Part 2:
6a) After initial evaluation of seriousness of injuries, call for ambulance
After there has been a quick evaluation of the number of injured people and just the most preliminary guess of seriousness, someone has to be sent to get an ambulance. Remember that an ambulance can only support one truly injured person.
It is important to remember that a lot of the injuries that don't look serious to us could very well be life-threatening and injuries that look fatal are relatively minor. Don't get fancy with the initial seriousness evaluation. If you can't tell, assume it's Urgent!
If a cell phone is not available, send one or two bikes to the nearest house. Send a woman if possible. The idea is that you don't have time to be turned away from someone's house and they are more likely to be receptive to a lady than some Scary Biker Dude. It may sound silly, but if you are turned away from a country home due to looking like a Scary Biker Dude, you may lose several minutes trying to find the next one. Selection of who goes to call is very important. He also says to have the person going to the door wearing light colors; if someone else has a white jacket trade jackets before heading out for the house. Chances are the person going to the door will look friendlier wearing a light-colored outfit than black leathers. In short, send a female to the door if at all possible.
When you go to the door, REMAIN CALM... THINK! Take a second and a couple of deep breaths. It will not help to have this biker person in a very excited state on the doorstep of some person's home. The people will be far more receptive to someone who looks like they have a grip on themselves.
Do not ask directly for entry into their house; something like "There has been an accident. Please call 911.'' There is no need to specify that it was a motorcycle accident to them (it is important to let the Emergency Medical Services dispatcher know that it was a motorcycle accident, however). It is less threatening to ask to call 911 than it is to ask to come in and use their phone.
6b) Things to tell Emergency Medical Services dispatcher
1. there has been a motorcycle accident
2. need an ambulance
3. the # of injured people (and how badly injured they are). A severely traumatized person will require an entire ambulance to themselves, so it is important to give the EMS dispatcher some idea of the scope of the accident. If they only send one ambulance and there are two people who need one immediately, it will be a problem.
4. location of accident
(get help from the people whose phone you're using, they should know how to describe their location best)
5. You (the caller) hangs up last!
The EMS dispatchers are well-trained and will get all the information they need from you before hanging up. Stay on the line until they do.
6c) Things that may be necessary for victim.
It is helpful if you know some special equipment is going to be necessary to tell the dispatcher;
1. Helicopter
Most rural areas cannot handle severe trauma and they may need to get the victim to a trauma center via helicopter. If they know there may be a need, they can get the helicopter ready to leave for the rural hospital when a doctor establishes the extent of the injuries. Slider says that in Iowa at least, if the helicopter comes out and it turns out it wasn't necessary, there is no charge for the service.
2. fire
Should the fire department be called in?
3. Jaws of life
4. Utilities
See (2-C) about downed power lines above.
7a) Document personal information if possible (victim may pass out)
Before the ambulance arrives, if possible, document information about the victim. They may become unconscious and it will be helpful to have information like;
Full name
Next of kin (plus phone number)
Age, date of birth
Doctor
7b) AMPLE documentation
There is AMPLE time to document this before the ambulance arrives. Again, this will be very helpful to the paramedics if the victim passes out.
A Are you allergic to anything?
M Are you on any medications? Street drugs?
P What's your past medical history?
L Last meal - when did you eat last?
(will help anesthesiologist if one is necessary)
E What were the events leading up to the injury?
Document the mechanisms of injury. If the doctors and paramedics have some idea how the accident occurred, it will give them better ideas on what kind of injuries to look for. Did the person low-side and slide for a while on one of their sides? Did they go over the bars? Did they head-butt a solid object, such as a car? If they went over the bars, is there any obvious damage to the tank/handlbars which might indicate they hit the lower abdomen/groin area? This kind of stuff could help the doctors/paramedics.
Wallets, purses, rings
Do not go rooting through personal effects of the person. There should be no need to go through their wallet or purse for insurance information; the hospital personnel will deal with all of that. If there is some important reason that you need something from their wallet or purse, make sure you have at the very least a witness! Preferably a law enforcement officer if possible. If the person is conscious, ask first and if they say "no'' then don't push it.
If the person has rings on, the fingers may swell up and it is important to get them off. Consent is paramount if the person is conscious. Make sure there is at least one witness when removing them.
9a) Have person check pulse every 5 minutes & document it
Every 5 minutes the pulse should be checked at the wrist. If the pulse goes away at the wrist, check at the throat. This is a late sign of shock (see 10).
Write down the number of beats per minute and the time you took the measurement.
9b) Have person check breathing every 5 minutes & document it
Just like the pulse, check number of breaths per minute, the most reliable method being by placing your hand on the person's chest. Obviously if the victim is female it would be best to have another lady do this if at all possible.
Try to check their breathing rate without their knowing it. If they know you are counting their respirations, they may unconsciously alter their breathing rate.
Record this number along with the pulse every 5 minutes. Also note the type of breathing; fast, shallow, yodelling, gurgling, labored, easy, whatever. Even in layman's terms it may be useful to the paramedics.
10) Watch for signs of person going into shock
People invariably die due to shock. "you don't die by the gunshot wound but by the shock of the gunshot wound."
Signs of shock:
1. Inability to answer the 3 questions coherently (Who are you, etc.) (see 4)
2. Pale, cool, clammy skin
3. Delayed capillary refill press your fingernail so that it turns white. It should turn back to pink in less than 2 seconds. If it takes longer, that is not a good sign.
4. Radial pulse (pulse at the wrist) goes away but there is still a pulse on the neck
There isn't much we can do once someone starts going into shock, but a few minor things that may help:
1. Assure adequate breathing. This really comes with the AB of U-ABCC.
2. Loosen restrictive clothing.
3. Reassure victim.
4. Keep the person warm (not too hot though).
5. Elevate the feet ~6 in.
This is actually a judgement call since you shouldn't really do that with suspected spinal injuries.
6. Control bleeding.
This is probably obvious but if you don't realize the victim is bleeding and they are rapidly going into shock, this should tell you something.
7. Immobilize fractures.
This helps relieve pain and control bleeding.
11) Stop bleeding, using sterile bandages/dressings if available
Two important things here are to (a) stop any bleeding as soon as possible and (b) keep the wounds sanitary as much as possible. (a) is far more important than (b). Peripheral limbs are commonly lost to infection, but given the choice between stopping bleeding and using a nonsanitary cover, using the nonsanitary wrapping is preferred. Blood loss is bad. Wounds can be cleaned at a hospital.
If sterile dressings are not immediately available, women in the group may be carrying sanitary tampons, or Kotex napkins. Either can be used as a sterile dressing, although obviously the sanitary napkins would be superior.
Carry some sterile dressings with me in my tankbag, backpack or trunk space. They cost about $1 at your local drugstore. * Personally, I carry a Backpacker's First Aid kit. They are campact and don't take up too much space.
EXCEPTION: If there are cuts anywhere on the head, do NOT apply pressure. If there is a bone chip it is possible to push it into the brain. It is also possible that stopping the flow of blood or cerebral spinal fluid can lead to a buildup of pressure on the brain which is not good. You should still bandage the cuts loosely.
12) In case of femur injuries (extremely common in moto accidents), check for blood loss
Femur (the "thigh bone'') injuries are very frequent. There are huge arteries that run along the inner thigh; if these are compromised the person can bleed to death in a very short amount of time. It is important to minimize bleeding in this region! Use a pressure point above the cut to control blood flow out of the femur artery.