Ambulances & Vehicle Ops, Operations

Motorcycle Response Units in EMS

Motorcycle use in both Fire and EMS is very common outside of the US. In many countries in Europe and Asia, fast response motorcycles are used to reach patients and emergency scenes where dense populations, traffic and small streets in old cities slow traditional ambulance and quick response vehicles (QRV).

Distances, poor weather, obstacles or lack of resources can hinder helicopter response, so Motorcycle Response Units (MRUs) are an extremely versatile, efficient way to augment traditional EMS and fire response.

Safety is the key for EMS and fire agencies who are considering MRUs to bolster their system capabilities. With proper training, the safety issues of using motorcycles are minimized and are almost negligible when compared to the real-world benefits of running EMS and fire MRUs. Fire and EMS MRUIs have very different riding modalities than police motor unites, yet most EMS and fire MRUs use Police Motor Unit training and proficiency standards.  

Considering the amount of mileage accrued, there are very few accidents involving fire and EMS MRUs. The International Motorcycle Response Unit Association (IMRUA) is working closely with motorcycle safety professionals to create proper training standards for MRUs.

Resource Management

One of the primary benefits of MRUs is their versatility. Unlike Police motor units, which are very similar worldwide, EMS MRUs are as variable as the imagination of the organizations that utilize them.

Hungary and Turkey, MRUs are staffed by emergency physicians in addition to paramedics and nurses. They bring with them a wide scope of practice and gear similar to the ambulances operating in their systems (except, of course, backboards and gurneys).

Some MRUs, such as those in Portugal, are BLS-only and are for patients that the dispatch center has marked as low priority, to ensure that they don’t need a higher level of care.

Some departments, like those in Sao Paulo, Brazil, use motorcycles to easily traverse low-quality roads, jump curbs, or ride down stairs on underpasses. They do all of this while carrying ALS medical gear to quickly reach patients in less accessible areas of the city.

Many cities in the U.S. have MRUs for special events and mass gatherings in small areas which make traditional ambulances QRVs impractical.

Personnel Retention

The turnover rate at MRUs is significantly lower than any other EMS or fire unit, creating a large pool of experienced personnel who are eager to work in their field and don’t leave the profession.

The exact reason why attrition rates for MRUs are so low isn’t known, but it’s most likely due to the fact that most people who work on EMS or fire MRUs would probably be riding a motorcycle on their day off, so their work environment and their hobby have a great deal of overlap, leading to significantly less burnout.

This is an important consideration for any department dealing with fast turnover and high attrition rates as often times the cost of running an MRU is significantly less than the actual cost of replacing an employee year after year.

Gear & Capabilities

The flexibility of EMS and fire MRUs is almost infinite.  Unlike ambulances, which seem to have a few standard categories, MRUs can be tailored to the specific needs of the department.  

The type and configuration of the motorcycle, and the gear that it needs to carry are highly variable. Some MRUs, like those in Budapest, Hungary, are practically rolling EDs. With proper training, procedures like ultrasound and invasive central lines can be performed by MRU personnel. 

Disaster Response

Both fire and EMS motorcycles have been shown to be invaluable after natural disasters, manmade disasters, and terrorist events in densely populated areas. Motorcycles allow skilled EMS and Fire responders to survey the situation firsthand and help coordinate responding resources. 

MRUs are a fast, effective way to put “eyes and ears” on the ground to survey and size up a scene quickly, and immediately relay the information back to command staff when cameras are non-functional, roads are impassable, and helicopters are either unavailable or haven’t been mobilized yet.  In many countries, the MRU acts as the incident commander until other resources can be properly activated and positioned. 

In addition, motorcycles are very fuel efficient, so when fuel resources are scarce, motorcycles can easily be utilized until logistics capabilities are built up to supply other vehicles with fuel. Additionally, should a scene suddenly become unsafe, a well-trained MRU rider can evacuate a scene much faster than most conventional 4-wheeled vehicles.

