G’day everyone and welcome to a belated start to the blogs for 2019. This first blog comes as a result of one of our Facebook quizzes we ran a few weeks back. It was also prompted by this news article I read yesterday: https://www.brisbanetimes.com.au/national/queensland/driver-impaled-by-metal-pole-in-warrego-highway-crash-20190225-p5106b.html.
Some of the questions raised were: What happens at a traffic crash? What do we do? So, dive in for a look at some stats on road traffic crashes, the types of injuries you can expect to encounter and what you as a first responder should do when first on scene at a traffic crash.
As a fireman for 15+ years, I have attended a lot of traffic crashes. Sadly, a number of them resulted in serious injuries and fatality. However, the statistics I found when researching this blog were astounding. Starting big picture – since 1989 until January 26 of 2019, there have been 48,592 fatalities on Australia’s roads. In January 2019 there have been 119 deaths in Australia, 18 more than in 2018. And in the 12 months to end of January 2019, there were 1,166 fatalities, which was actually a decrease of 5% on the 12 months before. Whilst these numbers reflect the fatalities, the information I can interpret from other sources for injury rates put these significantly higher, to the tune of 50X more injured than those killed.
So, what causes all these deaths? You’ll notice that I haven’t used the term ‘accident’ in here at all. That’s because the vast majority of these road deaths are deemed to be predictable and preventable. This is why public health officials have spurned the word ‘accident’ when it comes to road crashes. As these crashes are preventable, it would come as no surprise that the predominant factors in crashes are related to inexperience and risky behaviour. Things such as drink/drug driving, speeding, distracted driving (talking/texting on the phone) are big contributors. Driving late at night results in fatigue related crashes, as does people driving older vehicles with less or no safety features. According to a Bureau of Infrastructure, Transport and Regional Economics report from 2016, half of all road crashes occurred on roads with a posted speed limit of 100km/h or higher, with only 12% being on roads at or under 50km/h.
Knowing how a vehicle can crash goes a long way to understanding the types of injuries a person may sustain. Below shows a number of common impacts that vehicles sustain in a crash:
Head on impact
Vehicles impact on the centreline, straight on. Vehicles can also impact head on to a stationary object, such as a tree or pole.
When the front or rear quarter of the vehicle is hit.
As the name suggests, commonly called a ‘T-Bone crash’
Another one that is self-explanatory… Sometimes called ‘Rear Ended’. Generally these crashes occur at lower speeds, but not always.
Another descriptive term. Sometimes you’ll find the vehicle on its side, roof or completely rolled over back onto its wheels.
What to expect
Knowing how a vehicle can crash can lead us now to understand the types of injuries that may be sustained in an impact. This is what you can expect to encounter:
- Head on or frontal impact –
- Down and under – The path the occupant takes, sliding downward into or under the steering column then under the dash. The upper legs take most of the impact here, so expect patella (knee cap) dislocations, mid-shaft femur fractures, upper leg/hip fractures or dislocations.
- Up and over – Where the occupant travels forwards into, then over, the steering wheel forward to the windscreen. Chest, neck and head impacts are the big ones to look for here – lacerations to the head and face as well as skull and facial fractures. When the skull stops, the brain keeps moving, so a lot of internal head trauma happens, such as bleeds and bruising, as well as damage to the brain stem. Whiplash type injuries as well as more serious fractures can happen with the cervical spine region. Chest injuries occur, such as fracture ribs and sternum, flail chest, heart and lung contusions. Abdominal injuries may occur, as can thoracic vertebral injuries.
- Rear impact – As it mostly occurs at lower speeds, neck injuries such as hyperextension resulting in ligament strain/tears as a result of poorly positioned head-rests occur. Head strike and associated lacerations and bruising can occur. Obviously, injuries will be substantially more if in a high-speed impact.
- Side impact – Most of the injuries will be on the same side of the impact. Head and chest injuries, flail chest, lung contusion, rib fractures, thoracic aortic tears, cervical spine fractures or ligament tears and numerous musculoskeletal injuries can occur.
Rotational impact – When the vehicle spins around after an impact, injuries will be consistent with those found in both frontal and side impacts.
- Roll over – Hard to predict where the injuries will occur, it depends on how well restrained the occupant is and what damage is done to the vehicle. As the occupant impacts the vehicle in several places, expect injuries to the external and internal body at these locations, as described above.
- Ejection – When an occupant is thrown from the vehicle. Expect lacerations if through the windscreen as well as numerous internal and musculoskeletal injuries as described above. Increased mortality associated with these types of incidents.
- Vehicle safety restraints – Whilst seatbelts and airbags can save lives, they can also contribute to some significant injuries. Spinal soft tissue and skeletal injuries can happen, as can chest soft tissue and skeletal. Abdominal injuries are common, such as friction burns from the seatbelt, internal damage to abdominal organs and soft tissue damage. This is why seatbelt position of the lap sash is so very important. Do not place it on the abdomen, but rather lower down over the pelvis.
Look for this on dashboards, steering wheels, inside the pillars of the vehicles and in the footwells. Indicates an airbag is located here (several other places they might be, but these are the more common locations).
What you need to do at a car crash
- On approach, make the scene safe. Park at least 10 metres away from fallen power lines. Park vehicle to protect the scene, hazard lights on and warning triangles if you have them.
A UK police car parked in the ‘fend off’ position. This position makes the scene on the other side safe. Any vehicles that approach are theoretically ‘fended off’ and away from the incident.
- As with all incidents, your first priority is to check for DANGER. Approach the scene cautiously, looking constantly for hazard. Such hazards can include, but are not limited to:
- Leaking fuel
- Body fluids
- Aggressive patients
- Undeployed airbags
- Hazardous materials
- Electricity (above and below ground)
This is a photo of a green electricity pillar box. I have been to a car crash where the vehicle ended up on top of the box. The whole vehicle then became energised. If not for one bystander looking for and identifying the hazard, more people could have been seriously injured or killed.
- On accessing the vehicle, turn off ignition and remove the keys (place them on the floor of the vehicle or give them immediately to the first responding emergency services). Apply the park brake if you can and if you are able to, place a chock on the down hill side of the vehicle’s tyres.
- If a motorbike rider and you’re concerned with helmet removal, see this blog: https://www.paradisefirstaid.com.au/how-to-remove-motorbike-helmet/
- Ensure Triple Zero (000) has been called.
- Manage the patient and injuries that you can see.
- If the patient is unconscious, clear and open airways immediately. Then provide manual in line stabilisation of the head so as to protect the neck. Airways have priority, do not be scared or concerned about tilting the head back to access and open the airways. Check and manage any dangerous bleeding, have other people continue doing any first aid that may be required.
- If the patient is conscious, encourage them to stay still and apply stabilisation to the head. Control any dangerous bleeding and have helpers manage any other first aid that may be required.
- If the patient is unconscious and not breathing, immediately remove them from the vehicle if possible and commence CPR.
And that sums up what you should look for at a traffic crash. I have focussed here mainly on car crashes, but the information easily applies to heavy vehicle and motor cycle crashes as well. Just remember that the way the vehicle and body impact determine the nature of the injuries. As always, if you are still not too sure what to do in terms of hands on first aid, please don’t hesitate to get in touch with us on 07 5572 5299, Monday to Friday. We run courses 6 days a week at our three training centres in Helensvale, Biggera Waters and Mermaid Beach. Check us out at https://www.paradisefirstaid.com.au/. Stay safe folks and thanks for reading.
Reference list and photo credits
Curtis, K. and Ramsden, C. (2011). Emergency and Trauma Care for Nurses and Paramedics.
ANZCOR Guideline 2 – Managing an Emergency