EMS: Back to Basics

Guidelines to establishing a bike medic program

By Drew Fried, EMT-B

The concept of using a bicycle as a means of transportation for emergency services workers dates back to the late 19th and early 20th centuries. After the invention of the automobile, this practice came to an end in the 1920s. In 1987, two Seattle police officers proved that bicycles could again be effective in emergency services. Approximately six years after the development of police patrol units, EMS agencies began to use bicycles for EMS operations. Today EMS agencies use bicycles for many different situations-including bike tours, congested urban city streets, busy parks, and visits by high-profile officials. In 1980, NYC*EMS used mopeds during the New York City Transit Strike. This proved that the traditional system of deploying EMS providers may not be the best way.

EMS bicycle units were developed to give mobility to the EMS provider. EMS personnel can get through congested urban areas with them and use them during special events, in amusement parks, and at sports arenas.

Organizing a Bicycle Unit

Prior to organizing a bicycle unit, you must gain the support of your administration. Without such support, the unit cannot succeed. It will be helpful to have some statistics available from other agencies, indicating their success rate. These stats include the improvement of response times and the ability to have greater access to patients. To benchmark and compare, you will need to be able to look at stats for at least the year prior to deployment of the bicycle unit. You should see a decrease in the response times and an increase in the ability to gain access to patients.

After you receive the needed support, appoint a Bicycle Program coordinator. This person is responsible for coordinating day-to-day operations of the unit. Duties include but are not limited to the following:
- Maintain an inventory of the program's equipment, and order when necessary.
- Schedule maintenance.
- Coordinate the selection process of candidates.
- Coordinate special event activities.
- Prepare the unit's standard operating procedures.
- Conduct Quality Assurance/Quality Improvement.

Ensure that all members are wearing safety equipment at all times while riding.

Selection Process

The selection process should be under the supervision of the coordinator. Most agencies find it useful to post the position and ask for volunteers. Make sure you are clear about all of the requirements of the selection process.

Selection requirements include the following:
1. Complete agency application.
2. Have at least one year of service providing prehospital care at either the CFR or EMT level.
3. Supply two letters of recommendations from agency supervisors.
4. Complete medical examination or provide a medical certificate from healthcare professional if last medical exam was within six months. Candidates should be in good physical condition with the understanding that portions of the training and unit activities are physically demanding.
5. Provide a short summary of what special skills the candidate could bring to the unit.
6. Complete interview process.

Policy Considerations

A policy provides a framework or guideline within which bike patrol units can work. If you have an established unit, you may not understand what the person who started your unit went through to write and develop the policies you take for granted. If you are starting a new unit, you must decide what policies you will need to develop. Some agencies choose to write different types of policies, such as one of the following:

- Rules and Regulations-set policy.
- Special Orders-usually expire after a short period of time.
- Standard Operating Procedures (SOPs)-set the guidelines you want your teams to follow.
- Uniform Regulations-determine what the uniform of the day will be.

Training

As with any specialized unit, it is important that members of your EMS bicycle unit receive the proper training. As part of this training, the candidates learn their function and receive instruction on how to use and ride the EMS mountain bike. If you fail to provide this training, you leave your agency open to a number of lawsuits. Some of these lawsuits involve pedestrians injured by reckless operation, accidents with motorists causing damage to the vehicle or injury to the riders, injury because of incorrect bicycle fit and lack of maintenance knowledge, and injury from lack of an agency bicycle maintenance program.

Lessons include the following:
- Fitness and Nutrition
- Promoting Bicycle Safety
- Effective Cycling
- Technical Cycling
- Hazard Avoidance
- Basic Maintenance
- Uniforms and Equipment
- Legal Issues
- EMS Safety Considerations.

Selecting the Mountain Bike

Selecting the mountain bike is not the same as going to the store and purchasing a bicycle for your child or even for yourself. Contact a number of manufacturers directly and determine what mountain bike is best for your use. Most of the major manufacturers have special bicycles and equipment for medical and police bicycle units. You may not be able to purchase a bicycle directly from a manufacturer, but you will be able to find out which distributor sells the equipment you need. The manufacturer might also be able to pass on a special price to you.

You will need a number of accessories: Some of them will be for comfort; others are needed for safety. Before selecting equipment, determine if your unit will operate at night. If so, purchase a good light system. A rechargeable system is best; also, try to determine the candlepower of the light. Because of the amount of physical activity and the need to stay hydrated, you will need to purchase a bicycle with a water cage and provide a water bottle.

