other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Thursday, May 21, 2009

Death on a Motorcycle

He came up the street like a rocket, witnesses said. According to the police, he was riding his motorcycle through downtown streets at more than one hundred miles per hour.

And now he was dead.

We were in the emergency department at the Massachusetts General Hospital when the call went out over the air. A few minutes earlier, we'd transported a pleasant, middle-aged man who seemed to be having his first angina attack. The dispatcher asked if we could handle a call for a motorcycle accident, and at the same time, several police officers sprinted out the door.

I wondered if it was a motorcycle officer who'd been injured.

My partner had put away the equipment we'd used on the previous call. I could write the report later. Sure, I told the dispatcher. We could handle the call.

A few minutes later, we turned onto the street where the collision had happened. The motorcycle lay on its side in the middle of the intersection. It was a big, powerful Japanese bike, the kind used in road racing. Two cars and an SUV had stopped nearby. Each had damage along its side.

According to the 911 caller, the motorcyclist had been trapped beneath the SUV. The EMTs who arrived before us had pulled him out and were strapping him onto an immobilization board. We lifted him straight into the ambulance.

He wasn't breathing. He had no pulses. While my partner prepared to intubate him, I set up the IV equipment. Meanwhile, one of the EMTs started to pump on his chest, while the other cut off the man's clothing. This took a while, since he was dressed entirely in leather. When his torso was finally exposed, I saw scrapes and bruising all over his chest and abdomen. The impact must have been extraordinary.

"There's blood coming out his ears," one of the EMTs said. This was a sign of a skull fracture.

"Did he have a helmet on when you got here?" my partner asked.

"We didn't see one," the EMT said. "I don't know whether he lost it during the collision or not."

"His pupils are fixed and dilated," my partner observed. He didn't have to say anything else, because we knew what this meant. He was already brain dead. We were trying to resuscitate him for nothing.

But we'd already begun, and so we'd continue. We started for the nearest trauma center. My partner talked to a nurse by radio, to let them know we were coming. They were ready for us. A dozen nurses, doctors, and technicians greeted us inside.

"Why would anybody do that?" one of the EMTs asked as the trauma team continued the resuscitation effort. "I mean, going that fast downtown is like suicide."

I didn't have any answer for him. Neither did anyone else. A police officer passed us in the doorway. He looked at me, as if he was about to ask a question, and I already knew what it was, because police officers at hospitals always ask the same question.

"He's not going to live," I told him. "He's dead right now, and he's going to stay dead."

"I'll call Homicide," the officer said.

39 Comments:

Anonymous Beverly said...

How awful, but in the end, he was acting brain dead before he actually became brain dead. I'm appalled at the danger he put others in, he could have killed people. I'd love to see the results of a tox screen.

8:51 AM  
Blogger TS said...

Usually, it's the other way around--the intoxicated person walks away after killing innocent victims.

Not so this time.

8:54 AM  
Blogger Michael A. Burstein said...

Is it possible the driver had a heart attack or something else while driving, and that his foot fell leaden on the accelerator, leading to the crash? Or were witnesses sure that he was driving so dangerously out of volition?

9:27 AM  
Anonymous Matt M said...

How old was the man? It sounds like foolish youth, cut off too soon.

10:08 AM  
Blogger Mr. 618 said...

Mr Burstein, motorcyles have the throttle on the handlebars, so a foot falling would not affect the speed. Also, a cycle requires constant, conscious balancing, which would pretty much rule out a heart attack. I'm speaking as a former cop, not a paramedic.

I suspect it was someone enjoying the senstation of speed and the wind in his hair, and the 'freedom' of thinking his speed and maneuverability would allow him to outrun police and keep him from getting ticketed.

This patient might -- and I emphasize might -- have survived, had he been wearing a helmet. Many riders feel it is a personal choice to wear a helmet, but when they are injured, the massive trauma, especially to the head, often results in medical expenses far beyond whatever insurance the person may carry, leaving all of us to (indirectly) foot the remainder of the bill, leading to higher healthcare costs for all.

10:33 AM  
Blogger Michael A. Burstein said...

