Elsevier

Injury

Volume 38, Issue 10, October 2007, Pages 1131-1138
Injury

Review
Trauma and motorcyclists; born to be wild, bound to be injured?

https://doi.org/10.1016/j.injury.2007.06.012Get rights and content

Summary

Background

Regrettably motorcyclists frequently suffer related significant injuries. Doctors who manage trauma will encounter victims of motorcycle accidents and many aspects of care are unique to these patients due to the protective and performance enhancing equipment used by motorcyclists. This review examines the patterns of major injuries suffered by motorcyclists, the unique aspects of airway, circulatory and spine management, and suggests some interventions, which may allow primary injury prevention for the future.

Data source

Literature searches of the PubMed, EMBASE and Cochrane library with hand searches and author's experience.

Interventions

None.

Data synthesis and conclusions

The airway and (cervical and thoracolumbar) spine cannot be managed effectively in the helmeted patient with a speed hump in place and intubation by direct laryngoscopy is almost impossible with a speed hump in place. Helmets should be removed and the speed hump cut from the leathers. Leathers act as fracture splints, particularly for pelvis and lower extremities. Removal or extensive cutting away of the lower portion of leathers should be considered as part of “circulation”, and only take place in a medical facility and in anticipation of circulatory deterioration.

Motorcyclists sustaining thoracic spinal damage more frequently than cervical and spinal fractures at multiple levels are common. Back protectors are used commonly and these may be left in situ for extrication on a spinal board, but they should be removed in-hospital to allow full assessment.

Injury prevention will require coordinated research and development of a number of key pieces of equipment and design in particular helmets, speed humps and clothing/textiles. In managing the injured motorcyclist in the pre or in-hospital settings, health professionals require greater awareness of the implications of such devices, which at the present time appears largely restricted to motorcycling enthusiasts.

Introduction

Most motorcyclists appreciate that riding a motorcycle is a risky business.17 United Kingdom (UK) figures suggest that a motorcyclist is killed or seriously injured approximately every 665,894 km ridden, compared to 18,661,626 km amongst car drivers8; although this relative risk of 28–1 may be falling with time Fig. 1.6

Therefore, if a motorcyclist attains a riding license aged 17 and rides 13,500 km per year until retirement lifetime risk of death or serious injury approaches 100%.

Doctors who regularly manage trauma will certainly encounter victims of motorcycle accidents and many aspects of care are unique to these patients due to the protective and performance enhancing equipment, which is used by competitive, and increasingly noncompetitive, motorcyclists.

In this clinical review we examine the patterns of major injury suffered by motorcyclists, the unique aspects of airway, circulatory and spine management, and will suggest some interventions, which may allow primary injury prevention for the future.

Section snippets

Methods

A comprehensive literature search in PubMed, EMBASE and the Cochrane library supplemented by hand searching bibliographies of retrieved articles using the keywords above. The resulting narrative review of the typical patterns of major trauma suffered by motorcyclists is supplemented by the author's extensive experiences in pre and in-hospital trauma care.

Interventions

None

Considerations

Motorcyclists typically suffer multiple injuries; head and lower limb/pelvic injuries being the most frequent.1, 14 Head injuries sustained through motorcycling are proportionately more severe than those from other road traffic or sporting accidents.9 Indeed, a motorcycle accident is in itself a predictor of poor outcome in patients presenting with acute severe head injury.31 Unfortunately, injuries sustained by motorcyclists tend to have chronic consequences, particularly following brain

Airway management and motorcycle helmets

Helmets reduce morbidity and mortality, reduce hospitalisation and ICU admission and improve outcome compared to non-helmet users, as well as reducing the financial burden created by motorcycle-related injuries.4, 22, 27 Head injury risk is reduced by around 72%16 and helmeted riders have a higher GCS at presentation3 and at discharge from hospital.23 However, benefit is only gained from wearing type-approved standard helmets (British standard BS 6658:1985 or UN ECE regulation 22.05). In fact,

Techniques for helmet removal

Modern helmets are quite amenable to removal using a bone-saw, since once the hard outer carapace is breached the inner layers are easily dissected, though this can be a time consuming task. If the tools are available, a technique for cutting the chin-bar from the helmet –effectively converting a full-face helmet into an open-face helmet– has been described,5 allowing rapid and definitive access to the airway.

Helmet removal is a safe procedure if performed correctly by experienced personnel5

“Speed humps” during intubation and cervical spine control

There remains a great degree of confusion about the role of speed humps, even within the motorcycling fraternity itself. They were initially conceived to improve the aerodynamics of a helmeted rider in a racing crouch on a competition motorcycle. In some instances they contain data-logging devices to allow race teams to collect information on the various forces acting on rider and motorcycle, and in hotter climates they have been modified to contain fluid. In recent years they have become a

“Total” spine management

While cervical spine control is quite rightly emphasised alongside airway management in modern trauma care,2 in fact motorcyclists sustain thoracic spinal injuries more commonly.12, 25, 26 The mechanism typically involves flexion injury.7, 25 Some workers advocate performing an over penetrated upper thoracic film as part of the “motorcyclist trauma screen”7, although a strong case for CT can be made. Non-contiguous spinal injuries are common, and protocols concentrating on the clearing the

Back protectors

Back protectors have yet to be studied as a protective item, but circumstantial evidence abounds, and almost no competitive motorcyclist participates without one. Back protectors come in a range of designs, but the philosophy is similar between brands.

Essentially they are a piece of armour, either strapped to the body, or attached to the inside of the leathers, extending from the upper thoracic to lower lumbar region. Some designs also incorporate sacral portions or kidney protectors. Back

Circulatory management

Wearing a good quality set of leathers proffers a great deal of protection to the motorcyclist. Despite developments of space-age materials, no synthetic fibre has yet been developed to match the friction resistant qualities of leather. While cow-hide had prevailed, there has been a trend towards kangaroo leather, since it offers similar abrasive-resistant qualities with the benefit of being significantly lighter.

In combination with internal armour and Kevlar reinforcing competition riders have

Summary

All motorcyclists who suffer significant trauma will require helmet removal if only for assessment, and techniques for doing so are described.

The airway and (cervical and thoracolumbar) spine cannot be managed effectively in the helmeted patient with a speed hump in place and intubation by direct laryngoscopy is almost impossible with a speed hump in place. The helmet should be removed and the patient logrolled to the lateral position, where the speed hump can be cut from the leathers quickly

Acknowledgements

We thank Dr Fred MacSorley, Dr David McManus of the Motorcycle Union of Ireland Medical Team for their input.

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