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Original article
Medical emergency motorcycles: are they safe?
Cláudia C. Kiefe and Miguel Soares-Oliveira
Objective Ambulances in emergency medical services
(EMS) might be supplemented or supported by vehicles
that lack the capacity to transport a patient, especially in
crowded urban areas. This paper addresses the safety of a
first-response vehicle, the medical emergency motorcycle
(MEM), which is driven by an emergency medical technician
provider. We analysed the number of crashes, as well as
the incidence and nature of injuries sustained.
Material and methods A prospective study was conducted from July 2004 to January 2007. Administrative data
were collected over this period regarding MEMs operating
in a metropolitan EMS group who had responded to 3626
calls. The MEM responders use limited equipment to
perform initial assessments and interventions (basic life
support and defibrillation). Undergoing an emergency
driving course and wearing protective equipment are
mandatory. We analysed the number of crashes, the proper
use of the protective equipment, and the type and severity
of the injuries sustained.
Results Accidents included 12 (n = 12) motorcycle falls,
resulting in three injured MEM drivers. No fatality was
registered. One serious injury and two slight accidents
Introduction
Emergency medical services (EMS) encompass a wide
field of people who respond to emergencies in many
areas. To guarantee a fast and efficient response many
different strategies have been suggested [1–3]. Ambulances can be supplemented or supported by vehicles that
might lack the capacity to transport a patient, but are
adequate as first responders, especially in crowded urban
areas [4,5]. This paper addresses the safety of a first
response vehicle – the medical emergency motorcycle
(MEM) – by analysing the number of MEM crashes, as
well as the incidence and nature of injuries sustained.
occurred. One victim presented a dental trauma and
another presented minor abrasion skin lesions. The third
sustained a femur fracture. The first and second victims
had not been using the protective equipment properly.
Conclusion MEMs can impart a quick and efficient
response to EMS services in urban areas, if managed with
acceptable levels of safety. Defensive driving courses as
well as correct use of personal protective equipment can
improve security. European Journal of Emergency Medicine
c 2008 Wolters Kluwer Health | Lippincott
15:40–42 Williams & Wilkins.
European Journal of Emergency Medicine 2008, 15:40–42
Keywords: emergency medical service (EMS), emergency motorcycle,
safety
Instituto Nacional de Emergência Médica (INEM) (National Medical Emergency
Institute), North Delegation, Porto, Portugal
Correspondence to Miguel Soares de Oliveira, MD, Regional Director,
Instituto Nacional de Emergência Médica (INEM), Delegação Norte,
Rua Alfredo Magalhães, 62. 4000-063 Porto-Portugal
Tel: + 351 222065029; fax: + 351 222065010; e-mail: [email protected]
Received 19 April 2007 Accepted 20 May 2007
ing includes airway oxygen and ventilation skills – upper
airway adjuncts; handling bag-valve-mask-apneic patients; bleeding control/shock management; cardiac arrest
management/automated external defibrillators (AED);
immobilization skills – joint injury, long bone injury,
traction splinting; mouth-to-mask with supplemental
oxygen; oxygen administration; and patient assessment
– medical – trauma.
A defensive emergency driving course of a duration of 8 h
(theory and practice) is mandatory. A minimum of 2 years
of experience with motorcycle riding is required before
applying for the course.
Materials and methods
A prospective study was conducted over a 30-month
period from July 2004 to January 2007. Data were
collected over this period regarding the MEM service
operating in a metropolitan EMS system in the second
biggest city of the country. In this period, the MEM had
received 3626 calls.
The MEM responders use limited equipment to perform
initial assessment and intervention. They provide atscene cardiopulmonary resuscitation (CPR); their train-
Individual protective equipment encompasses a helmet; a
jacket with elbow, shoulder, and back protection; trousers
with knee and leg protection; and protective gloves. In
addition to the protective suit described, it is also
mandatory to use reflector material (Fig. 1). Use of all
the protective equipment during the entire shift is
obligatory [5].
The vehicles currently used are Honda Transalp 650 and
BMW 650 GS. Every crash is recorded in a specific
c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
0969-9546 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The medical emergency motorcycles Kiefe and Soares-Oliveira 41
Fig. 1
crashes. Although 12 single vehicle crashes were reported,
nine sustained property damage only. No fatal injury nor
accident was registered; one serious injury and two slight
accidents occurred.
The first victim sustained a limb (femur) fracture, which
was given surgical treatment with functional intraosseous
synthesis; 13 months later he presented no physical
impairment. The second victim presented a dental trauma
and was subjected to dental fracture repair; the third
victim presented minor abrasion skin lesions (knees).
Analysis of the data on motor vehicle crashes and crashrelated injuries revealed that the first victim had worn the
appropriate protective equipment, the second victim had
not used the helmet in an appropriate way, and the third
had not used the protective trousers.
