September 10, 2012
By Ryan Ford
The first EMS motorcycle response unit—two paramedics on donated BMW G 650’s dual-purpose motorcycles fully equipped with sirens, lights, and standard ALS medical equipment—was deployed with great success at the Austin Marathon in February 2009. In the spring of 2011, ATCEMS added a highway program, which focuses MRU response to accidents and any other medical emergencies along the heavily congested I-35.
When on highway duty, MRU teams wait at their staging points for three hours in the morning and three hours in the afternoon during rush hour times; the units average about five calls per shift. MRUs regularly arrive in enough time to assess the patient and either downgrade incoming units or prepare the patient for ambulance transport.
“Whether used on highway duty or at special events, they act as a force multiplier (to borrow a military term),” Chief Jakubauskas said. “Their presence enhances our current operations and provides a better service to citizens.”
Emergency motorcycle response offers dispatch flexibility in responding to calls that have a low likelihood of patient transport. This makes patient triage through MPDS an ideal tool for determining whether to dispatch a MRU, ambulance, or both. Motorcycles are especially well-suited for many ALPHA- and OMEGA-level calls when transport is unlikely. In lieu of dispatching an ambulance, a single paramedic on a motorcycle can assess the patient, render care, and secure a patient refusal for transport far more efficiently than an ambulance crew. Motorcycle units responding to “lighter duty” also leaves ambulances available for more urgent calls.
ATCEMS is dispatched through a central agency, Combined Transportation and Emergency Communications Center (CTECC), which classifies them as ALS units without the obvious transport capabilities. The paramedic rider has the tools, equipment, and supplies necessary to handle triage and many less severe injuries. If transport is needed, motorcycle paramedics attempt to stabilize the patient in anticipation of the emergency vehicle’s arrival.
At special events, CTECC notifies the designated commander who coordinates the movement of special units reserved for the event (motorcycle, bicycle, ATV, ambulance). The versatility of motorcycles is a definite asset since they can navigate thick crowds attending one event, cover great spans of area in another, and even go off road for patients that may be in more remote, inaccessible locations.
During highway operations, MRU teams are CTECC tracked with the automatic vehicle locator built into each motorcycle. Motorcycles are manually placed on the call and dispatched in tandem with the first ambulance due for that location. Austin’s MRUs can downgrade incoming units although they never handle the situation independently.
Advantages of motorcycle EMS include mobility, speed, and the lower operating cost of motorcycles compared to ambulances. A motorcycle can ride the shoulder or weave in between vehicles to reach a traffic crash minutes before an eight-foot wide ambulance is able to make its way through heavy traffic. The patient receives help faster.
Chief Jakubauskas estimates ATCEMS motorcycle units arrive on scene to highway incidents an average of 1 minute before the ambulance. The time saved is typically greater during special events like the Austin Marathon. Dr. Mencl, in his presentation at the EMS Safety Summit, showed Australian motorcycle EMS response times are an average 4.5 minutes below the average response time for an ambulance crew. According to Dr. Mencl, during the same talk, motorcycle response was less than three minutes for lifethreatening calls compared to six to eight minutes with an ambulance.
A study published in the American Journal of Emergency Medicine (A method to reduce response times in prehospital care: the motorcycle experience, 1998 Nov;16(7):711-3) arrived at similar results. “During rush hours [in Taipei, Taiwan, a densely populated urban area], the response times of the BLS motorcycle and ALS ambulance were 4.9+/-3.0 minutes and 6.3+/-3.4 minutes, respectively, and in non-rush hours, 4.2+/-2.1 minutes and 5.1+/-2.5 minutes, respectively. Using motorcycles to transport EMTs to the emergency scene significantly reduced response time compared with a standard ambulance in a congested urban setting.”
Sending a MRU costs less than ambulance response. A study in Oslo, Norway, revealed the hourly operational cost of dispatching a MRU was 61% less than an ambulance (Nakstad et al, 2009). The authors of a study published in the Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine (2009 17(1):9) concluded that ambulance use was avoided in 23.5% of all motorcycle responses. Treat and release is more likely to occur when the motorcycle medic responded irrespective of complaint, except for the elderly who are more likely to be transported irrespective of response mode, according to Dr. Mencl.
Since responder safety is paramount in EMS, some skeptics may be quick to dismiss motorcycles units because of perceived risks. The accident rate, however, is lower than one might expect. According to a 2008 report in Portugal by Kiefe & Soares-Oliveira, only 12 MRU paramedics were involved in traffic accidents over the course of 30 months and 3,626 calls. Each accident involved just the MRU and only three paramedics were injured. Of those three, only one injury was considered serious due to a broken femur. ATCEMS has had three minor incidents and no injuries in the past three years of operations. Two accidents were merely scratched paint but recorded nonetheless.
Chief Jakubauskas attributes lower operating speeds to relatively minor accidents when they do occur. “A paramedic will likely be operating a motorcycle through crowds at a special event or congested traffic at a much lower speed in comparison to a police motorcycle unit that must keep up with or even exceed the speed limit in the course of duty,” he said.
Even so, Chief Jakubauskas stresses safety equipment and sound training as the most important elements in planning a MRU program.
Motorcycle paramedics require advanced safety training and ATCEMS follows the typical training regime police riders receive: 80 hours (2 weeks) of initial training followed by regular refresher courses. Austin is the first city to send a paramedic to certify as a motorcycle instructor, which eliminates the need to outsource training and allows ATCEMS to cater its training specifically to the needs of its EMS motorcycle operations.
Chief Jakubauskas estimates 10 to 12 agencies have approached him for information and ideas about how to start similar programs. He stresses the importance of networking, finding grants or donations to help cover initial costs, and making safety and training the program’s centerpiece. Overall, he is optimistic about the future of his department’s EMS motorcycle program and believes other cities will soon follow.
Whether a MRU will be coming to your town any time soon depends on three factors. The first two are climate and population density.
If you’re reading this article from a dispatch center in a large southern city, your odds of seeing MRUs implemented are much greater than, say, a small town in Maine. There’s a role for them in northern cities, but they’re limited by inclement winter weather. Areas with a larger population typically have greater problems with traffic congestion, which is where the most utility is found with a motorcycle unit.
The third factor is culture.
A MRU program requires leadership willing to risk the investment of money and personnel. It also requires advocates within the department with enough clout to champion the program. However, as Chief Jakubauskas pointed out, it’s yet to be seen if this trend will take hold in the United States like it has internationally.
If a few more cities can soon follow the lead of Austin, Miami, and Pittsburg, others may indeed find their center dispatching this latest addition to the EMS fleet.
What Is Moral Injury?
Causes and effects of moral injury in the dispatch environment
AED Use In Infants
Emphasis should be on ventilations and compressions initially