EMS Magazine`s Resource Guide: EMS Bike Medics

Association Profile: IPMBA

The International Police Mountain Bike Association (IPMBA) is a professional, nonprofit organization dedicated to providing specialized training and education to emergency services personnel who use bikes in the line of duty. Since it was founded in 1991, IPMBA has certified more than 700 instructors throughout the United States and Canada, who have trained more than 25,000 police officers, EMS professionals and other public safety cyclists. IPMBA has over 3,000 active members representing over 2,000 agencies in all 50 states, the District of Columbia, Canada, the Netherlands, United Kingdom, Germany, Switzerland, Belgium, Finland, Australia and Israel. IPMBA offers a series of training programs, including the IPMBA EMS Cyclist course, the IPMBA Maintenance Officer course and the IPMBA Instructor course.

The Annual IPMBA Conference features preconference courses, more than 20 on-bike sessions, over 50 classroom-based workshops and a product exhibition for public safety cyclists. The conference, which will be held May 1–8 in San Antonio, TX, offers a series of sessions designed for EMS cyclists, including: EMS Night Operations; EMS Scene Safety with Practical Operations; Search & Rescue: A New Terrain to Tame; Advance Planning for Special Events; EMS Specific Equipment Needs; and Effective Use of EMS Bikes. Members of IPMBA's EMS cycling instructor cadre have also presented at EMS EXPO, the National Collegiate EMS Foundation and the International Tactical EMS Association. IPMBA makes a variety of resources available to police and EMS bike units, including start-up information packets, sample policies and procedures, and training tips. The association strongly supports worldwide growth of the profession, and, through industry partnerships, encourages development of products that increase the efficiency, effectiveness and safety of the public safety cyclist.

Membership is open to individuals. Members receive a subscription to the IPMBA News and discounts at the annual conference, as well as discounts on products and equipment offered by participating suppliers. Next year, the conference will be held in Scottsdale, AZ, in April 2005. For more information about IPMBA's programs, or to become a member, visit www.ipmba.org, or call 410/744-2400.

-Maureen Becker, Executive Director, IPMBA

Preplanning for Special Events
By Gene Williams, Jr.

It's November when your agency receives a call to provide medical coverage for an upcoming national golf tournament. Fifteen big-name players, plenty of media and 25,000 spectators will be in your service area for four days.

To EMS, most special events mean a large public gathering in a specific area that is usually confined by some type of barrier. The ability to respond to medical emergencies is often severely limited by these barriers, topography and crowd congestion, requiring EMS to respond effectively using unconventional means. One unconventional response vehicle that is gaining widespread support is the EMS bicycle.

If your agency already has an EMS bike team, you're halfway there. The other half is preplanning for the special event. Surprises are not a good thing during large-scale events. Preplanning should include: the proposal, site survey, equipment, logistics, communications and the actual operations plan.

The Proposal

Event sponsors usually want a written proposal from the EMS agency to justify the cost of providing EMS coverage. Do not quote a price or promise anything until you know all the facts concerning the event and a site survey has been conducted. This proposal reflects on your agency's professionalism.

Site Survey

Physically examine the entire area encompassing the event site. Request floor plans or maps of the site. Ensure that you know what will change or be added during the event. Within two weeks, a golf course will be transformed into a fenced-in village. Locate a secure site for the command post and check out your communications to ensure you have coverage throughout the entire event area. Walk the entire site; locate all entrances and exits; designate perimeter pickup points for responding EMS units; locate staging areas, etc.

Equipment

Inspect all bicycles prior to the event to make sure they are in good working order. Who is the target population? What additional supplies might the team need? Is your command post a tent, trailer, truck? Establish a resupply location for medics. Ensure that tools and spare bicycle parts are available on site.

Logistics

Include the plan for transporting personnel and equipment to and from the event site. Food and hydration needs should be addressed, as well as proper attire for the weather, staff scheduling, equipment storage, security of equipment and command post, and how you will notify other EMS agencies and hospitals. It is good planning to advise local hospitals of the possibility of a sudden influx in population if an MCI occurs. Above all, there needs to be dedicated leadership and dispatch.