Mr. 618, thanks for the information. I wasn't sure if this might be another alternate reason. Last year my wife and I witnessed a car speeding in Brookline that led to a fatal crash in Coolidge Corner. One theory was that the driver might have had a heart attack or something that led to the accident.

And my philosophy is that helmets are an absolute necessity. Interestingly enough, this morning my wife related a story about a young friend of ours, who a few years ago was sideswiped as he rode his bicycle. He hit the ground, and his helmet ended up cracked into two pieces. His head was unharmed.

10:36 AM  
Blogger Last Angry Man said...

The only comment I can make is, "the urge towards stupidity is overwhelming in the human species."

10:37 AM  
Blogger TS said...

Michael A Burnstein:

Highly unlikely. Motorcycles have twist-grip accelerators on the handlebars. When you let go, the engine drops back down to idle. Unlike the driver of a car, a motocyclist isn't going to speed up upon passing out. If anything, he's simply going to fall off. And besides, we could tell from the path this guy had taken that he'd negotiated several turns. An investigation will have to be made, of course, but at this point, everything points toward excessive speed as the cause.

12:35 PM  
Blogger TS said...

Matt M:

Patient confidentially prevents me from giving his exact age. Let's just say that he was certainly old enough to know better.

12:36 PM  
Blogger TS said...

Mr 618:

If I'd seen your comment before replying to Michael A Burnstein's, I could have saved myself some typing. You and I are on the same page.

And while you wouldn't have known this from reading my post--because I intentionally left it vague--I think that he did have a helmet on, but that it wasn't securely fastened and flew off during the impact.

Your point is well taken, though, that if he'd been wearing it properly, it could have saved his life.

12:39 PM  
Blogger Michael A. Burstein said...

TS: Just a reminder; it's Burstein, not Burnstein.

I appreciate your responding to my answer. As you can probably guess, I have no experience with motorcycles.

12:44 PM  
Anonymous mistab said...

A lot of assumptions are being made without sufficient facts...question...why call homicide?..unless it's just protocol as I though homicide was death at the hands of another?

12:57 PM  
Anonymous Anonymous said...

I don't understand why there is a need to call homicide? The guy was driving recklessly it sounds like through busy city streets without even the cheap insurance of a helmet.

Seems like a fairly simple case. No one deserves this fate, but one certainly tempts fate when doing things like this.

12:58 PM  
Blogger Michael A. Burstein said...

I may be incorrect, but I believe homicide is called to the scene of all accidental deaths, just to rule out homicide. (If I'm wrong, I'm sure someone will correct me.)

1:03 PM  
Blogger TS said...

Mistab:

Michael A. Burstein is correct. Notifying the Homicide Unit is purely a procedural matter. In Boston, homicide detectives are notified about virtually every death that occurs outside of a hospital. Different police departments handle these situations in different ways, but that's how it's handled here.

In no way does this suggest that the death occurred as a result of a homicide, or, indeed, that any type of crime occurred.

1:26 PM  
Blogger TS said...

Michael A. Burstein:

Sorry. That was merely a typo.

1:28 PM  
Blogger Michael A. Burstein said...

Yeah, it's a common typo. :-)

Thinking about why homicide would be called out, I started to imagine a scenario where someone cuts the driver's brakes or something like that. It's exactly the reason why we do want accidental deaths investigated, to make sure they really are accidents and not homicides disguised to look like accidents.

1:31 PM  
Blogger Rebe said...

MA still requires motorcyclists to wear helmets. There is a large group that wants the law repealed so it's more in line with NH. You'll often see riders with 'brain buckets' vs. a full face helmets. They are called brain buckets for a reason and aren't much help in an accident. I've also seen the brain buckets with the straps just flapping useless in the breeze, which could possibly be legal.

As a licensed rider for 15 years, I'd never ride without a full face helmet and all my safety gear. It frightens me to see t-shirts, flip-flops and bare hands zooming down the highway.

How this person TS writes about ever thought zooming through city streets was a good idea we'll never know. Personally I'm shocked he even tried.

6:38 PM  
Blogger Fibro Witch said...

Odd that the person wore full leathers on a hot hot day. But forgot the most important bit of protection.

Well I hope he was an organ donor.

7:53 PM  
Anonymous scannerbuff1 said...

