When car meets bicyclist ... first response? How to assist

The basic standard is "Do what a reasonable and prudent person with similar training would do in the same situation".

It's really going to depend on the situation. I (as a former EMT) would treat a no pulse/breathing lying on the ground pretty aggressively with regards to CPR. If they are stuck in the windshield, I'm dialing it way back. I'd hate to slash their neck up dragging them out of a window to do CPR. :-/

but yeah, the basic no pulse/breathing means they are clinically dead, you can't do much more to them. It's a devils dilemma, do you do the CPR and risk further neck/back injury, or do you wait and risk brain death?

I don't know how much first responder trains you in proper rolls/alignment to reposition someone for CPR, so I can't really recommend much in that area.

John

As a lifeguard the emergency action plan(EAP) at my pool for any and all emergencies is as follows:
Survey the scene:  If the area around the victim is not same, then DO NOT approach the victim.  If you endanger yourself then there are now two victims.  Keep yourself safe then provide care.
Put on gloves:  We are trained and knowledgeable about bloodbourne pathogens.  Gloves are a necessity for keeping yourself safe because you never know what diseases other have.
Check for a response:  Tap/touch victim to see if they give any response whatsoever.
Signal for help:  Call EMTs 911 etc.  Give your name and any description of the victim.
Breathing:  Look listen and feel bor breathing for no longer than ten seconds.
Two breaths:  Tilt head back and give two deep breaths.  Chest should clearly rise if breaths go in.  If not, then retilt the head and give two more.
Chest thrusts:  If breaths still don't go in after second attempt, then give 5 chest thrusts in order to clear the airway.  Scoop out any blockages of the mouth with your little finger.
Two breaths:  By now the airways should be clear.  Retilt the head and give two breaths.
Pulse:  Check for a pulse for no more than ten seconds.  For adults and children check for a pulse near the carotid artery.  For infants check for a pulse on the inner bicep.
If pulse:  Perform rescue breathing:  1 breath every 3-5 seconds.  Recheck breathing/pulse every 2 minutes.
If no pulse:
CPR(cardiopulmonary resuscitation): 30 compressions and 2 breaths.  Compression depth: infant(.5-1 inch) child(1-1.5 inches) adult(1.5-2 inches).  Continue CPR until: the scene becomes unsafe, you become too fatigued to carry on, halp arrives, and AED becomes available, or the victim shows signs of life(throwing up, waking up, etc)

If one is not specifically trained in CPR, I would be very cautious when providing care.  Trained individuals have a responsibility to act, others do not.

For a bike related accident I would do as follows:
Call 911 no matter what
Survey the scene
Signs of life
Breathing
Pulse
CPR

very helpful and thanks

Great thread!  I don't have much to add but appreciate reading the tips with Richard and Julia's accident so close to home. 

The biggest thing ppl fail to realize is that they can be in danger as well.  2 weeks ago, car wreck, I was one of the first responders, car was smoking, then caught on fire with the guy unconscious in there.  I did NOT approach the car.  Thank God someone had a fire extinguisher to put it out.  2nd car had a woman being pulled out of it and was taken about 100 feet away from her car.  Bad idea b/c they were slinging her around like crazy.  I did the cspine neck hold (basically imagine standing behind the person with both of your hands on their ears, but your fingers touching their collarbone).  This will prevent them from moving their head. 

Big thing, stay calm, act fast and smart, ABC's.  I usually don't worry about 911 since there are tons of people around on cell phones anyway (isn't this why most wrecks happen?).

Or you can do the cricothyroidotomy with a pen.... Nevermind, forget I said that.  I had to assist with many of those before.

I think the problem with "not worry about 911" is what if everyone thinks someone must have already called?  I don't think it costs much time or effort to look at someone and direct them to call 911. 

Your right, and by the book its the first thing now so, throw your phone to someone and tell them to call while your doing cpr. 

Sorry, but real world experience kicked in there.

Not much to add but good idea to think about.

When I went head first into a metal street sign in a crit race those that came upon me asked me where I was and who was president both which I could answer correctly. But when my husband came upon me, he said something about our kids, and my response was what kids. Then he mentioned my parents were here and my response was why? They were here for my son's graduation from HS.

I had a pretty bad concussion and don't remember anything for about hour after the crash even though I was talking. When I was talking my  husband said I sounded like I was really drunk.

Exactly why you assign jobs.  6 years on the Fire Department helped me understand that your first priority is gaining control of the scene.  Anything you can do to make bystanders into partners by task assignment helps.  If they are just standing around thinking about what just happened mass histeria can build in a hurry.

It's hard to focus on patient care when everyone want's to ask questions even if they are trying to be helpful.

