries, and/ or major bleeding, enlist SMR, load, and start transporting.

En route cardiac monitor/ SPO2 with waveform pleth, take a rider in back, reassess V/S and GCS q 5 minutes, grab a BGL. Time permitting, 2 large bores, one being a lock, if not both (if patient is normotensive), recontact base as promised and update findings, vióla.


----------



## DesertMedic66 (Nov 10, 2016)

First thing for me is to get him out from under the truck. Is there clearance to where we can just carefully pull the truck back or are we going to need to jack it up? Is he responding or moving at all from under the truck?


----------



## NysEms2117 (Nov 10, 2016)

For me as a B/CC-P rig that i work on, i think it would go something like: after scene safety and all that EMT-B school stuff
If the patient is pinned wait for fire, I would get gear for the medic(while he is making primary contact with the patient(s), and contact base with the trauma code(xyz), assuming fire has come and freed said patient if need be, load and go, do any BLS airways/ bleeding control we needed then, we would then get the transport going, i would assist my medic partner with anything he may need while he is doing is assessment, then proceed to assist with interventions he started/asks me to start(vitals, bvm, ect). I would then update MC/base with what we have, the vitals, ETA, ect. and done


----------



## DesertMedic66 (Nov 10, 2016)

As for what I would do after he is out from under the vehicle is dependent on what is going on. All we know is he is under a truck. We don't know if the truck hit him or even ran him over. 

It's LA so the freeways are packed which means the rider was probably not going over 40mph while splitting lanes.


----------



## Jim37F (Nov 11, 2016)

Ok so I guess my first question from y'all would be how would you go about securing scene safety on the freeway? You are in the merging lane on the far right and when you locate the collision it is nearly even with you on the far left with a curb in the gorepoint.....do you cut a hard left and hop the curb and park perpendicular to the scene (since you otherwise have no other room to maneuver) or try to pass it and loop around, or even get off at the next exit, hop back on the opposite way and loop around the far way....or another option?

Anyway, so you get over and start assessing your patient. You find an adult male laying supine almost completely underneath the pickup truck. His hips are pressed up against the driver side front tire with his legs sticking out and his head under the middle of the truck, kind of curled up against the tire (as opposed to laying flat and straight like in EMT class scenarios).

He is wearing a thick leather jacket and does have a helmet on, not a full face helmet though. It's dark and you can't see much of anything without the aid of a flashlight.

However, your patient is alert and talking to you in full sentences with a patent airway, but cannot remember what happened, does not know where he is. He does know his name, but not his age. The cop on scene says he has been asking the same questions about what happened to him several times now.

You do not see any immediately obvious bleeding, nor any obvious fractures, but can't rule them out yet due to the awkward positioning of the patient under the truck combined with his full motorcycle clothing.

You're laying down under the truck with the patient holding C-spine, your partner can't access more then the patients legs and left arm, he says you should remove the helmet and place a collar on, and wants the two of you to try to get the patient on the board by yourselves.

Do you remove the helmet or keep it on? Since you're holding C-spine and have only your partner and one cop with you at this point in time do you try to move the patient onto a backboard or wait for incoming fire for assistance? What else would you be trying to do or assess in the meantime?

BTW, you have your local community hospital 2 miles away....though your local Level II trauma center is 5 miles away....both straight down the freeway in the same direction as traffic flow.


----------



## VentMonkey (Nov 11, 2016)

Jim37F said:


> Ok so I guess my first question from y'all would be how would you go about securing scene safety on the freeway? You are in the merging lane on the far right and when you locate the collision it is nearly even with you on the far left with a curb in the gorepoint.....do you cut a hard left and hop the curb and park perpendicular to the scene (since you otherwise have no other room to maneuver) or try to pass it and loop around, or even get off at the next exit, hop back on the opposite way and loop around the far way....or another option?
> *Use the gutter lane, then swing hard and block all traffic with the unit; too bad, so sad, yaaay LA traffic. Bottom line for me? We'll get there when we get there, safe and efficiently. I don't think I need to ovet think this. At least like I said block with the unit, at most park directly in front of the scene.*
> Anyway, so you get over and start assessing your patient. You find an adult male laying supine almost completely underneath the pickup truck. His hips are pressed up against the driver side front tire with his legs sticking out and his head under the middle of the truck, kind of curled up against the tire (as opposed to laying flat and straight like in EMT class scenarios).
> *How long has he been pinned? I'm guessing not long? But more importantly, if we can't get him out without the help of the "big burly firemen", you can ask for Bicarb orders juuuust in case; next question...*
> ...


