I am often being asked a question: “Why do you still ride a motorcycle despite seeing people getting seriously injured or killed in motorcycle accidents?”

This question has made me reflect on my constant wish for the thrill of a slight adrenaline rush. During my time as a medical student, I attended a career talk where fellows shared the career of their respective specialties. I can still vividly remember an emergency physician showcased photos of his skydiving adventures. While he was talking about how emergency physicians could plan their days off for travel, it was the comparison between his hobby and his day-to-day work in the resuscitation room that intrigued me the most.

Three years ago, I obtained the licence for motorcycling and purchased a Yamaha MT-03. This lightweight naked street bike with a 321cc engine is a popular choice for beginners. After three years, I have come to appreciate its ease of control, agility, and aesthetic appeal.

I was not alone in enjoying the thrill of motorcycling. Local statistics from the Transport Department revealed that during the first 18 months of the COVID-19 pandemic, not so long after I started to learn motorcycling, the number of registered motorcycles in Hong Kong surged by 21%, while the number of private cars increased by only 7%. The pandemic raised the demands for individual transport and delivery services. Soaring petrol prices, limited parking spaces and media promotion also contributed to the expansion of the motorcycle market.

As emergency physicians, we are of course aware of the dangers associated with motorcycling. These vehicles are inherently unstable. Motorcyclists are highly vulnerable to suffer from the worst and the most unusual traumas in any motor vehicle accidents. They have earned the colloquial term “donorcycles”.(1) We saw injuries named after motorcycle parts, such as "handlebar sign", "fuel tank fracture", "spoke wheel injuries" and "exhaust pipe burns". Motorcyclists can sustain fractures in any bone in crashes. Have you heard of “motorcycle radius” (2), “motorcycle tibia” (3), “motorcyclist’s thumb” (4) and “motorbike toe"(5)?

I consider myself fortunate enough yet to have a motorcycle crash (touch wood). Local bikers would tell you that it's not a matter of if, but rather a matter of when and how many crashes you will have. In 2020, a motorcyclist was killed or seriously injured every 968,815 km ridden, compared to 38,424,242 km for car drivers. In crashes, motorcyclists were injured 92% of the time and fatally injured in 4.3% of cases. It is evident that there is a need to improve motorcyclist safety.

When seeing an injured motorcyclist in A&E, I pay particular attention to specific details including the motorcycle model, because its shape and engine size, as well as the mechanism of injury (e.g. high side, low side, high stepping) can impact the pattern and severity of the injury. During the physical examination, assessing the rider's helmet can provide valuable clues about the severity of the impact. Considering that approximately half of the riders with clinically significant findings on CT scans had normal clinical examinations, I advocate for a lower threshold for performing whole-body CT scans in motorcycle collision cases.(6)

Even after seeing so many fatal accidents of young riders, it is still heart-wrenching for me to deliver the tragic news to their friends and families. I am inspired by the Japanese idiom of "ichi-go ichi-e" (一期一会), which emphasises cherishing unique moments and interactions in life because they will never recur in the same way again. Whether this person is my biker pal, my family, or a patient whom I may ever talk to for only a few minutes in my life, every moment should be treasured.

References

1. Thorp SD, Le J, Adams NS, et al. Are motorcycles really "donorcycles"? Examining organ donation rates between unhelmeted and helmeted motorcyclists. J Safety Res. 2020;75:173-177. doi:10.1016/j.jsr.2020.09.006

2. Zettas JP, Zettas P, Thanasophon B. Injury patterns in motorcycle accidents. J Trauma. 1979 Nov;19(11):833-6. doi: 10.1097/00005373-197911000-00007. PMID: 513169.

3. Findlay JA. The motor-cycle tibia. Injury. 1972 Aug;4(1):75-8. doi: 10.1016/s0020-1383(72)80016-0. PMID: 4665153.

4. Alexander C, Abzug JM, Johnson AJ, Pensy RA, Eglseder WA, Paryavi E. Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes. J Hand Surg Eur Vol. 2016 Sep;41(7):707-9. doi: 10.1177/1753193415620186. Epub 2015 Dec 6. PMID: 26642850.

5. Kane S. Motorbike toe: a toddler's sporting injury. J Accid Emerg Med. 1998 Jan;15(1):22. doi: 10.1136/emj.15.1.22. PMID: 9475217; PMCID: PMC1343002.

6. Compoginis JM, Akopian G. CT Imaging in Motorcycle Collision Victims: Routine or Selective? The American Surgeon. 2009;75(10):892-896. doi:10.1177/000313480907501006