Each bicycle should be equipped with the following:
- Toe clips and straps for the pedals.
- Rear-mounted kickstand.
- Fenders.
- Derailleur guard-to avoid injury from sharp points on gears.
- Warning devices-red blinking lights and siren devices.
- A good steady seat (a gel seat is preferable)

You also will need a rear rack with a rack bag designed to hold emergency medical equipment. This equipment should include the following:
- Oxygen tank "C" size
- Airway adjuncts
- Disposable gloves
- B/P cuff
- Stethoscope
- AED
- C-collar
- Suction unit
- Assorted medical equipment
- OB kit

The equipment may be shared among teams members if they patrol/respond in pairs.

Uniforms

Uniforms have always been the backbone of every public safety organization. Agencies with a bicycle unit have found that they have had to change their policy with regard to uniforms. You cannot expect a bicycle unit member to wear the regulation duty uniform. During the summer months, members should wear comfortable shorts of nylon or cotton. In place of the regulation shirt, most bicycle units have opted to wear golf shirts, with the department logo silk-screened on the front and EMS in four-inch letters on the back. Patches, embroidery, and silkscreen have replaced the traditional shields. In cooler months, bike medics should wear long nylon bicycle pants specially made for bike riding; the pants come with stirrups to pull the pant legs down and keep them from getting caught in the chain. You can also have the shirt distributor silkscreen or embroider long-sleeve golf shirts or long-sleeve T-shirts. Have a good waterproof wind-resistant jacket for inclement weather. You can order most of this equipment from your local uniform vendor, by mail order, or on the Internet.

Each bicycle patrol member is required to wear a bicycle helmet approved by the American National Standards Institute (ANSI) or the Snell Memorial Foundation, padded cycle gloves in the summer and regular gloves in the colder months, and eye protection (sunglasses) that are shatter-resistant and have UV protection. Remember, on a bike you have no windshield to keep dust, bugs, branches, and other debris out of your eyes.

Start of Tour Procedures

At the beginning of each tour, each bicycle patrol team member should inspect his assigned bicycle using a standard department checklist. If any deficiency cannot be immediately repaired, take the bicycle out of service. Riding a bicycle that has a maintenance problem can cause an accident.

If more than one team is assigned to the tour, each team should have an assigned response area. Each team should check for special instructions or events in the assigned area.

It is important that each member carry a water bottle and wear the proper uniform of the day, determined by the temperature. Each team must check the status board to see if the unit will perform its normal function.

Care and Maintenance of Bicycles

Keeping your bicycle in good working condition is as important as a vehicle operator's keeping his emergency vehicle in serviceable condition. As part of my unit's standard operating procedure, we had a service agreement with a local bike shop. Some agencies choose to send a member to become certified as a bike mechanic. This can sometimes save on the cost of repairs and yearly maintenance. Whichever program you decide on, make sure that each member understands his role in bicycle maintenance. Each member will be required to inspect his assigned bicycle daily and weekly and to schedule yearly maintenance. A trained and experienced bicycle mechanic should conduct yearly maintenance.

General Guidelines

- All medical bike unit members must attend an approved EMS cyclist course and continue to attend refresher training.
- It is recommended that medical bike units do not operate under the following conditions:
- The temperature is above 90°F.
- The temperature is below 35°F.
- There is heavy rain and slippery conditions.
- There is snow or ice on the ground.
- During high winds.
- The unit should operate at the discretion of the senior supervisor on duty.

As noted above, all members should be required to wear a properly fitted bicycle helmet approved by ANSI or Snell while the bicycle is in motion.

A medical bicycle unit can help improve the organization's response time and public relations. The use of bicycles comes with a number of responsibilities, however. All members must obey the vehicle traffic law, just as they would in an emergency vehicle. In some states, EMS bicycles have the same privileges as a motorized emergency vehicle. Make sure to research what other bicycle units are doing in your area.

References

1. The Bicycle Patrol Program; Bikes on Patrol, Jose Dominguez, 1994.
2. The Complete Guide to Police Cycling, The International Police Mountain Bike Association, Joe Martin and Erik Blair, Calibre Press, 1996.
3. The International Police Mountain Bike Association, www.ipmba.org.
4. New York State Policy Statement # 00-08.

Drew Fried, EMT-B, has been an EMT for 22 years and a NYS EMT instructor for ten years. This article originally appeared in the September/October 2003 issue of fireEMS magazine. It also appeared in the Winter 2004 issue of IPMBA News.