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Emergencies and the Ironhorse Culture


Specializes in OR, CVICU/CTICU.

I was at an EMS conference recently and one of the sessions was focused on what to expect / how to manage patients who are part of an outlaw motorcycle club (e.g., Hell's Angels, Bandidos, Pagans, Mongols, or their support groups) both prehospital and in the ER. I didn't see any such info here on AN and thought there were some pretty useful tips. I'll share some below, and if you guys have others, please feel free to share!

- 1% groups are incorporated and have a legal right to the vest of a downed rider (it's the property of the group). If they ask for the cut (vest) and colors (patch), they have every legal right to them. If, however, the patient's clothing is kept by the hospital during recovery, the group will have to get a court order to have the vest released to them.

- Never cut through the colors if you have to cut off the vest. Make every effort to cut down the seams, pull the front of the vest over the head of the patient, and slide it out from under him/her.

- When handing the vest to a "brother" or fellow rider, always present it with the patch facing up - it's a sign of respect.

- Don't touch the patch if possible. Doing so is a sign of disrespect.

- Address the patient by their "road name" - usually a patch on the right chest of the vest - unless the patient tells you his "real" name.

- Riders will typically want to accompany a downed brother in the ambulance. Use your own judgement and preserve your safety, but allowing this may be a good diplomatic move and foster trust between the group and the ambulance crew.

- A rider's unofficial DPOA may be another rider instead of a blood relative. This can lead to an awkward situation depending on hospital protocols.

- If the patient is the president or other ranking member of an outlaw group, you can expect another ranking member to insist on being present at every time (this is usually the "sergeant-at-arms").

- Treating the patient and the group in general with the same respect and compassion as you would with any other patient, and knowing a little bit about the culture, can make a significant difference in how the 1% group interacts with the ambulance crew and hospital staff.

Do any of you out there have anything to add?

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

I've worked ED in a town where a prominent 1%'r group was headquartered and cared for many of it's members and it's no different than caring for anyone else, nor should it be.

We treat them with the same respect we would treat any other patient with, and expect the same level of respect in return that we expect from any other patient.

I've never had another member "insist on being present at every time", but the same visitor rules apply to 1%'rs as any other patient. We do not hand over the patient's belongings to someone else unless the patient can consent to it, it makes no difference if the person claims a form of ownership of any of the patient's belongings, the patient's belongings are secured until the patient can retrieve them or given to the next of kin if the patient cannot. The same legal process for gaining possession of patient belongings apply to all patients.


Specializes in OR, CVICU/CTICU.

Thanks for the clarifications - I realize learning something at a conference isn't the same as boots-on-the-ground experience. I've had zero exposure to the 1% culture - not too many riders in my neck of the woods.