Original Contribution

Emergency motorcycle: has it a place in a

medical emergency system?
Miguel Soares-Oliveira MD
*
, Paula Egipto MD,
Isabel Costa RN, Luis Manuel Cunha-Ribeiro MD
Instituto Nacional de Emergencia Medica (INEM) R Dr Alfredo Magalhaes, 62, 4000-063 Porto, Portugal
Received 7 September 2006; revised 3 November 2006; accepted 12 November 2006
Abstract
Introduction/Aim: In an emergency medical service system, response time is an important factor in
determining the prognosis of a victim. There are well-documented increases in response time in urban
areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift,
alternative measures to achieve this goal should be addressed. We report our experience with a medical
emergency motorcycle (MEM) and propose major criteria for dispatching it.
Material and Methods: This work presents a prospective analysis of the data relating to MEM calls
from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and
need for subsequent transport. A comparison was made of the need to activate more means and, if so,
whether the MEM was the first to arrive.
Results: There were 1972 calls. The average time of arrival at destination was 4.4 F 2.5 minutes. The
main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of
hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases
(18%), there was no need for transport.
Conclusion: The MEM can intervene in a wide variety of clinical situations and a quick response is
guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of
emergency vehicles. We propose that it should be dispatched mainly in the following situations: true
life-threatening cases and uncertain need for an ambulance.
D 2007 Elsevier Inc. All rights reserved.
1. Introduction
Survival from cardiac arrest is dependent on response
time. Benefits have been demonstrated with lower response
times [1,2]. Thus, prehospital emergency care should be
efficient and swift. The usual traffic congestion in larger cities
means that achieving these objectives is somewhat affected
when traditional medical emergency vehicles are used [3,4].
Medical emergency motorcycles (MEM) are used in
several countries, although few results have been published
to date, and they may provide advantages in the provision of
prehospital emergency medical care, by reducing response
times, as described by various authors [3-7].
The authors present the results of their analysis based
on their experience with this type of vehicle within a
0735-6757/$ see front matter D 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.ajem.2006.11.030
* Corresponding author. Instituto Nacional de Emergencia Medica
(INEM)Delegacao Norte, 4000-063 Porto, Portugal. Tel.: +351
222065029; fax: +351 222065010.
E-mail address: miguel.oliveira@inem.pt (M. Soares-Oliveira).
American Journal of Emergency Medicine (2007) 25, 620622
www.elsevier.com/locate/ajem
medical emergency system, and report the main criteria for
its dispatch.
2. Material and methods
The emergency medical service system in Portugal was
previously described by Gomes et al [8]. It is run by a nonprofit
governmental organization, which has 4 regional centers. Each
center has it own dispatch center, Basic Life Support (BLS)
units, and Advanced Life Support (ALS) units. Each
emergency call that enters the dispatch center is received by
a technician, who has undergone specific training (a 210-hour
course), and supervised by a medical doctor, whobesides
hearing each callcan intervene in it. A telephonic triage is
performed to classify 3 main categories: very urgent situation
(requiring an ALS and a BLS unit); urgent (requiring BLS
unit); nonurgent situations (neither an ALS nor a BLS is
dispatched). The MEMs were assigned to 2 major cities of
Portugal as part of a pilot project to try to reduce response
times. They were placed in preexisting facilities, in the center
of areas were there have been many previous emergency calls.
We focused this study on the countrys second major city,
which has an overall population of about 1 500 000.
The principal aim of using MEM is to provide help more
quickly, mainly in areas with traffic congestion, taking
advantage of its size and versatility.
Dispatch criteria for the MEM, before this study, were all
emergency situations in an urban setting, where a BLS or an
ALS unit is needed.
The MEMs are driven by a professional trained in medical
emergency techniques (a 210-hour course on medical emer-
gency techniques for ambulance crew members), automated
external defibrillation (a 10-hour course), and motorcycling.
The first aid equipment carried by the MEM comprises
an automated external defibrillator (AED), portable oxygen,
basic airway management and trauma gear, sphygmoma-
nometer, stethoscope, capillary glucose meter, and ther-
mometer (Fig. 1).
The motorcycles, Honda Jazz 250, Honda Transalp
650 (Honda Portugal S.A., Sintra, Portugal), and BMW 650
GS (BMW Motorrad Portugal, Lisbon, Portugal), are
equipped with siren and warning lights, radio, and mobile
phone communications.
Because safety is a constant concern, the crews of this first-
aid vehicle are properly equipped with personal protection
suits: summer and winter gloves (Spidi, Meledo Di Sarego,
Italy), jackets with elbow and shoulder protection (Dainese,
Molvena, Italy), pants with knee protection (Dainese), and
appropriate boots (Dainese) (Fig. 2).
