Accidents happen every day. The question is not if you’re going to be involved in one, but when. When the unexpected happens, whether it is an accident or a medical emergency, it is nice to know that you are prepared to get help and effectively handle the situation.
The following question and answer article is geared toward the bicycling community and is designed to inform, educate and promote bike safety. We will try to answer those common questions that come up during an emergency on the road or trail. The information presented was compiled with the help of a paramedic with one of the most respected emergency medical services in central Pennsylvania: West Shore EMS. West Shore EMS, a service of Holy Spirit Health System and based in Camp Hill, Pa., is a provider of emergency and non-emergency patient care/transport. They provide paramedic service to Cumberland, Perry, Northern Franklin, York and Adams Counties.
Rex Carmichael sat down with us to share his knowledge and expertise in managing emergencies. In 1982, Rex became one of the first paramedics certified in Central PA. He is also an avid cyclist. Rex is a West Shore EMS paramedic, serves as a Tactical Medic with a County Special Response Law Enforcement Team, and is a member of the West Shore EMS bicycle squad used at large events such as Jubilee Day in Mechanicsburg (the largest one day street fair on the East Coast). Rex is certified by the International Police Mountain Bike Association (IPMBA) and rides his Raleigh GrandSport 15 miles (one way) to and from work during the summer.
What to do?
Harrisburg Bicycle Club (HBC): What are the top three things bicyclists should do when they, or a member of their group, are involved in an accident on the road or on a trail?
Rex Carmichael: After an accident occurs, be aware that secondary accidents happen frequently as traffic slows and drivers “gawk.” Do what you can to alert traffic and make yourself visible. Generally, you don’t want to move the patient. However, if more injury may occur if the patient is not moved to a place of safety, then he or she should be moved as carefully as possible. Keep the patient warm/cool and comfortable. Involve bystanders. They are often happy to help; they just need to know what you need them to do.
HBC: When calling 9-1-1, what information is needed to ensure a quick and effective response by emergency personnel?
Carmichael: The dispatcher will ask questions about the patient: gender, age and extent of injuries, level of consciousness, breathing difficulty, if they are bleeding, and if they have any broken bones. Having the patient’s past medical history is also helpful.
HBC: Often people hesitate to call 9-1-1 because they’re not sure whether the situation is a “real emergency.” What if anything should delay the call to 9-1-1?
Carmichael: If you are questioning whether you should call 9-1-1 or not, make the call. Emergency services are dispatch based on your answers to their questions. You may get an ambulance with no lights or sirens with a staff that will evaluate you (the patient) and simply let you “sign off” and continue on your ride. If the situation warrants, you might end up with a full response of fire engines and maybe a medical evacuation helicopter. Don’t worry about inconveniencing anyone.
HBC: If a cell phone or mobile device is used to place an emergency call, will the 9-1-1 operator automatically have access to the caller’s name and location?
Carmichael: The wireless Enhanced 9-1-1 (E-9-1-1) capability that automatically provides dispatchers with your name and location is not yet consistent when using mobile devices. The 9-1-1 dispatcher may not receive any caller information or location data. The 9-1-1 center can trace these calls with varying accuracy, depending on the wireless carrier’s technology. All modern cell phones have an embedded GPS device for 9-1-1 that cannot be disabled by the subscriber, but there is still a disparity in the technology in use today. A 9-1-1 center can request detailed information from the cellular carrier regarding the origin of the call, but the process is too cumbersome and time-consuming to be of value in most medical emergencies. If a mobile device is used, it’s best to possess significant knowledge of the geography area where you are riding.
HBC: How can we aid the 9-1-1 operator in narrowing down the incident location if we are unfamiliar with the area or it is isolated such as a trail?
Carmichael: If you are in a remote area and are unable to provide your exact location, ideally have one person stay with the patient and another person head towards civilization. Look for nearby residences or businesses to get help. If the site of the accident is isolated, but you have communications with 9-1-1, look for specific landmarks that could help narrow down your location. It is helpful to have someone available to meet emergency responders at a designated, or planned, location if the incident location is remote or isolated. They can help guide responders into scene and save a lot of time.
HBC: What if you are alone and injured?
Carmichael: Obviously you are going to wish you had a pre-plan! Like a pilot’s flight plan, leave word with an individual who knows your general route of travel and a time that you are going to check in. If your injury prevents you from being mobile, you have no choice but to stay put. You don’t want to aggravate injuries or become lost trying to find a way out. Wilderness survival is about making do with what you’ve got. I suggest you take a wilderness course and have basic survival supplies if you do any deep mountain biking alone.