*Patient is considered a "yellow tag" at best in my area, he goes to the the Level ll. What else you need, Jimbo?

Also, may I ask: how bad (or good) did the squaddies do?...*


----------



## DesertMedic66 (Nov 11, 2016)

It sounds like you would be able to back the truck up safely unless I am not reading that correctly. 

Lay him on his back. Remove the helmet. Cut the gear off and do a full trauma assessment. C-collar and depending on protocols backboard. If you are allowed to transport then you might as well load the patient in the ambulance and wait for the medic to get on scene. If not and the transporting unit is not very far away then just chill out on scene. 

Record vitals and reasses mental status. 

Really the only thing I am going to do as an ALS provider for this patient is start an IV or 2 depending on if I'm feeling froggy or not.


----------



## VentMonkey (Nov 11, 2016)

Any potentially critical patient keeps me "froggy", so two locks time permitting.


----------



## DesertMedic66 (Nov 11, 2016)

My last motorcycle down (well one of them) was pretty similar to this patient so far. Only injury was a Fx clavicle. Altered with repetitive questioning. Met up with another ground unit to transport to the trauma center (motorcycle down at 80mph is automatic trauma center transport). I was surprised to see him 4 hours later with just a sling on after being discharged


----------



## VentMonkey (Nov 11, 2016)

DesertMedic66 said:


> My last motorcycle down (well one of them) was pretty similar to this patient so far. Only injury was a Fx clavicle. Altered with repetitive questioning. Met up with another ground unit to transport to the trauma center (motorcycle down at 80mph is automatic trauma center transport). I was surprised to see him 4 hours later with just a sling on after being discharged


Understandable, nonetheless, from all I have been taught, and the simple fact I try and help our trauma team out, that's my "thankin'"...

Heck, I've had RSI's get extubated, but at the time of our arrival it was much safer for everyone (crew, and patient), so I say, let 'em hash it out at the ED; truly not that big a deal though.


----------



## DesertMedic66 (Nov 11, 2016)

VentMonkey said:


> Understandable, nonetheless, from all I have been taught, and the simple fact I try and help our trauma team out, that's my "thankin'"...
> 
> Heck, I've had RSI's get extubated, but at the time of our arrival it was much safer for everyone (crew, and patient), so I say, let 'em hash it out at the ED; truly not that big a deal though.


I used to hate motorcycle down calls. Since I have been on our racetrack team we get way more than our fair share of riders down. Luckily they are required to wear around $2,000 worth of gear so the majority of what we get are broken long bones, abrasions, and concussions. 

The going price tag for flights from the track to the trauma center currently is $42,000. So we ground transport a lot of them. If they are out for more than 5 minutes or have any seizure activity then we will fly (unless airship is too far out).


----------



## exodus (Nov 11, 2016)

DesertMedic66 said:


> I used to hate motorcycle down calls. Since I have been on our racetrack team we get way more than our fair share of riders down. Luckily they are required to wear around $2,000 worth of gear so the majority of what we get are broken long bones, abrasions, and concussions.
> 
> The going price tag for flights from the track to the trauma center currently is $42,000. So we ground transport a lot of them. If they are out for more than 5 minutes or have any seizure activity then we will fly (unless airship is too far out).



Apparently when they first started the track, they could buy flight insurance through the air companies. Not sure if they still do that.


----------



## NomadicMedic (Nov 11, 2016)

It's been a while since I've done one of these. My last lmotorcyclist down was wearing full protective gear. Hit something and went underneath a vehicle, prone.  We got him slid out and rolled over, entire front of the helmet was full of blood.  He was unconscious, responsive to painful stimuli with a groan.  Got his helmet off, suctioned out his airway, jaw thrust airway and a board/collar. 

He became fully awake and alert shortly after we got him in the truck, turned out he had bit his tongue when he hit the ground.He did get 2 large bore lines and uncomfortable ride to the hospital. 