Could it have been a deliberate suicide? Doesn't sound that way, given that he navigated the turns, I would imagine a suicidal motorcyclist would just run right into a wall, but his behavior otherwise sounds like suicide. Or maybe a mental health crisis, fit of rage, etc.
I'm glad no bystanders were killed or injured.

8:14 PM  
Blogger Mr. 618 said...

Rebe, last week I saw a couple of girls -- maybe 15-17 years old -- riding a pair of 4-wheel ATVs on a gravel road. They *were* wearing helmets, so good for them... but the only "clothing" they were wearing were bikinis.

8:26 PM  
Blogger TS said...

Scannerbuff1:

Possible, but I doubt it. For reasons that nobody has ever been able to explain to me, we see the same thing all the time--motorcyclists riding like maniacs in the city. Usually it happens later at night, and usually they travel in packs, but for someone to ride out of control, sadly, is not exactly uncommon.

9:27 PM  
Anonymous Anonymous said...

Ah thanks for clearing it up.

I must say I like how there's a little commenting community here. Good people!

10:13 PM  
Blogger Linda said...

I am a bit confused as to why the cops would call homicide for a fatal motor vehicle accident? Stupidity, for all that it should be, is not a crime that I know of yet.

9:04 AM  
Blogger TS said...

Linda:

In Boston, the Homicide Unit is notified about every out-of-hospital death, purely as a procedural matter. In no way does this suggest that a crime has been committed. You're not alone in being confused by this. Take a look at the comments left by previous readers. Several other people asked the same question.

10:05 AM  
Blogger TS said...

Anonymous:

I like that, too! My favorite part of doing this blog is seeing the comments left by readers. I especially like it when something is controversial enough for one reader to leave a comment for another reader.

10:07 AM  
Blogger TS said...

Additional comment to Scannerbuff1:

I meant to tell you that I agree totally with your analysis of the turns. That was one of the first thing that came into my mind, too--that someone trying to crash on purpose wouldn't have bothered with all those turns.

What usually seems to happen is that motorcyclists (and drivers of sports cars, too) seem to overestimate their own driving skills. They roar through the city, thinking they are in control, when actually they're not. Only when they crash do they suddenly realize that they shouldn't have been going so fast. I'm pretty sure that's what happened here.

10:11 AM  
Blogger TS said...

Additional comment to Scannerbuff1:

I meant to tell you that I agree totally with your analysis of the turns. That was one of the first things that came into my mind, too--that someone trying to crash on purpose wouldn't have bothered with all those turns.

What usually seems to happen is that motorcyclists (and drivers of sports cars, too) seem to overestimate their own driving skills. They roar through the city, thinking they are in control, when actually they're not. Only when they crash do they suddenly realize that they shouldn't have been going so fast. I'm pretty sure that's what happened here.

10:13 AM  
Blogger Last Angry Man said...

"Only when they crash do they suddenly realize that they shouldn't have been going so fast."

A modest problem involving momentum and inertia. The bike suddenly stops; they do not, with predictable results. This is how my old friend, "Mister Butch" died in 2007, doing a header into a light pole at 50mph.

Motorcycles are deathtraps.

10:19 AM  
Blogger Gábor said...

It's a sad story. Unfortunately I find that even though 99% of people here wear helmets, a surprising amount don't strap it up which means it's practically of no use. Another fraction of those use "clip" straps, i.e. basically normal buckles when in reality all motorbike helmets should come with the D-rings system - any clip system is bound to break during a crash while D-rings are much more simple and resistant. Great story, I love the blog (I'm the one who just sent you the email in case you're wondering), I read it every day.

5:12 PM  
Anonymous Anonymous said...

Do they make you write a report on every single call? I can see requiring a report for a car accident, suicide, assault or other call that will be investigated by Police. And I can see requiring a report if the patient died in the ambulance or for any call with a high risk of a complaint being filed, for EMS administration purposes. But I can't see why you need to write a report about the "middle age man who had his first angia attack". Not something that will be investigated or is a major EMS event. Why is a report needed for all the routine calls? And how long are they/ how long do they take to write? Maybe that's the solution to the ambulance availability crisis- stop making EMTs and Paramedics write reports on minor/routine calls that the report isn't needed for.

9:27 PM  
Blogger TS said...