What to Expect?
Harrisburg Bicycle Club (HBC): Will the 9-1-1 operator ask the caller to provide emergency care or first aid? If so, am I protected against being sued?
Carmichael: The dispatcher can provide information on how you can best care for the patient; however, a layperson performing first aid and acting in good faith is protected by the Good Samaritan Act. The Good Samaritan laws were developed to encourage people to help others in emergency situations. They protect people against claims of negligence when they give emergency care in good faith without accepting anything in return. These laws would not protect a paid healthcare professional.
HBC: I know you mentioned this before, but can you clarify when, if ever, a patient should be moved by anyone other than emergency personnel?
Carmichael: The rule of thumb is: never move a patient. The most important reason is to reduce the risk of causing paralysis from a neck injury. Anything you can do to keep the neck straight i.e. head in line with the body will be of benefit. You also do not want to aggravate injuries. Exceptions to moving a patient include an unsafe scene or a compromised airway. There are many agencies that offer community first aid and CPR classes; it is a good idea to be prepared.
HBC: After hanging up (ending the call) with 9-1-1 what should the caller do?
Carmichael: After the initial call to 9-1-1, monitor the patient’s condition. If it appears to deteriorate, if there is a change in mental status, or if the bleeding cannot be controlled, make another call to 9-1-1. This will “step-up” the EMS response.
HBC: Will the ambulance be the only emergency unit dispatched to the scene?
Carmichael: Depending upon the location of the incident and the structure of EMS in that area, you may get a Basic Life Support ambulance, an Advanced Life Support (paramedic) squad (non-transporting unit with the paramedic and their equipment) or a Mobile Intensive Care Unit (MICU). A MICU commonly consists of an ambulance staffed by a paramedic and an EMT. Also, if the 9-1-1 information indicates a potential need, fire / rescue apparatus and personnel may respond. Examples of circumstances where this would happen include the involvement of a motor vehicle, fluids leaking on the roadway or other hazards, the injured party being entrapped or located in a wilderness area or other area allowing limited access.
HBC: What are the most common bicycling-related injuries? And which of these injuries would require the patient to be airlifted?
Carmichael: Scrapes and broken bones are the most common bicycle injuries. Life-threatening injuries include severe head injury, chest trauma with breathing difficulty, neck injury, exposed fractures and uncontrolled bleeding. The decision to have a patient airlifted is based upon the accident location, the length of time it would take to transport to a trauma center and / or the severity of the injury.
Harrisburg Bicycle Club (HBC): Understanding that all situations are different, what can the injured bicyclist expect as far as patient care?
Carmichael: You can generally expect to be fully immobilized prior to transport. This means having a cervical collar put in place and being strapped to a rigid spine board. Uncomfortable, yes. However, the trade-off may be being paralyzed. The physician will evaluate the patient’s situation and will have these items removed when appropriate.
HBC: How important is it for bicyclist to carry ID and emergency contact information?
Carmichael: ID is very important, especially if you ride alone. I use a Rode ID product, the dog tag style. It is not important where the information is placed on the person as first responders are trained to check for med alert tags and ID. Some people place contact numbers of responsible people who know your medical history on the tag. I wear the same tag when traveling or if I am involved in any higher risk activity. Ideally, what EMS needs to know is your name, date of birth, past medical history, medications and allergies to medication. I also included my doctor’s name and my hometown on my ID. Contrary to popular belief, blood type is not important. The information I mentioned is a lot for one tag, but there are acronyms for most of the information. If you need help designing your ID tag or bracelet, give us a call at West Shore EMS (717-763-2108).
HBC: Some companies now offer bar-coded ID that can be used by emergency departments to access the cyclist’s medical and contact information via the internet, have you seen that type of ID before and has it been helpful to the local emergency departments?
Carmichael: I am not familiar with the bar-coded ID. I don’t believe it is widely-used. But, I’m sure we will one day all have microchips!
On behalf of the Harrisburg Bicycle Club and its membership, I want to express my sincere appreciation to West Shore EMS Paramedic Rex Carmichael and his colleagues at the Cumberland County Department of Public Safety for taking the time to educate us. Most of us who ride bicycles understand the risks and take safety very seriously. I hope this information has increased your knowledge, gives you motivation to ride safely, and helps you to prepare in advance for an emergency.