Edited by Batlou 2009-08-25 9:32 PM

this is great stuff...thanks all!  I don't have any more suggestions to add BUT as an aid to any of you if you come upon me lying in the middle of the road in a heap, I just went and purchased a Road ID

www.roadid.com

Considering all of the other posts/pics of bike accidents posted today alone, I think we should probably all consider doing this.  I hope it is never examined closely...but it will be on my ankle during all rides and runs from now on!

One thing to add.. if they end up 'in the middle of the road' there is a danger that another car will come along and  hit you both..... rule #1  is don't put yourself in danger, that means you need to get them off the road if you are alone, or get people stationed down the road to stop/warn other drivers of the situation.

Aside from that follow the ABC's  and c-spine precautions as already mentioned.

I used to ride with a guy that had stickers on his helmet, telling people in the event of an accident don't remove the helmet.  They were orange and he had one on each side.  I think he got them at a motorcycle shop.  If I could find them I would wear them.

Glad to see the lifeguard kicked in the with SURVEY THE SCENE! Never, EVER make yourself into a victim, even if it means the other person dies.

All the rest of the responses are good. The only thing I'll add is to get thee to a First Aid/CPR class. They have them all the time, all over the place. Call up your local American Red Cross to find the next class (or community college, or university, or high school...). Better yet, get a bunch of your cycling gang together (tri club, weekly ride, whatever) and schedule one. While there are good suggestions here, reading this stuff is NO substitute for actually learning and practicing it live.

As a student paramedic here in Oz, the way we approach every scene is:

Danger-to myself, to my patient, to bystanders. Eg. leaking fuel, traffic
Response-does the person respond to you voice? If not you can use painful stimuli which is putting pressure on their nail bed (there is another method of rubbing their sternum with your knuckles but you would need to be careful in a situation like this-probably better left to the professionals)
Airway-open the person's mouth-is their any vomit or blood (if so finger sweep)
Breathing-look at the person's chest (is it rising and falling), listen (can you hear them breathing), feel (place your cheek near their mouth-can you feel the warmth of their breath)
Circulation-do they have a pulse? If unconscious best to check their carotid pulse on their neck.
C-Spine-take cervical (neck) spinal precautions

If someone isn't breathing but has a pulse then you shouldn't do CPR (except in certain circumstances which are more appropriate for paramedic level training). If someone isn't breathing and doesn't have a pulse then you should commence CPR. Currently here the CPR is 30 compressions:2 breaths (called 1 cycle), and approx. 6 cycles every 2 mins (or 180 compressions). If you don't feel comfortable doing the breaths at least do the compressions. The compressions should be to a depth of 1/3 of the person's chest. DO NOT stop if you feel or hear ribs break-this is actually normal and quite common in CPR. In regards to where to place your hands-probably best to Google for a diagram.

In regards to the DRABC above, that is the order everything should be addressed in. If danger is present remove it before entering the scene. If their airway isn't clear, clear it before moving on to breathing.

In regards to the scenario you posted, to do CPR the patient needs to be on a flat, hard surface (such as the road). In this specific scenario (and any scenario where a patient isn't breathing and has no pulse) the number 1 priority is commencing CPR. A person starts to becomes brain dead after approx. 3-4 mins without a pulse and CPR. However, in saying that if there were more bystanders in the above case attempting to take spinal precations whilst moving the patient off the car would be good.

In regards to helmets that's a tricky one. I'm not entirely sure if someone with a bicycle helmet on would have a good airway or not for CPR (never come across it myself). Sorry really can't give advice here. Myself I would have to see it to decide what to do (obviously if I was at work at the time I would remove it but off duty not so sure).

Think about it this way. If you don't do CPR because of spinal precautions the person is almost guranteed to die. If you move the person to do CPR they have a much better chance of survival and may not even have a spinal injury. Yes spinal is important but there are also more important factors to consider.

Now if you have a patient who is conscious, you should not move them (block the road if necessary-only if you can do so safely), try to keep them talking, and keep them warm. If someone does have a spinal injury they can lose their ability to thermoregulate (regulate their temperature). This means they take on the temperature of the environment they are in. So if they were on a hot highway they would take on the hot temperature, if they were on snow they would take on that cold temperature. If a conscious patient who may have a spinal injury needs to vomit, you should have one person to control the head and another 1, preferably 2 people on the body and perform a log roll holding the person on their side while they vomit. If you don't roll them they're going to choke on their vomit and then you will have an airway problem. Try to control any external bleeding and keep them as calm as possible. People who have brain injuries can become quite aggitated and often require a lot of reassurance about what is going on.

Above all, listen to what the 911/000 operator has to say. If you aren't sure what to do ask and they should tell you!

Please realise that protocols in your local area could be different to what i've told you here. Sorry for the long post-I could go on even more if I wanted!!! (But i'll spare you all )

I've been a Paramedic for 23 years.  Many of the suggestions are very good!  Here is what I'd recommend.