When we got him to the trauma center, they spun his head and his neck. Nothing wrong with him aside from his tongue. Discharged two hours later. Thank god for Kevlar suits.


----------



## DesertMedic66 (Nov 11, 2016)

exodus said:


> Apparently when they first started the track, they could buy flight insurance through the air companies. Not sure if they still do that.


Reach air still has a program where you pay per year and if you get flown you are not charged. However at the track you have about a 25% chance of getting Reach. Could be Mercy, Reach, Native Air, Careflight, or CHP.


----------



## StCEMT (Nov 11, 2016)

I was almost so proud of my last motorcycle crash. Dude had an awesome helmet and a thick jacket. Some hand abrasions due to crappy gloves. Upper body was fine, barely anything. Wore freaking khakis though and got a nice scrape on his *** and legs though. I remember looking at him going "dude, kudos on the helmet, but why the khakis?"


----------



## Flying (Nov 11, 2016)

StCEMT said:


> I was almost so proud of my last motorcycle crash. Dude had an awesome helmet and a thick jacket. Some hand abrasions due to crappy gloves. Upper body was fine, barely anything. Wore freaking khakis though and got a nice scrape on his *** and legs though. I remember looking at him going "dude, kudos on the helmet, but why the khakis?"


Good protective motorcycle pants that aren't baggy and grungy are expensive. Imagine wearing oversized BDUs over your regular pants.

There are a crazy few who will wear all leathers though.


----------



## VentMonkey (Nov 11, 2016)

DesertMedic66 said:


> Reach air still has a program where you pay per year and if you get flown you are not charged. However at the track you have about a 25% chance of getting Reach. Could be Mercy, Reach, *Native Air*,* Careflight*, or CHP.


How close to the AZ border is this racetrack? 

Back on topic, again, as far as getting to the patient, I am no extrication expert, so if they're pinned there's not a whole lot I can but wait for them to be _safely_ extricated. You can approach the scene several different ways, but as long as you're _safe _and you protect yourself, your crew, and your patient, then you'll be able to treat them when they're treatable. I guess the bottom line for me is that it's trauma, so treatment-wise it seems pretty straightforward, and there's no reason to rush to try and figure out how to get the patient from underneath the vehicle if it can't be done _safely _without heavy extrication equipment. 

Again, the biggest thing here being the _safety _of everyone involved on these types of incidents.


----------



## CALEMT (Nov 11, 2016)

VentMonkey said:


> How close to the AZ border is this racetrack?



Another 50 miles maybe.


----------



## VentMonkey (Nov 11, 2016)

Interesting. I'm guessing the CareFlight airship would be coming from Havasu.


----------



## DesertMedic66 (Nov 11, 2016)

VentMonkey said:


> Interesting. I'm guessing the CareFlight airship would be coming from Havasu.


Yeah it's around 50 miles or so and you are correct they come from Havasu


----------



## Jim37F (Nov 13, 2016)

Ok so what went down is just like I wrote out, we were merging onto the freeway for the call (Actually we were merging in from a N-S freeway to the E-W freeway where the call actually was) reported at the next cross street when I spotted the guy down under the pickup truck almost parallel to me. I opted for the hard left turn and hopped the shallow curb in the gore point, and still had to actually make a short three point turn to fit in behind one of the stopped cars (traffic was heavy enough that was the only way I felt I could position the ambulance to block the scene without driving around in a giant circle fighting hordes of people wanting to get home on the 105 ha). I was literally at a 90* angle on the freeway....but I had two whole lanes blocked off where we could work safely 

The cop on scene must have been a detective or something, he was in plainclothes (his badge was on a neck chain) driving an unmarked Charger with two little LED's flashing away in the back window.....parked so the entire scene was BEHIND him (thus exposed to traffic -_- ) Otherwise no other responders on scene. We were initially dispatched with LACoFD but a) the station the units were coming from was West of our westbound incident, they'd have had to get on the eastbound, pass us and most likely pass the freeway interchange to the next exit a couple miles before that to get to our actual location, which was b) in LA City Fire's jurisdiction. We called in the updated location to dispatch (and then had to convince them that yes, we were pretty sure this was the correct not a duplicate incident, how many motorcyclists down under a pickup truck are there on that stretch of freeway at that time? Once away from the rig I couldn't hear the County radio so I honestly don't know if they investigated their stretch of the freeway just in case of a duplicate or once told of the corrected location simply said "That's City's area, send the call to them")

