Two-Wheeling It

Bike Types: Who's Using What?
     According to information from IPMBA, most units use multispeed mountain bikes, which are heavier than the average street bike, with wide tires and a more upright seating construction. IPMBA estimates the average purchase price at about $1,200, while maintenance on a properly maintained bike runs to around $300 per year. Many go a step further and purchase bikes specifically designed for public-safety/EMS teams. Often called "police series," these are a heavy-duty version weighing a bit more than the recreational variety. Public-safety grade bikes are not generally available at your neighborhood sporting goods store or bicycle shop, but they are made by several manufacturers, including Trek, Cannondale, Smith & Wesson, Fuji, Raleigh and others.

     IPMBA's Becker recommends considering the specially designed public-safety models for two reasons: Many of the manufacturers equip the bikes with the accessories that are needed for EMS use, and the bikes are a little heavier and more heavy-duty than those required for recreational riding. "It has to be strong, sturdy and produced by a reputable manufacturer," she says. "Don't go to your local 'big-box' store and buy a cheap, heavy bike. It will be uncomfortable and probably won't stand up to the kind of abuse the EMS bikes get. The medics are carrying heavy equipment and often riding in challenging conditions--negotiating curbs, stairs, potholes and other things that jar a bicycle. There are also times when a bike falls over, although they're typically equipped with a rear-mount kickstand, which is more stable."

     Bicycles and other two-wheeled vehicles are becoming increasingly prevalent in the EMS industry, helping agencies provide quick care in crowded settings like fairs, festivals and sporting events. Maureen Becker, executive director of the International Police Mountain Bike Association (IPMBA), which has a fast-growing EMS division, says that "As of 2002, 52% of EMS agencies in the nation's largest 200 cities were [reportedly] using bikes." Additionally, she says, "estimating from IPMBA membership, approximately 300 bike medic teams across the country are being deployed in a variety of circumstances."

     IPMBA, whose annual conference was held May 6-13 this year in Dayton, OH, is the preeminent trainer of both police and EMS cyclists. IPMBA-certified cyclist instructors have trained most, if not all, of this country's bike medics, as well as the United Kingdom's famed London Ambulance Service (LAS) bike medics. The growth of the bike medic niche might be reflected by next year's conference host, East Baton Rouge Parish EMS in Louisiana, the first emergency medical service to host the conference, says Tom Harris, NREMT-P, public service coordinator for the municipal third service.

     "It's predominantly hosted by large police departments," says Harris. "I'm flattered to be allowed the opportunity to even bid on it, let alone get it."

     The 24-medic bike team in East Baton Rouge Parish EMS, in service since 1995, is an advanced life support team that works the bikes as an extra detail. "We utilize our bike medics for all large special events," he says. "These vary throughout the year, but I will have a bike team out every week. Louisiana State University typically gets over 100,000 people here for a home football game, so it gets very crowded and we can't hardly get a vehicle down the streets at all, so we use the bikes for initial first response. They're meant to stand alone for 10 minutes in a cardiac arrest situation."

     A similar scenario is echoed by the leaders of other bike teams. As metropolitan areas and public events get more crowded, and people's expectations for emergency response get higher, it makes sense to deploy bikes.

     Boston EMS, another third-service municipal agency that had the foresight to invigorate EMS with bicycles some 10 years ago, has 45 medics on its team who share 20 bikes among them. Until recently, the Boston team patrolled day and night, says Deputy Superintendent Neil Blackington. "And, we will do it again if we have the staffing, but right now our unit--like about 90% of the rest of the country--is using its bikes primarily for special events like parades, festivals and unusual concerts. Two of our biggest events are the Boston Pops 4th of July concert and fireworks, which attracts somewhere in the order of 500,000 to 750,000 people to the Esplanade along the Charles River, and the Boston Marathon on Patriot's Day. About 1.5 million people gather here for that, mostly in the city of Boston, which is where it finishes."

     Bike teams have become more common around the country for these special event standbys, especially in services that consider themselves "very progressive," as Blackington sees Boston EMS. "We have a lot of alternative response devices for EMS," he says. "We already had electric cars and golf carts, and we used Segways for a period of time. Bikes were of interest to us as just another tool in the toolbox."