1. Call 911 (obvious but sometimes people start to help and forget this step)
2. Survey the scene.  Make sure you are safe.  If possible make traffic aware of the incident. You are NOT the police and have no legal right to direct traffic.  If you get hit while directing traffic the driver is NOT at fault unless they purposely ran you down.  But, making traffic aware of the incident is fine.
3. Unless the patient needs CPR or is in a dangerous situation don't move them.
4. Try to have the patient stay still and keep them from moving their head and body.
5. Don't remove the helmet unless it interferes with something life threatening.
6. Apply pressure to any obvious bleeding that is flowing or squirting.  Road rash can wait.
7. Put bystanders to work.  It's hard to do all this by yourself.

If you have to do CPR don't expect any real results.  This is not TV and CPR rarely saves anybody by itself.  It keeps minimal blood flowing to keep the brain from dying for a few extra minutes, the problem needs to be corrected and you probably don't have the equipment to do that.  Unless of course you have that pen and pocket knife ready:-)

Statistically trauma patients that need CPR have less than a 1 in 10,000 chance of surving.  If there is that much damage to the body that it killed them, it could happen in a trauma room with the trauma surgeon and team right there and the survival percentage would still be very low.

CPR has a much better chance with heart attacks and drownings.  Statistically it depends on response time.

Last notes about biking and running on the road.  Road/TT bikes are like sports cars they don't take bumps well.  If I was riding a MTB I could stay to the side of road easier, road bikers tend to come further into the road and drivers that aren't bikers do not understand.  So keep this in mind.

Some bikers and runners get the attitude that they have the right to be there and legally they do.  But if you collide with a vehicle it does not matter who is 'right', YOU LOSE!!!

  Be mindful of this and keep the attitude in check, it is better than being DEAD right.

BE CAREFUL!

Hope this helps.

Bob

Kind of nasty to think of but was on a fire department call one time and a bicycle rider went through a windshield with a helmet on.  Unfortunately the person hit the windhield where the glass meets the frame at the top right at his forehead.  This caused the scalp to literally be peeled backand ripped the helmet off.  We responded before the ambulance arrived and the best we could offer until the EMT's got there was to, literally, flip the still attached scalp back onto the top of the head and provide slight pressure to limit bleeding from the top of the head.
Very nasty accident, this was my first MVA I responded to (nice introdution to the team) and I had the luck of being the scalp holder.  Person ended up survivng but still had extreme blood loss from the head. 
Someone else said it, and don't forget it, apply pressure to bleeding wounds.

When I was in the police academy one of the instructors teaching about this very subject would wink at us and say to drive around the block until the fire department gets there. 

A few other things to think about is if there is a car involved in a bike accident to get the vehicle information as well. A license plate would help. A drivers description.  We have drivers stop to make sure people are okay and then take off. I wouldn't expect someone treating the patient to obtain that but to think about delegating tasks.

Take control of the situation. Don't be afraid to tell people what to do. If you hurt someone's feelings too bad. You could be talking the difference between saving a life and someone dying in your arms.

 I have experienced a baby's first breath and someone's last breath. Every situation is different. Just do what you think is right and you will be just fine. I think that is better than living with the guilt of not doing anything at all.

Yeah, we joke about the Police ABC's are: Ambulance Before Cruiser.

In reality the police in the community I work are EXCELLENT first responders but other communities I have worked the ABC's certainly apply:-)

Bob

I know that without my training and knowledge as a lifeguard, I would never feel confident acting as a first responder.  I would recommend that all people should take a CPR/AED or some srt of first aid class.  It might cost some money but the certifications don't matter, the knowledge is what counts.  It could save someones life one day, or even your own.

Good to see people discussing this topic. I work as an EMT for our county EMS and know how difficult these situations can be. Lots of good info in this thread already, especially from the paramedics above, and I won't repeat what's already been said. I wanted to reiterate though that any training you can get is helpful. Unless you do this for a living it's still going to be a traumatic experience, but the more you've practiced recently the easier it will be. In addition to that, a lot of treatment protocols have changed over the years, so if you took a first aid/cpr course 20 years ago some of what you remember might be outdated. So get some folks together, your family/kids/training group/whatever, and sign up for a course.

One last thing, if you are a first responder to something like this understand that it might stick with you for awhile. People experience all sorts of emotions after being part of a traumatic experience and one of the biggest is often guilt. (Did I do the right thing? Did I do enough? Did I make it worse? etc) This is natural, and usually completely unfounded. Just know that there are people you can talk to. Go to your fire station or hospital or somewhere and ask about a local counselor you can talk to if needed. Keep yourself safe, know you did your best, and talk to someone if you need to.

Safe travels....