Motorcyclists are in a unique position as riders on the road. They ride on two wheels, which is an inherently unstable position. They ride without the benefit of any protective metal around them, which makes direct vehicle to patient contact likely. Road to victim contact is almost inevitable and these riders often suffer from significant injuries. Many motorcyclists use performance enhancing equipment, which makes the chances of severe injury or death quite likely.
One recent review study looked at the patterns of injury, particularly major ones, seen in motorcycle riders following their injuries. There are unique aspects of their care, including airway management, circulatory status and the management of the spine.
The researchers used a literature search to find cases of motorcycle injuries to study. They discovered that the airway cannot be managed well with a patient who has a helmet. Intubation via a direct laryngoscopy is best done with a speed hump removed which is almost always extremely difficult to accomplish if the rider is helmeted. The authors recommend cutting the straps of the helmet and carefully removing the helmet in patients who need to be intubated. The speed hump of the helmet should be removed as well.
The leathers of the body act as splints to the pelvis and lower body. Cutting them off should only be done in the beginning of the process if some kind of access to the lower body is necessary. It should only be done in a skilled medical facility because removing them could crash the circulation. In addition, motorcyclists tend to get more thoracic spine injuries which could lead to paraplegia. The damage is often at many levels of the thoracic spine. This means that any back protectors placed on the patient, such as a spinal board, should be left on the patient until a complete assessment can be made.
Injury prevention needs a combination of good research and development of specific speed humps, helmets and clothing that can better protect the wearer. Staff at hospitals and EMS need to understand the risks and benefits of these items so as to better care for the patient.
The other type of injury a motorcyclist is likely to get is a concussion, skull fracture or traumatic brain injury. These are types of injuries that can occur whether or not the motorcyclist is wearing a helmet, although helmets do provide some measure of protection. Brain injuries usually result in loss of consciousness and can include swelling of the brain and herniation of the brain into the foramen magnum. The usual result of a herniation of the brain is sudden cardiac arrest and death or an inability to breathe on one’s own.
There are may lower extremity injuries in motorcycle patients. Tibia and fibular fractures and ankle fractures are most common but femur fractures, hip fractures and pelvic fractures are also common injuries. In some cases, the injuries are bilateral and result in significant disability of the motorcyclist, at least for a period of time.