See Me, Hear Me
     Because EMS bikes are emergency vehicles, most use lighting and siren systems. According to Blackington, one of the most popular brands is NiteRider, which makes a 115-db siren that is substantial enough to get peoples' attention. The typical bicycle light, he adds, is suitable to meet the standards in all 50 states, and is usually located on the handlebars or just below. Some medics also use supplemental lighting on their helmets.

Training to Ride
     Obviously, there's more to providing EMS from a bicycle than just knowing how to ride one.

     "We teach a 32-hour program for EMTs and paramedics that is geared toward using bikes rather than teaching medicine," says IPMBA-certified instructor Blackington. "Our presumption is, whatever you do once you get off the bike to treat the patient you have gleaned from other training and experience. Our job is really to help people get oriented to professional public-safety biking, which is different from what you learned about bike-riding as a child. Putting that much extra weight onto a bike changes the dynamics of how you handle it. And, we're doing a different type of cycling most of the time. We aren't racing around; we're usually carefully weaving our way through high-density crowds or narrow access points, so we teach a lot of slow-speed skills. The first thing our students learn is that it's not about racing or about how fast they can get from point A to B. It's that bikes can maneuver crowds or congested streets better.

     "We also teach physical fitness and nutrition. Most places require tryouts, so employees are getting in better shape in order to participate on the team, which creates an upside in having better-conditioned employees. There's also a maintenance segment in our course that teaches EMTs and paramedics how to handle routine maintenance issues that might occur in the field. Almost everyone carries a spare tire and some emergency tools to keep their bike fine-tuned to their particular fit or to maintain it if something comes loose."

     Blackington says they realize that some departments may not be able to afford a bike for each medic, and that is addressed in the training sessions.

     "Some departments just buy a couple of bikes in the mid-range sizes, so we teach students how to make adjustments in seat height and direction and handlebar height, and how to tailor the bike to their particular stature, experience, capability and things like that," he says.

Storing Your Equipment
     Public-safety bikes require little to no modification. "The customization comes more in how we carry our equipment on the bike," says Blackington. "There are now companies that cater to the EMS bike market and make saddlebags--or panniers as the French refer to them--the storage that allows us to carry upwards of 45 lbs. worth of medical equipment." And that’s on every bike.

     The saddlebags sling over the back fender, with heavy-duty racks that go between them. "There are even some departments and services around the world that use some sort of front-mounted storage facility," Blackington adds.

     Greg Johnson, a paramedic/bike medic and freelance photojournalist for the Williamson Medical Center (WMC) EMS bike team in Franklin, TN, says some carry panniers and some backpacks. He prefers the backpack. "If you use panniers, you have to put a rack on the back and you can’t have a rack with a full-suspension bike," he says. WMC bike medics carry the typical array of gear: AEDs, oxygen, basic and advanced airway equipment, basic and advanced pharmacology, IV equipment, bandages, gauze, burn treatments, hot packs, cold packs, bee sting kits and more.

     Many teams also carry a few bike maintenance tools--in some cases, even a spare tire.

     In Baton Rouge, says Harris, "bikes work in all-paramedic teams of two, with one bicycle carrying all the trauma equipment and the other carrying medical equipment."

     Most services divide their bike crews into two-person teams, dividing the equipment between them.

     "A well-equipped bike probably costs about $1,500, and that includes the cost of the bike, a modest investment in saddlebags and other tools necessary to carry the equipment, and then lighting and siren systems sort of round out the cost of the bike," says Blackington.

     If that sounds expensive, consider the cost of an ambulance. Since bike use keeps ambulances in service on 75% of their calls, it saves not only the purchase price of the trucks, but their operating costs as well.

     "Bikes are what I like to call a force-multiplier," says Blackington. "Their ability to answer calls quickly, discern whether an ambulance is really necessary or treat and release a patient means that, in some situations, a couple of bikes are really more valuable than a couple of ambulances. An ambulance these days can run $175,000 to purchase. And I personally have seen assignments that used to include five or 10 ambulances reduced to two or three. The bikes go to every single call initially, and, for many special events, the call is for burns, bruises, cuts, bee stings or sunburn--things that don’t necessarily require transportation. Anecdotally, we’ve seen that in special events we only transport 25%-30% of all the calls."

Where To Next?
     As bike use in EMS grows, so, too, has the number of manufacturers that offer emergency lighting systems, bicycle accessories and clothing. Some manufacturers, says Blackington, are even making bullet-resistant vests specifically for bike duty.

     Which leads to the question: In these turbulent times, how safe is it to be a medic on a bike?