Communication

Establish a system for event staff and EMS to communicate, whether it's through a dedicated medic or on-site dispatch. It's good policy to have dedicated dispatch at your command post to handle all traffic between event staff and bike teams in the field. Make sure everyone can communicate from anywhere within the event site. (I find that headsets work much more efficiently than lapel mics.) Assign teams to cover specific areas to decrease response times. Don't forget to bring extra batteries.

Operations Plan

This is the final document, which incorporates all of the above into a manageable form. The operations plan should start with the dates and times of the event; the number of bike team members available for each day, including any support staff and dispatchers; event location and who is in charge. Make sure the plan includes contact information for the medic in charge of the event should a problem occur. Document the type of staffing: EMTs, EMT-Is, etc. Outline what equipment will be on site for the duration of the event, where it's located and how it will be secured. Designate the location of the command post and outline your communications procedure. Specify the staging location and transportation information for your medics to follow, and attach a complete schedule and assignment sheet. Specify uniform policy and personal bike bag inventory list. Attach any maps of the event site; designated ambulance pickup points around the perimeter of the site; the MCI response plan; and information on the primary EMS transporting agency. Give copies of the operations plan to all bike medics, event staff, security and law enforcement, and place one in the command post to ensure that everyone involved in the event is fully aware of his or her role.

Conclusion

Managing and operating an EMS bike team effectively during a special event encompasses a great deal of planning and forethought. Riding around an event site with no communication, poor logistical support, a few Band-Aids and no plan reflects poorly on the EMS agency and does the public a great injustice. The special event need not be large: It may be only a BBQ cook-off within a two-acre area. The only difference in your planning is that it may take only hours instead of a few days or weeks. Good planning and organization will ensure a successful operation for your team and will positively reflect on your organization's professionalism. At Cypress Creek EMS, our motto is: "When seconds count, count on us." That's why we have a plan.

Gene Williams, Jr., is special operations coordinator for Cypress Creek EMS in Houston, TX.

EMS Bike Patrols-Night Operations

Being part of an EMS bike patrol can be complicated under the best of circumstances. Responding to scenes on a bike after dark comes with a whole new set of challenges. That's one issue that will be presented at the International Police Mountain Bike Association's (IPMBA) upcoming annual conference in San Antonio, TX.

"We'll be talking about safety concerns at night, where it takes people a bit longer to process who we are," says Neil Blackington, deputy superintendent for Boston EMS and member of its bike patrol. "Because people lose a bit of their night vision every seven or eight years as they age, we like to remind our bike medics that we have an older population in this country that is less able to recognize images at night," he says. One way to be easily identifiable, he adds, is to wear uniforms that use different colors than other agencies.

"We've just signed a contract to improve the quality of our riding all-weather suits, and they will have 1" reflective material around the body of the jacket, as well as on the cuffs of sleeves and running down the outside of the pantleg margins," Blackington adds. "We've also added quite a bit of reflectability to our bike frames. Our department logo is now in reflective tape and material, and we've experimented with small LED lights that screw onto the top of the tire valve stem, so when the tires spin, the lights sense the motion and automatically come on."

In Boston EMS's 32-hour basic bike program for EMTs, they cover other types of lighting and reflective material that send a quick signal to motorists and others that a bicycle is approaching. They are interested in developing a marker similar to those used on the backs of trucks and other vehicles that send a clear message that a bicycle is nearby.

Another unique aspect to bike response at night is that the types of calls are frequently different from what responders see during the day, meaning they may be more dangerous. As a result, heavy emphasis is put on EMT and police officer safety.

"The whole reason for having EMTs on bikes, of course, is that they can arrive at incidences much sooner than any other form of transportation," says Blackington. "So, unless we have a significant contingent of police officers on bikes who can arrive equally as quickly, we have to remind our people about safety concerns, such as identifying yourself as an EMT or paramedic so bystanders are not mistaken about what their public safety role is. We also remind them to survey scenes from a distance and then make a conscious decision about whether it's appropriate to be the first person on scene. In some cases where the injury we're responding to is a result of a violent incident, it sometimes behooves us to wait until we have police backup or another unit."

Boston EMS's bike unit is a four-season operation, Blackington says proudly.

"Whether it's over 100ºF or below zero, we have appropriate clothing and bike components to deal with the weather. We've been lucky that there hasn't been a lot of snow for most of our major events."

