Scenario one ~ Allison Hooley

The motorcyclist is more vulnerable and more likely to suffer severe injury and death in an accident due to the exposed position of the rider. Motorcycles are much smaller than other modes of transport. Although helmets can decrease the probability of sustaining a head injury, head injuries are still the primary cause of death and prolonged disability post incident.When a motorcycle is struck by another vehicle, the force absorbed by the bike and rider can be immense leading to traumas such as broken bones and head injuries. When a person suffers severe physical injury in a traumatic event, there are often psychiatric injuries also. (Feliciano et al 2008).

The major factors contributing to the likelihood of a crash include speed, vehicle instability, braking deficiencies, inadequate road design and alcohol or drug intoxication. Add to this rider inexperience and riding at night and most of the risk factors are present in the scenario being discussed.

Statistics

In 2005, motorcyclists accounted for 18 % of road fatalities.

In 2006 there were 599 fatalities and 6484 seriously injured motorcyclists on the UK roads.

In 2007, 9 out of 10 motorcyclists were men.

The prominent age category for motorcycle casualty rates is 17-19.

In 2007, there were 23, 459 motorcycle casualties, 561 fatalities and 6737 seriously injured.

In 2007, there were 541 male fatalities and 20 female fatalities.

In 2007, in the county of Cornwall there were 82 killed or seriously injured motorcyclists.

Motorcyclists account for 1 % of road users

70 % of motorcycle fatalities occur in rural areas.

Males (young men in particular) have a higher incidence of RTA’s.

Subdural haematoma accounts for 20-40 % of severe head injured patients.

Males have a higher incidence of urethral injury (15 %) than females (6 %).

Compression injuries have a strong association with intra-abdominal injuries.

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Alcohol is proven to be a contributing factor in RTA’s although recreational drug use has some effects on the standard of driving, I have not uncovered any firm research to prove that it is a direct causative factor.

(DoT, 2007) (DoH, 2005)

Trauma injuries

The resulting injuries and their severities are determined by the mechanism of injury, speed of impact, helmet use, protective clothing and the source of impact for example frontal or lateral. There are two types of trauma injury, penetrative and blunt trauma, the latter being the more complex due to the energy transfer and application of forces. The motorcyclist is more likely to experience blunt trauma with the initial impact. Blunt traumas can cover multiple areas of contact where the impact is the greatest force sustained and the energy then disperses over a larger area which causes injuries such as compression and internal injury to solid organs which have sustained continuous movement which can include lacerations to the liver and spleen in particular. . (Feliciano et al 2008).When the motorcyclist is ejected from their machine, penetrative injury may occur. This could be due to the rider impacting with another vehicle, their own machine, road signs and posts. Amputation is another injury sustained if the rider has a lateral impact.

Types and explanations of injuries

Most commonly reported is Head Injuries

Charlotte will uncover the evidence.Alcohol will have a significant outcome on the mortality/mobidity rate of patients with a head injury as it is a blood vessel dilator. This effect can be catastrophic in a patient with a brain haemorrhage as shock is more likely and there will be widespread blood loss.

Gravel or Road Rash

Road rash is the reference given to the loss of skin when a rider is in contact with the road surface and clothing has been ripped away during the force and impact. This type of injury can lead to a mass loss of fluid due to blood and lymph.

Bilateral testicular dislocation

This occurs due to the force impacted on the lower abdomen usually by the fuel tank. This forces the testes out of place and into the abdomen. This can happen without the urine showing signs of blood. Severe swelling in the area can hid signs of injury and hinder diagnosis. Infertility can result.

Allison Hooley

Bruised or ruptured spleen – The spleen being the largest of the lymph organs is located on the left side of the abdomen around 12cm in length and 7cm wide weighing approximately 200g. It is rich in blood containing up to 350mls and consists of a network of vessels and lymphatic tissue. The spleen breaks down old blood cells, leukocytes and microbes and the breakdown products such as bilirubin and iron are passed to the liver via the splenic and portal veins. The spleen and liver are important sites of fetal blood cell production. In cases of haemorrhage, the spleen can return much of this volume back into the circulation to raise blood volume. In our scenario case, the spleen has been bruised, small blood loss may occur. If the spleen had suffered major trauma, a splenectomy would be carried out. This is contraindicated in a child as the spleen has a important role in blood cell formation and the vulnerability to sepsis. The functioning of the spleen in an adult can be successfully compensated for by the liver. (Driscoll et al, 2000) (Marib, 2006).