     "I don't think homeland security circumstances have impacted bikes that much,"says Blackington. "There has always been a training component that deals with EMT and paramedic safety when they're on a bike. In the last five years or so, we've developed a teaching program at the IPMBA conference that deals with putting SWAT officers or special response officers on bikes."

     In EMS providers' favor is that they can approach a scene relatively unnoticed, allowing medics the opportunity to survey the scene from a distance with relative anonymity, then make a decision about whether it's appropriate to go the rest of the way. Obviously, the mobility with the bike means they can maneuver out and away from a situation faster than if they were locked into an automobile. They don't have the glass and steel enclosure that an ambulance provides, but an ambulance doesn't always provide protection anyway.

     "For the most part," Blackington concludes, "bicycling EMS is a lot of fun. It's a morale booster for agencies that have bikes and an opportunity to reward good employees."

     For more on bicycle EMS, visit www.ipmba.org.

Dressed for Success
     Like their EMS colleagues who travel in ambulances, bike medics wear distinctive uniforms that identify them as public safety personnel. One of the most popular brands seems to be Coolmax from Olympic Uniforms in Seattle, WA.

     "My medics wear a basic bicycle uniform," says Harris. "They use a CoolMax-type shirt with bicycle shorts, a helmet, glasses and gloves. The shirts are a bright yellow, which separates them from law enforcement and the other street medics. We have GoreTex rainsuits that are navy blue with reflective material blended in. When light hits it, it looks almost like a huge traffic vest."

     The WMC medics' uniforms are all bike-specific, says Greg Johnson. "The knees in our pants overlap and are pleated to give room when we pedal, and there are stirrups to hold the pants around our feet so the pants legs don't ride up or get caught in the chain. The shirts are also longer in the back than in the front to keep them from coming untucked when you're riding. The pockets are designed to be low-profile, so they don't catch in the wind, and everything is zippered or closed with Velcro, so stuff doesn't fall out."

Motor Medics to the Rescue
     Providing EMS from the back of a Harley is nothing new for Daytona Beach (FL) Fire Department medics. They've been covering special events on their Harley-Davidson Road King motorcycles since April 1995, when the program was introduced as a way to provide speedy and effective emergency care to patients in crowded conditions.

     "We're a special-events town," explains EMS Division Battalion Chief Paul Neely, "so we have our Bike Week, race weeks and spring break, when we go from a town of 65,000 to close to one million. In certain areas of town, we had a hard time cutting through traffic, so we tried everything from modified golf carts to small rescue vehicles, and the Motor Medics have worked best for our particular situation."

     Standard bicycles were never an option, Neely explains, since the Daytona International Speedway by itself covers a 2-1/2-mile area, and the beachfront stretches for 10-15 miles. The best alternative was a special deal from Harley-Davidson on purchasing two bikes, which carry all the necessary equipment except backboards, which are carried on the rescue trucks. "Everything is in miniature," he explains. "We have smaller O2 tanks and monitors. But everything from drug boxes to Band-Aids is combined on two bikes, which are ALS-equipped."

     The training program consists of 80 hours of police motorcycle school, says Neely. "The class teaches EMTs and paramedics how to ride in tight formations in crowds and how to control the bike at walking speed. It's extremely dangerous to ride a motorcycle Code 3 around the city. I wouldn't recommend putting someone out there who doesn't have police motorcycle school training as a minimum."

     In the long run, the motorcycle program is a win-win situation for the entire community. "Before we started, we would have fire trucks tied up in traffic for two hours, and we had to call on fire companies from other districts," says Neely. "This puts a unit in service specifically for our guests and keeps the fire services available to our citizens who pay for them year-round."

     Farther south, Miami-Dade Fire Rescue's (MDFR) Motorcycle Emergency Response Team (MERT) patrols the highways from 8 a.m.-6 p.m. Monday through Friday and provides emergency care for special events or OEM disaster activation. The team consists of three units of two personnel, with each unit patrolling a different part of the county. Initially, BMW of North America refurbished 10 former California Highway Patrol motorcycles and donated them, free of charge, to MDFR. According to MERT member Lt. Roman Bas, as of May 1, the department began transitioning to 12 Harley-Davidson Road King motorcycles. After the transition, team members will be retrained to meet the 80-hour police training standard.

     For more on bicycle EMS, visit www.ipmba.org.