This new first aid facility has been operating in the
countrys 2 biggest cities since July 2004. It operates during
hours of greater traffic congestion, that is, from 8 am to
12 pm on working days.
Prospective analysis was performed in respect of the
MEM call-outs in the countrys second biggest city from
July 2004 to December 2005.
The analyzed parameters were as follows: age, sex, reason
for call, action, need for subsequent transport to a health
establishment, and time of arrival at destination. Acomparison
was also made, over the same period, of the need to activate
more means and, if so, whether the MEMwas the first to arrive.
3. Results
During the period there were 1972 calls. The average age of
victims was 51 F 21.1 years (median, 48 years); breakdown
in terms of sex shows that 51% of calls were for men.
The main reasons for the calls were as follows: sudden
illness (n = 868, 44%), trauma (n = 419, 21%), intoxication
(n = 96, 5%), and support for other first aid teams and
vehicles (n = 63, 3%).
The main actions consisted of administration of oxygen
(n = 626, 48%), immobilization (n = 118, 9%), control of
hemorrhage (n = 101, 8%), and use of AED (n = 13, 1%).
Fig. 1 Medical emergency motorcycle and its main clinical
material (AED, oxygen, etc).
Fig. 2 Medical emergency motorcycle rider with personal
protective gear.
Emergency motorcycle: has it a place in a medical emergency system? 621
The average time of arrival at destination was 4.4 F
2.5 minutes.
In 767 of 1217 analyzed cases (63%), in which 2 or more
medical emergency vehicles were called out, the MEM was
the first to arrive at the destination.
With regard to the need for transporting victims to a
health care establishment, there was no need for such
transport in 355 (18%) cases. The main reasons for no
transport being required were as follows: victims refusal of
treatment, 63%; false call-out, 11%; death, 6%; medical
decision, including decision at the place of the occurrence
by the physician of the emergency medical and resuscitation
vehicle (mobile advanced life support unit), or by the
coordinating physician of the dispatch center, 3% [5].
4. Discussion
Response time is an important factor dictating survival
among emergency victims. Time of arrival at the destina-
tion, in emergency situations, is often conditioned during
peak traffic hours. To overcome this difficulty, many
different approaches were proposed, including increasing
the number of ambulances, their geographic relocation,
defibrillation programs, etc [1-7].
Although there are several medical emergency systems
scattered around the world that use emergency motorcycles,
few results have been published to date. Lin et al. [4-7]
have demonstrated that an emergency motorcycle had a
shorter response time than a regular ambulance, in 274 cases
studied, during a 3-month period.
A MEM, driven by an individual with training and
experience in medical emergencies and provided with
adequate clinical materials, allows swift, efficient response to
the difficulties posed by city traffic congestion, keeping
response times at the desired level. Trained personnel using
MEMs can intervene in various clinical situations. The training
given to MEM crews and the materials provided allow a large
number of fist aid and life-saving measures to be implemented.
In addition to this obvious advantage stemming from its
speed in traffic, the MEM allows better resource management.
In a large number of cases, telephone triage cannot determine,
with 100% certainty, if the situation is serious and if transport
to a health care unit is not required (eg, a victim found lying
in a street, recovery from lipothymy, minor trauma). In our
series, in 18% of cases, there was no need to transport the
victim to a hospital. Most of these cases are attributable to
the victims refusal to be transported. These data stress the
importance of using MEM, considering the limitation of a
telephonic screening process. It will quickly and efficiently
allow prompt assessment of these situations and confirm the
need for urgent transport, and, if required, can provide initial
clinical stabilization. This will ensure optimization of man-
agement of available resources without jeopardizing the level
of medical emergency response to patients [9-12].
A limitation of this study is that no control groups
were included.
In short, and in the wake of the arguments set out in this
report [13-15], we propose that the MEM be included in
medical emergency systems, mainly in zones of severe
traffic congestion during peak hours, based on the following
call-out criteria:
1. life-threatening situations in which speed is cru-
cial; and
2. situations in which the need for transport to health
care units is bdoubtfulQ or bnot very probableQ
(eg, recovery from lipothymy, a convulsion crisis in
an individual with a history of epilepsy, minor trauma,
etc), but the dispatch of emergency medical facilities
is bprudent.Q
5. Conclusion
The addition of this newmeans of providing care within the
medical emergency systems in major urban centers seems to
allow fast response, while maintaining the quality of service
provided and allowing better management of available
resources. Further study is needed to confirm these results.
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M. Soares-Oliveira et al. 622