As you approach the motorcyclist, you can see he is wearing full leathers with helmet and boots. The outer layer of the clothing seems in-tact. You can’t see any obvious haemorrhage but can hear him struggling to breath under the helmet visor. You look at his leg and see it is deformed, what should your first management be 

You note the helmet is snug on his head and lift the visor. You see he looks panicked but cannot assess the airway. Should you remove the helmet

Your colleague assists you in removing his helmet and maintaining C-spine control. As you remove it, you can see the patient is fully alert but in a state of distress. You try to calm the patient and assess his airway, where you see no obstructions. The patient starts pleading you for pain relief and says his hips and legs are in agony. What should you do

You continue to review the primary survey and cut the leathers to tactfully expose the patient. There are no breathing issues, but you consider this to be a major trauma due to the speed and mechanisms involved. What should you apply in major trauma to assist with reversing acidosis in the trauma triad 

You apply O2 to the patient. In circulation, his heart rate is rapid at 125 bpm and he has a weak radial pulse. You are concerned by the deformity of the right side of the pelvis where there is significant swelling around the iliac crest. What management should you apply to reduce bleeding into the pelvic cavity 

What landmark do you aim for when applying a pelvic binder

You’ve applied the pelvic binder and now look at the significantly deformed leg as another potential source of internal blood loss. Can splintage of a limb help with reducing further blood loss

The limb is significantly deformed and will be difficult to splint in its’ current shape. Is it acceptable to try and realign grossly deformed limbs to a position as close to normal anatomical alignment where possible 

You look to administer some analgesia prior to splinting the leg, but query what is best to give. The patient has no chest trauma or injury to the upper body, all the impact has been to the pelvis and lower limbs. Can Entonox be given in this scenario 

You manage to realign the limb and splint it. You continue with your primary survey and find no other deficits. Your colleague prepares extrication and immobilisation equipment while you continue to monitor the patient. You have been administering O2 for combating acidosis of the trauma triad, what other 2 elements do you need to be aware of and manage

Given the history, injuries, and signs of shock, what is your impression of patient pathology

The Paramedic EA arrives, and you give a handover to the crew, what do you include