What to do at the scene of a road crash
Tony Smith
Outline
What to do at the
scene of road crash
Road crash
Environment is unfamiliar
Little or no equipment of their own
– Ambulance equipment is often unfamiliar
Unrealistic expectations of themselves
– Try to do the same things they would do in a well lit and well staffed hospital resuscitation area
These factors can combine to make it a difficult and stressful experience
Need not be so
Road crash
What are your priorities?
Where are you going to start?
What if the scene was quite different?
Road crash – stop or not?
What to do at the road crash scene
What to do at road crash - S
What to do at road crash - A
What to do at road crash - B
What to do at road crash - C
The trapped patient
Ask fire service to pause again after disentanglement
– Re-examine the patient for things that may affect they way you remove them
– Provide some pain relief if possible
– Secure/remove things that might snag
– Clear communication for removal
– Position stretcher so that removal occurs in one smooth move
– Secondary survey once removed
Other bits
The cervical spine
The golden hour
Helicopters
Which hospital?
CPR
Afterwards
Gear
The cervical spine
In general people worry too much about the spine
Clinically significant injury is uncommon
– 2% of trauma admissions to DCCM
Significant abnormalities in the primary survey take priority over the cervical spine
– Deal to these problems first
Many patients can be cleared clinically
Immobilisation has downsides in some patients
Immobilisation should be kept simple
Who can be cleared clinically?
The cervical spine can be cleared clinically if the patient
– Is awake, alert and cooperative and
– Has normal peripheral movement and sensation and
– Has no neck pain on palpation or gentle movement and
– Has no significant distractions
Note - regardless of mechanism of injury
Immobilising the cervical spine
If you can’t clinically clear the cervical spine
– The neck should be in a neutral position with the nose facing in the same direction as the toes
– Awake patients do not need their neck held
– Blankets and towels are a waste of time
– A well fitted hard collar should be applied when one becomes available
– The patient should be kept supine if possible
– There is almost no role for head blocks
– There is no role for transporting on a spine board
– Judgement call on uncooperative patients
The golden hour
It doesn’t exist – even for major trauma
Each person has a golden time period
– For most patients this is measured in many hours
Saving twenty or even thirty minutes makes no difference to the vast majority of patients – even major trauma
Take your time and don’t rush
Helicopters
Helicopters take time
Which hospital?
CPR
Cardiac arrest secondary to trauma has a 99.99% mortality rate
There is almost no role for CPR in the setting of trauma
There is absolutely no role for CPR in the vehicle
We do see a small number of primary cardiac arrests ‘at the wheel’ each year
– Typically low speed
– Typically seen to slump forward and veer off road
– If you think this is the case, drag them out, ignore the spine and perform CPR
Afterward
What equipment to carry?
Summary
The road crash scene can be difficult and stressful
– Need not be so
Remember SABC
Keys to success
– Managing the scene, rather than the patients
– Taking a team approach
– Having a good team leader
– Clear, concise and explicit communication
– Forward planning
– Appropriate prioritisation and delegation
Questions?
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Ministry of Health