Summing it up, says Blackington, the most important aspects of night response are: the increased time it takes for people to process that the responder is on a bike and then take appropriate action; safety issues; lighting issues; and easy identification of bike responders.

Scene Safety for EMS Bike Patrols

EMS bike patrols have two strikes against them from the get-go: They're more vulnerable to other traffic, and they're often mistaken for law enforcement. Those are two reasons that safety training is a high priority for bike medics in Orange County, Florida.

"The No. 1 method for being safe is verbally identifying themselves as they approach the scene," says Ed Brown, battalion chief for Orange County Fire Rescue and bike patrol member. "Another means is uniform identification, which is distinctly different in color than what is worn by both the ambulance service and law enforcement.

"There are other things in the standard operating protocol about approaching scenes," he adds. "They're taught to approach scenes more cautiously, taking in the big picture and not getting tunnel vision on the patient, especially if they're going into an unsecured-type scene. Whatever their SOPs would be in a motorized vehicle for an unsecure scene are the same on a bike, including staging in a safe area. They also learn self-protection if they get caught in a situation they shouldn't be in. And, if they see a situation is turning bad, they have the mechanical advantage with a bike of being able to get out quickly and wait for law enforcement."

Although body armor is now available for police bike patrols, Orange County prefers to not put their medics into situations where they will need it, says Brown. As an added precaution, their medics also work in pairs.

"We've been doing this since 1993," says Brown, "and we physically patrol certain areas. We do special events like most EMS agencies, but also cover the International Drive corridor, which is all of our tourist industry, and we cover some heavily populated bike trails."

Brown assisted in the expansion of the minimum 32-hour curriculum for bike medics in central Florida to 40 hours, adding a section on scene safety and night operations.

"We teach the medics how to maneuver and set up their bikes at a scene so they have a safe working zone," Brown says. "They learn how to use the bikes for personal protection when they're working on a patient, and how to secure the scene with their bikes so they can keep bystanders at a distance."

Theft from the bikes is not a problem, since medics are basically considered "good guys" who help people, says Brown, but they learn how to secure the bikes so they aren't stolen.

"A medical director typically decides how controlled drugs will be handled by a bike team," says Brown. "Here in central Florida, controlled drugs must be with the medics at all times, so we use fannypacks to carry them. A lot of the other equipment is disposable, so that can be easily replaced."

The Orange County Fire Rescue bike team, which has complete ALS capability, is growing appreciably, and expects to increase from 22 to 35 medics this year.

"EMS on bikes is growing right now," says Brown. "It's needed, and it's good for public relations. We cover one trail that's 19 miles long and goes through a couple of municipalities. The fire department believes in us and loves to have us out there."

The real icing on the cake, says Brown, is that bike patrol duty is considered overtime.

"By the 15th of each month, the medics let the coordinator know when they're available for the following month. It's nice to get paid to ride a bike."

EMS Bike Deployment
By Pat Donovan

Nothing ruins your day more than to hop on a bike for an event, only to find that its brakes or derailleur need adjustment or the tires are flat. How often have you had to call back to the station to find out where the uniforms or helmets are? How often have you opened an EMS pannier only to find that the drugs are expired? Although these things can happen throughout the bike season, they are more prevalent before the first event.

Most teams' events start in the spring and run through the fall. Overall maintenance is best taken care of right after the last event of the season. Our uniforms and helmets are cleaned, inventoried and stored together in a common locker. We empty all panniers-eliminating any half-eaten energy bars from becoming a sticky science project that will take more time in the spring to deal with.

A routine maintenance bicycle program alleviates most of the first-event problems. Have your bikes professionally maintained with periodic tune-ups and overhauls based either on mileage or time. We generally overhaul one bike each winter and do adjustments on the other bikes as needed. Remember to add these costs into your annual budget.

One week before our first event, a crew is assigned to prepare the bike panniers and EMS equipment. Most teams have checklists or inventories for each pannier or case. Also check communication equipment and bike repair supplies that are carried on each bike. If you are doing night operations, make sure your bike light batteries are charged. Several days before our first night event, we charge and discharge the battery to make sure it is operational, then we charge it again.

