Uneasy Rider

An injured bicyclist insists his bike come with him—what's a crew to do?

   There are calls where the complexity of patient care cannot easily be predicted. "Person injured in a bicycle accident" is one of them. Attack One is dispatched with that information, and nothing else, to a rural road, where the crew prepares to find a major trauma patient. They are instead fortunate to find a single victim, helmet in hand, his intact bicycle a few feet away. As the crew arrives, he is talking with a single bystander who came upon the rider and parked his car to shield the man from traffic as he waited.

   The victim is on his knees, moving his head from side to side and trying to find a position comfortable for his obviously injured right shoulder. He is wearing the gear of an experienced cyclist, with a rugged helmet and expensive but now damaged biking suit, and taking a drink from his water bottle. He thanks the crew for arriving promptly and reports that his right shoulder is hurting badly, but he believes that is the only damage he sustained.

   It is about 0800 hours and still cool, but he is sweating profusely...or is he diaphoretic?

   The man is 45 and says he was in the middle of his "sprint workout" when he hit a large pothole. He ejected over his handlebars and landed on his right shoulder. His helmet hit the ground, but he denies any head or neck injury. The helmet bears a confirmatory scratch down the right side. He denies shortness of breath, abdominal pain, nausea or leg pain. He says he's sweating because he'd been working out so hard before the accident occurred. He remembers all details of what happened. The bystander confirms the victim was alert on his arrival, and was asking for his water bottle because of his workout.

   But his right shoulder is a mess. He's torn his shirt, obviously broken his collarbone, and may have dislocated his shoulder. He's found a position on the ground where the bone edges of the broken clavicle don't grate against each other, and that allows him more comfort.

   The crew clears the cervical spine per protocol and determines the man does not require immobilization. They offer to support his arm for comfort while he rolls over, and have a sling available to immediately immobilize his injured shoulder. They prepare to put a chemical ice pack on his arm. But the bystander offers a bag of ice from a cooler in his car, which can deliver a colder compress for longer. The crew asks the man to prepare that for the patient. One of the EMTs then supports the patient's shoulder as he rolls upward and is placed on the cot, and in one motion they cut off and remove his shirt and tie the sling in place. They ask him to find his position of comfort and put the bag of ice on his shoulder in whatever way best reduces his pain.

   The crew completes its head-to-toe evaluation, loads the patient into the medic, and again asks him to find a position that minimizes his pain. He adjusts his sling and the bag of ice, and the crew moves to close the door.

   "Wait!" the patient cries. "You have to put my bike in here with me! That's a $6,000 bike--you can't leave it on the side of the road. Put it on top of me if you need to!"

   The bike is, in fact, still on the road, and this is a problem. The bystander has a small car, law enforcement hasn't yet arrived, and there are no houses nearby to store it. The patient has no friends or family within 30 miles of the scene. That makes it impossible to reassure him the bike could be safely left for pickup by the side of the road. But there's also no way the bike will safely fit in the passenger compartment.

   "Sir," the paramedic says, "we have a policy that says we can't transport bicycles on the roof of the ambulance. But we can have your bike taken to the hospital on the canvas hose cover of the first-response fire engine. Would you agree to that?"

   The patient does, and the bike goes to the hospital on the engine. The emergency department staff is prepared for both arrivals--while the patient is in the ED, the bike will be locked up at the EMS entrance by hospital security.

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