Fractures - Fractures in motorcycle crashes commonly occur in legs, arms, clavicles, wrists, knees, ankles, sternum, pelvic region and the cervical spine area. Fracture types depend on the mechanism of injury, whether sliding and impacting on an object, or a limb trapped resulting in a spiral type of fracture.There are 3 types of bone, classified as long, short, irregular, flat and sesamoid. Examples of long bones include the femur, tibia,fibula, radius and ulna. Short bones are found in the wrists and ankles, irregular bones refer to the vertebrae, flat bones include the sternum, ribs and most skull bones and the sesamoids are the patellas. The bones consist of connective tissue surrounded by collagen fibres. The centre of the bone contains the bone marrow, red marrow responsible for producing the blood cells and yellow marrow which is fatty connective tissue. Bones have the capacity to regenerate and continue to develop until the approximate age of 21 meaning that our scenario character has the potential for good fracture recovery. (Waugh & Grant, 2001).

A fractured pelvis is commonly associated with motorcycle crashes due to the high energy blunt trauma often suffered by the lower abdomen on the tank of the motorcycle. This type of injury is known as anterior compression which is common in head on crashes. The mortality rates overall from pelvic fractures resulting in uncontrolled pelvic haemorrhage is 39 %. If pelvic fracture is suspected, immediate treatment of pelvic stabilisation takes place with either sheets wrapped tightly around the pelvic area or external fixator devices to minimise haemorrhage and thus reducing the chances of developing shock. Nerve dysfunction (sciatic nerve injury) may persist even after reduction and fixation of a pelvic fracture. Due to the high energy force necessary to fracture the pelvic ring, associated injuries include damage to the urethra and bladder. Male riders are more susceptible to urethral injuries than females due to the extended length and mobility of the urethra. Bladder injuries are classified as extraperitoneal, caused by direct injury from fragments or shearing forces near the base of the bladder or intraperitoneal, classified as occurring from blunt trauma to a distended bladder. 80 % of bladder trauma

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is extraperitoneal. Diagnosis is confirmed following a CT cystography. (Thorton, 2007).

Short and long term complications with bone fractures particularly pelvic fractures may include; wound infection or abcess formation in the pelvic cavity, urinary tract infections, fixation device infection, thromboembolic disease potential due to temporary immobility and DVT in lower extremities, pain, osteoarthritis and malunion/non-union of the pelvis which could result in leg length discrepancies and gait abnormalities.

Other injuries uncovered

My reading around the subject has uncovered many possible types of injuries that have been sustained in motorcycle crashes. The list is exhaustive and includes from one paper alone;

Fractured right femurLacerated scrotumLoss of testicleOpen book fracture of the pelvisMassive internal haemorrhage requiring 60 units of bloodSubluxation of both thumbsFractured pubic ramiSacro-iliac dislocationRuptured urethraFractured left ribsRight haemo-pneumothoraxCerebral irritation(Thomas, 2007)

Consideration should be given to the scenario character in relation to the correct method of dealing with this type of incident and the positioning of the unconscious patient at the accident scene and in the hospital setting who will not be able to advise of their pain. Christie (2008), states that;

“the therapeutic benefits of positioning should not be underestimated in care of the multiply injured trauma patient”.

Shock

Shock can take various forms such as anphylatic, cardiogenic, neurogenic and hypovolaemic. Our scenario character would most likely suffer from hypovolaemic shock caused by external bleeding, internal bleeding or both. External bleeding can be stemmed with pressure but internal blood loss can be directly attributed to mortality as only a clinical diagnosis can be assumed by a health professional. Major blood loss typically occurs from the following 5 sites;ChestAbdomenPelvis

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Long bone fracturesExternal haemorrhage

Public health interventions

Young riders have always shown to be a high risk category for accidents therefore in 1983 the cc (engine capacity) for learner riders was reduced from 250 cc to 125 cc in a bid to reduce casualties. This led to a estimated reduction of 25 % in motorcycle casualties.

‘Killspills’ was founded in 2003 by two bike forums to tackle the issue of diesel spills. Available at http://www.bmf.co.uk/pages/bmf_main_pages.php?main_page_id=704

The department of transport lauched a “Think” campaign for 2008 aimed at all road users but has a specific section applicable to motorcyclists. Available at www.thinkroadsafety.gov.uk/campaigns/motorcycles/motorcycles.htm

Bikesafe initiative run by police forces across the country in a bid to teach safer riding practices to all age groups with their own machines. The scheme has been running since the early 1990’s supported by the association of chief police officers. The day course takes in theory and accident prevention followed by an assessed ride by a police motorcyclist. There is a small fee for the day but courses run in Cornwall are free in an attempt to cut the higher than average casualty rate.Available at www.bikesafe.co.uk andwww.devon-cornwall.police.uk/v3/roadsafe/motorcyclists/bikesafe/index.htm

Allison Hooley