The Day of the Event

If this is a new event for your team, arrive early. Conducting a ride-through with your partner when there are no crowds will help you plan your response routes. Find where the pedestrian bottlenecks will be and find ways to avoid them. Look for less-traveled areas that you can use to skirt the high-traveled areas. Also look for a quieter area where you can complete your reports and take fluid and food breaks. Look for vehicle access areas for ambulance staging and bike restocking.

Remember, this is a huge public relations event for your bike team and agency. Prepare to become a roving information booth. Always carry a program guide, and be aware of where public facilities are: Know where the stages are located, as well as the nearest bathrooms, ATMs and food and water sources. Local knowledge and flavor are also helpful.

Our largest event is the Western Washington Fair. It is the sixth largest fair in the country, and runs for 17 days. Each weekend day, over 100,000 people will come through the gates.

There are six entrances to the fair, so early in each shift, we ride to each gate and introduce ourselves to the security contingent. This ensures prompt access through the gates when we respond to emergencies later in the day.

Our early experiences inside the fairgrounds were a learning time. Because the crowds were so thick, even our bikes were bogging down in the pedestrian traffic. Now we respond on a nearby street to the closest entrance gate to access our patients. Our response times are shorter than if we were trying to go directly through the crowds.

Various events may have a different communications system in place than what you normally work with. Preplanning communications frequencies reduces event-day stress. In addition to the communications aspect, introduce yourselves to the operational leaders of the event. This is great PR for the current event, but it also fosters goodwill for future events the promoters are planning.

Remember to hydrate and eat properly throughout the event. You are out there providing a service, and creating positive public relations for your organization. If you are not having a good day providing this service, it reflects negatively on your organization. Good news travels fast, but bad news travels faster. (One of our selection criteria regards positive public relations. We can teach anyone to ride a bicycle through crowds with weight, but you can't always teach being nice.)

Actively seek out positive interactions: Help adjust a youngster's helmet and show the parents how to do it; hand out badges; inflate low tires. Many guests come from out of town for our big fair, so we provide maps to area hospitals for the family if a patient needs transport, as well as re-entry tickets for the affected group.

Ending the Day

End-of-shift activities include the normal ones: restocking, charging batteries and completing run reports, as well as preparing your bicycles for the next ride. In coveralls or work clothes, wipe the frame and components to remove the grime of the day; re-lube your chain and recheck all the bolts for your rack and other bike bolts. Do an "ABC quick-check" on your bike before you put it in storage: air, brakes, cranks, quick releases.

If any components need adjusting, follow your bike maintenance protocol for repairs. Create a good relationship with your local bike shop for immediate repairs or quick parts-replacement for ongoing service. Using a local shop not only supports your community, but a mail order Internet bike shop can't do repairs.

So there you have it! Preplanning prevents poor performance. Have your bikes and equipment ready to go before the event, know your response area and what's happening during the event, and leave your equipment ready for the next event. Have fun-you get to ride around saving lives, enjoying the sights, and creating great public relations for your organization!

Pat Donovan is a captain/paramedic with the Puyallup (WA) Fire and Rescue Department. He is an IPMBA-certified EMS cyclist instructor and is coordinator of the PF&R emergency bicycle team.

Preventing Bike Injury-A Primer
By Kathryn Robyn, Assistant Editor

Bike medics might be assigned to patrol a rural mountain trail, an urban street festival or a county fair; their jobs may involve intense uphill trekking or rigorous crowd maneuvering, but one thing remains the same, according to cycling expert and sports doctor Jeffrey B. Noftz II, PT, MD: Preventing injury is all about bike-fitness.

It's All About Bike-Fitness

Start with a bike that fits. One size fits all doesn't make for an adequate bike, any more than it would make for an adequate pair of shoes. All kinds of strain and overuse injuries can be avoided by having a proper fit from handlebars to pedals to saddle size and angle.

Equal to that, says Noftz, who is an assistant professor of Orthopedic/Family Practice at the Medical College of Ohio in Toledo, OH, "Make sure you're fit enough to get fit."

That means get off the couch and start conditioning. If you're seriously out of shape, get a diagnostic stress test and fitness counseling from a physician or physical trainer before embarking on a bike-fitness program. Jumping from the couch into a dynamic training program is a formula for injury.

Assuming you're in pretty good shape-that means you can run up a flight of stairs without getting too winded, according to guidelines put out by the American College of Sports Medicine (ACSM)-then you're ready to condition yourself for bike detail in both cardiovascular and muscular strength training.