So anyways, that's kind of what made this specific scene somewhat memorable to me, just me and my partner on the BLS ambulance alone with a patient and one LEO helper for an extended period while fire figured out what was going on behind the scenes.....both me and my partner were like "This is something straight out of EMT school skills day!" lol 

So back to the scene....bystanders/witnesses told us the motorcyclist was riding along in traffic, splitting lanes, when someone from the carpool lane cut him off, supposedly cutting right to make the next exit and the MC swerved and laid the bike down and slid up under the other pickup truck where we found him, the pickup truck swearing he didn't actually run him over. 

The patient was supine, mostly under the truck with his hips pushed up against the front tire. I literally got down on my belly and crawled under the truck to hold manual C-spine and begin assessing the patient. He was Conscious, Alert, Oriented to person only (knew his name and birthday but not where he was or what he was doing), the cop told us the patient asked those questions "at least 6 times before you got here" so we judged the patient Altered with repetitive questioning, +Knocked Out, unable to recall event. That being said he was talking to me in full, clear sentences, so he had a nice patent airway and was otherwise breathing just fine. Using our rigs flood lights and a hand held flashlight we determined that there was no immediately obvious major bleeding or long bone fractures or any other trauma jumping out at us at this point in time, Pt's only complaint was R Clavicle pain. He had good CMSx4. 

We did slide his helmet off and place a C-collar. Now this is the biggest point of divergence between what most of you said you'd do and what I actually ended up doing, where most of you went ahead and said you'd want to get the patient on the backboard with just you and your partner...while my partner was willing, I was personally a little hesitant. Partially because I wasn't quite sure the two of us could safely roll him onto a board without torquing his neck or back. I was already laid out under the truck myself  with a relatively limited range of motion, I just personally felt a lot more comfortable waiting for a couple extra hands due to the awkward positioning involved. Meanwhile, my partner got some vitals and did what he could do to assess for additional trauma while only having access to half the patient.

So City (finally, felt like they took forever!) showed up. Now many of you like to roll your eyes at LA Co for their habit of sending and Engine and a Squad and an Ambulance to calls. Well LA City is not one to be shown up by County....the call must still have come in on their end as a pinned rider because they brought a full Task Force. Not just an Engine and Rescue ambulance, but a Light Force as well for good measure (They turn a tillered ladder truck company into a Quint company by simply adding a full pumper engine and dispatching both vehicles as a single unit) so We got the engine, truck, it's second engine, paramedic ambulance, and a BC for good measure (when I got a chance to steal a look it was a sea of red behind my rig lol) From there they went right down the straight forward trauma pathway you guys said, stripped off the guys clothes for a full head to toe, and drove to the Level II just down the road a ways, presumably getting those large bore IVs enroute (I didn't get much chance to watch them as we started to police up our own gear, make sure we didn't leave anything on the roadway, and while their medics  didn't load and go per say, they didn't stick around all day either).

So all in all, pretty straight forward, glad it got as much discussion as it did!


----------



## CALEMT (Nov 13, 2016)

Jim37F said:


> Now this is the biggest point of divergence between what most of you said you'd do and what I actually ended up doing, where most of you went ahead and said you'd want to get the patient on the backboard with just you and your partner...while my partner was willing, I was personally a little hesitant. Partially because I wasn't quite sure the two of us could safely roll him onto a board without torquing his neck or back.



Me personally Jim I share your same view. With the awkward way with his body position (half of him underneath a truck) I would prefer another set of hands to help move his torso.


----------



## DesertMedic66 (Nov 13, 2016)

That is pretty much the type of TC that popped into my head. Motorcycle splitting lanes so he isn't going too fast at all. Car pulls out and he lays the bike down and slides a little bit without getting ran over.

If his speeds were under 20mph then for my system we would contact the trauma base hospital due to the LOC and they would tell us where to go. Honestly we may be transporting to a non-trauma hospital. Once again for my protocols I would not be placing this patient on a backboard but he may get a C-Collar. 

Only other thing I would do is establish an 18G and contact our trauma base for pain meds orders. Finish paperwork, talk to other crews, clear, rinse, and repeat.


----------