State law requires us to complete a report on every call involving a patient. So, if the police arrive first, and the officer says over the radio, "Cancel the ambulance. This man doesn't want to be evaluated," we don't have to write a report. But if we get to the scene, and take the blood pressure of an uninjured man who "just wants to be safe," then yes, we have to write a complete report about that.

You raise a fantastic point about the extent to which this ties up ambulances. In the past, city policy allowed us to take whatever time was necessary to write the report. But in an effort to comply with the law, and to keep ambulances available for calls, Boston EMS has adopted a new policy that says, essentially, "Do the calls first, and write the reports later."

Unfortunately, some crews are so busy that they have 6 or 7 unwritten reports at the end of their shift. To them, the city says, "Too bad. You're staying late. We'll pay you overtime, but you're not going home until those reports are done."

Great question.

9:56 PM  
Blogger Last Angry Man said...

Anonymous, this is pervasive across the medical field(s). As a (former) Biomedical Engineer (Medical Electronics), I could not change a fuse without documenting it six ways from Sunday.

10:49 PM  
Blogger brendan said...

Did the EMTs not realize he was a trauma code? I was under the impression that BEMS didn't work blunt traumatic arrest. Obviously once he's in the truck your hands are tied, but I wouldn't have thought it would even get to that point.

10:54 PM  
Blogger TS said...

Brendan:

No, they didn't. None of us did. It was dark, and the patient was wrapped in several layers of leather gear from top to bottom, and he was stuck beneath a vehicle with a bunch of debris. There was no easy way to determine what kinds of injuries he'd sustained, and whether he had any pulses or breathing. Since they couldn't be certain about any of these things, the EMTs made a decision to ventilate him as soon as they could. That, I think, was a prudent course of action.

By the time we moved him into a position that allowed us to check for pulses and survey his injuries, ventilation had already been going on for a minute or more. At that point, it made more sense to continue the effort than to justify stopping it.

Keep in mind, too, that the Preshospital Traumatic Cardiac Arrest Treatment Protocol allows us to withhold resuscitation from certain patients, but doesn't require it. When it doubt, it's always better for everyone to initiate CPR. And that's what happened here.

10:28 AM  
Anonymous Anonymous said...

I would also be curious to see the toxicology report. My guess is that if alcohol wasn't a factor in his poor judgement, then testosterone was.

Someone who wears full leathers would seem far more likely to be wearing a high end $500 helmet than no helmet at all. No helmet is more the realm of a youthful tank top clad squid.

Last, please do not make the easy mistake of assuming he represents all motorcyclists (just as the wifebeater does not represent all husbands). Though people like him are highly visible, they are but a subset of the general motorcycling population.

7:31 PM  
Blogger TS said...

Anonymous:

I didn't smell any alcohol on his body, although, of course, that doesn't necessarily eliminate the possibility of intoxication.

Similarly, I didn't see his helmet, but that doesn't mean he wasn't wearing one. As I've said previously, we do see a fair number of irresponsible motorcyclists in this city. One thing all of them seem to do, however, is wear helmets. I'm not sure that I've ever responded to a motorcycle collision in Boston where the rider wasn't wearing one.

And, no, I do not assume that this guy represents all motorcyclists. I never said that, and I don't think I've said anything in my post or in subsequent comments that would suggest such a thing.

By the way, for the record, while I don't own a motorcycle currently, I've owned two in my life. I have nothing against motorcycles or those who ride them.

9:51 PM  
Anonymous Anonymous said...

I don't think they meant to imply that you do think this person represents all motorcyclists - though, it is how we (motorcyclists) get acclimated to speaking. I can't count the number of times I've had someone say to me something to the effect of "I can't believe you guys (or "all of you", or "you and other bikers", etc) ride at 100mph with no gear on." People have a tendency to make generalizations based on specific events. Not to imply that you were -- just making sure that no one, in general, was making that particular assumption.

I do have to agree though that someone in full leathers would more than likely have a fairly decent helmet on as well. The fact that the helmet wasn't seen (or found?) however, is a testament to the speed and force of impact of the accident.

Always hate to see stuff like this happen.

10:31 AM  
Blogger TS said...

Fair enough. Thanks.

10:36 PM  

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