Cardiovascular Strength Training

This means aerobic exercises, 3–5 days each week. Include cycling in your regimen. Warm up 5–10 minutes before exercising. Build up and maintain your exercise intensity for 30–45 minutes, raising your heart rate about 50% higher than normal. Then gradually decrease your workout's intensity. Stretch to cool down during the last 5–10 minutes. For more, visit www.acsm.org.

Muscular Strength Training

Combining machines and free weights, work all the major muscle groups, upper and lower extremities, two to three days a week, with a day of rest between each session. If you're doing it right, you should progress 5%–10% per week.

Here's how to do it:

Find your maximum weight for one repetition, says Noftz. "That is, the amount of weight you can do just one time, without killing yourself doing it."

Then take 60% of that weight and do 10 or 12 repetitions of that-to fatigue. For example, if you can do just one squat holding 100 lbs. across your shoulders, 60% of that would be 60 lbs. Using a barbell or two 30-lb. dumbbells, do 10–12 squats to fatigue. If you reach fatigue before 10, use lighter weights; if you're not fatigued by 12, use more weight. "The key to any strengthening program is fatigue. If you're not fatigued at around 12 reps, you won't see the benefit."

How many sets of repetitions you do is up to you, Noftz says. "Evidence suggests fatigue is fatigue is fatigue-meaning one rep is enough. But some people-like me-don't feel like they're getting a good workout unless they do two or three sets."

But it's also important not to over-condition. Taking a day of rest between weight training sessions is crucial. "Exercising to fatigue injures the muscle; resting gives it a chance to repair itself, in fact over-repairing," says Noftz. That's how you build strength.

Noftz says you must also train a "smart muscle, not just a strong one." Called sport-specific training, it means you must train on your bike in the field. Inclines, road conditions and packing variations all use your muscles and reflexes in specific ways that can't be trained on a stationary bike or in a weight room. When you're out there on the street or trail, you want your body to know what to do no matter what you encounter on the bike. If you train smart, that's what you'll have.

Types of Injuries To Expect

While proper conditioning will prevent many injuries-even teaching your body how to go through injury and repair quickly and productively on a regular basis-accidents happen.

Traumatic injuries can result from crashes, endos (flipping over the handlebars) and falls; and overuse injuries can be an occupational hazard of compensation; poor bike-fit; and can result from not being prepared for a vigorous ride, a long day, or from over-training.

Common traumatic injuries range from abrasions, contusions and lacerations to more serious clavicle fractures, acromioclavicular (AC) separations and shoulder dislocations. Less common are pelvic fractures, intra-abdominal injuries, broken ribs (from crashing into the handlebars), facial fractures and brain injuries. Helmets prevent the bulk of the latter.

Overuse injuries can include muscle pulls and tendonitis from training too hard and too quickly, without resting or giving the body the chance to recover. But even the well-conditioned cyclist can overwork an area and experience hand numbness (from vibrations in the handlebars), carpal tunnel syndrome, hamstring strain, pulled Achilles tendon, patella/knee strain (iliotibial band friction), cervical strains, hip pain (trochanteric bursitis, mostly in women), groin injuries (including infertility, mostly in men using a saddle with the wrong fit) and low-back pain while riding.

Accelerate Recovery Time

As always, it can be the sprains and strains that take the longest to heal. Inflammation has three phases that can occur over the course of a year or more. The first phase cleans out the area; the second grows new tissue-collagen, muscle and scar tissue-but it's the third-the shaping and remodeling of the injury site-that takes the longest.

"But," says Noftz, "inflammation is always your friend-it's part of the reparative process. It's only when it gets out of control that it becomes a foe. So we treat it, making sure all the phases occur, but faster-that speeds healing."

To speed the process, doctors and physiotherapists use ice and anti-inflammatories to keep swelling down and reduce pain; next they utilize topical modalities such as ultrasound to speed up the healing phase and minimize scar tissue; finally, strengthening exercises reeducate and retrain the body to the mechanism of injury-building strength around it to increase support and stretching to keep it flexible. Extreme pain is not a good thing, says Noftz: "One day of pain after a bout of exercise is okay, but two days is too much."