Discussion
Medical emergency motorcycle (MEM) rider with personal protective
gear (helmet, jacket, trousers, boots, gloves, and reflector material).
information sheet and each victim is referred to an
emergency department for consultation. The information
sheet is filled in by a single person, who is responsible for
the maintenance of all the emergency vehicles, at the
scene immediately after the accident. Data from the
accident and medical data were collected and analysed.
The crashes were classified according to the National
Highway Traffic Administration (NHTSA) categories and
the injuries according to the Organization for Economic
Cooperation and Development – International Road
Traffic and Accident Database (OECD–IRTAD).
The development of an EMS system is a challenging task
for the various components involved. Response time is a
very important factor in determining the quality of
prehospital EMS: rapid access to definitive care is a
fundamental tenet of emergency care and forms the basis
for current emergency medical and trauma systems.
MEM rescuers, with their shorter response times, enable
medical treatment to begin before the arrival of the
ambulance or other specialized rescue teams. Additionally, they can be very useful in situations that the
Dispatch Centre had, by telephonic triage, excluded as an
urgent need for medical care. These two main situations
raise the importance of the MEM in an EMS [4–13].
Motorcycles are by their nature far less crashworthy than
closed vehicles. They are also less visible to other drivers
and pedestrians and are less stable than four-wheeled
vehicles. Operating a motorcycle requires a different
combination of physical and mental skills from that used
in driving four-wheeled vehicles. Motorcyclists and their
passengers are more vulnerable to the hazards of weather
and road conditions than drivers in closed vehicles. As no
one can predict accurately the nature of the hazards
MEM rescuers might have to face, this can place EMS
organizations in a bind: is it safe (enough) to include
MEMs in an EMS system?
In total, 10 emergency medical technicians are currently
enrolled in this service. All of them also work in
ambulance shifts on a regular basis.
The results of this analysis support the idea that if there
is a proper selection of skilled motorcycle riders, specific
training on defensive emergency motorcycle riding, and
adequate use of protective equipment, the crashes can be
minimized and their physical consequences reduced.
Results
References
The information gathered registered a total of 12 (n = 12)
motorcycle falls, resulting in three (n = 3) injured MEM
drivers, while responding to a total of 3626 calls (3/3626,
0.0008%). All motorcycle crashes were single vehicle
1
2
Pons PT, Haukoos JS, Bludworth W, Cribley T, Pons KA, Markovchick VJ.
Paramedic response time: does it affect patient survival? Acad Emerg Med
2005; 12:594–600.
Vukmir RB. Survival from prehospital cardiac arrest is critically dependent
upon response time. Resuscitation 2006; 69:229–234.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
42 European Journal of Emergency Medicine 2008, Vol 15 No 1
3
4
5
6
7
8
Peleg K, Pliskin JS. A geographic information system simulation model of
EMS: reducing ambulance response time. Am J Emerg Med 2004; 22:
164–170.
Lin CS, Chang H, Shyu KG, Liu CY, Lin CC, Hung CR, Chen PH. A method
to reduce response times in prehospital care: the motorcycle experience.
Am J Emerg Med 1998; 16:711–713.
Soares-Oliveira M, Egipto P, Costa I, Cunha-Ribeiro LM. Medical emergency
motorcycle. Has it a place in a medical emergency system? Am J Emerg
Med 2007; 25:620–622.
Papaspyrou E, Setzis D, Grosomanidis V, Manikis D, Boutlis D, Ressos C.
International EMS systems: Greece. Resuscitation 2004; 63:255–259.
Riley P. Motorcycle medics. JEMS 2000; 25:32–41.
Spivak M. Motorcycle medics. Delivering patient care from the back of a
bike. Emerg Med Ser 1999; 28:22–24.
9
10
11
12
13
Gomes E, Araújo R, Soares-Oliveira M, Pereira N. International EMS
systems: Portugal. Resuscitation 2004; 62:257–260.
Key CB, Pepe PE, Persse DE, Calderon D. Can first responders be sent to
selected 9-1-1 emergency medical services calls without an ambulance?
Acad Emerg Med 2003; 10:339–346.
Woollard M. Emergency calls not requiring an urgent ambulance response:
expert consensus. Prehosp Emerg Care 2003; 7:384–391.
Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, et al. Safety of
telephone consultation for ‘non-serious’ emergency ambulance service
patients. Qual Saf Health Care 2004; 13:363–373.
Marks PJ, Daniel TD, Afolabi O, Spiers G, Nguyen-Van-Tam JS. Emergency
(999) calls to the ambulance service that do not result in the patient being
transported to hospital: an epidemiological study. Emerg Med J 2002;
19:449–452.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.