Fire MRUs, if equipped with GPS locators, thermal imagers, and first aid equipment, can be used to quickly map fire perimeters, evaluate potential fire breaks,  and map and extinguish hot spots (especially if weather or resource problems prevent immediate helicopter use). They can also be used to efficiently provide frontline medical support for fire suppression staff at wildfires or other large scale responses while providing personnel a quick, reliable escape vehicle.

MRUs in the U.S.

The two primary issues that pose the biggest obstacles for MRU programs in the U.S. are 1) The transport-based reimbursement model; and 2) The perception that MRUs are more dangerous than their 4-wheeled counterparts.

Unfortunately, the vast majority of the U.S. EMS system is funded by insurance payments rendered on condition of transport to a medical facility. This stems from the original concept of the EMS system in the U.S. being an extension of the ED. This meant that most patients were being transported to the ED for further evaluation.

However, the MRU can still play a valuable role in a transport-based system, as there are some fundamental truths to the EMS system today.

First, the call volume is exponentially higher today than it was in the 1970s when the EMS system was being organized. People see EMS as a necessary emergency service to call upon in lieu of driving themselves to the ED for evaluation. A few decades ago, when immediate cash payment was required for treatment and transport by ambulance, the population was much more reserved in accessing EMS and would address low-acuity problems by themselves, or drive to the ED on their own.  

The number of available EDs hasn’t kept pace with the population’s demand, leading to long wait times at EDs. Many of these minor medical complaints could be treated by MRUs without a need to transport to the ED. Even a private ambulance company working as a contractor in a 9-1-1 system could potentially save money by operating MRUs during critical peak periods or when traffic in the response area is known to increase.

Second, there are very few deaths of MRU providers. Any part of the world that runs organized training programs for their MRU providers see remarkably few accidents, considering the amount of fire and EMS MRUs in use daily around the world.

Almost all MRU riders ride motorcycles as one of their hobbies, so they continue to gain experience riding in various conditions and maintain their riding skills even on their days off. Modern safety gear, which is a requirement and issued to MRU providers in most countries, is very advanced and protects the rider against bodily harm in the event of an accident.

In addition, training regimens that allow MRU riders to hone their accident prevention skills are used in almost every MRU organization in the developed world. For any motorcycle rider, preventing an accident with proper riding technique is the primary focus of safe riding. With LED and sound technology, it’s nearly impossible to build an MRU that can’t be properly seen and heard by traffic around them.

IMRUA Congress

IMRUA was founded in 2009 in Pecs, Hungary, and has held a biennial congress ever since. The last Congress was held in Gdansk, Poland from Sept. 21-24, 2017 and it was attended by MRU organizations from all over the world.  

The latest congress covered topics that are pertinent to EMS motorcycles, like emergency field Caesarian sections. EMS motorcycles have the ability to respond to a pregnant patient whose injuries are non-life threatening. 

MRUs in London and Oslo have been first on scene to emergencies that later turned out to be terrorist events, thrusting the MRU provider into potential tactical scenarios. At the congress in Gdansk, tactical EMS experts have helped give training to MRU providers about basic tactical procedures and the kind of equipment and training needed in case the emergency they roll up to turns out to be a tactical EMS scenario.

Another medical scenario commonly encountered by MRU personnel, toxicology and the popularity of new “designer” drugs was also addressed by a very interesting lecture. Since MRU personnel work alone, it’s imperative that they quickly recognize the potential of violence or aggression often caused by intoxicated patients.

Due to the unique solitary work environment, the topic of guidelines and protocols was discussed to help MRU personnel act more efficiently while still ensuring that the highest standard of care is given.

The next IMRUA Congress will be in Maribor, Slovenia in April of 2019.  It will also be the 10th anniversary of IMRUA, with some festivities and a great chance to interact with various MRUs from around the world.

The topic of Fire and EMS MRUs is very complicated, but it can be simplified greatly to best address the needs of the department operating or considering the MRU to augment the fire or EMS service provided to the community.