Pre-hospital care at road traffic accidents
When world's first road traffic death was recorded in 1896, everybody concerned at that time reported to have said, "This must never happen again". More than a century later, 1.2 million people are killed on roads every year and up to 50 million more are injured.
Road Traffic accident (RTA) ranks as the 11th leading cause of death and accounts for 2.1 percent of all deaths globally. It is the second leading cause of death among people aged 5-29 years. RTA injuries are becoming the third largest contributor to the global burden of diseases. Although there is no clear cut statistics of the number of deaths and injuries on our roads, experts say that it is increasing.
It is well established fact that accident victims who are brought to hospitals and receive initial medical care within one hour, chances of survival (even with disabilities) are much higher. This is why the first hour following injury is called the golden hour.
Majority of us are not aware of the significance of the golden hour. The scenario at the site of accidents is chaotic, transportation is tardy because of heterogenous and undisciplined traffic. Over crowding and lack of standardised protocols are some of the major factors in delaying proper management. Pre-hospital care is vital to reduce the morbidity and mortality of the injured people. We can prevent the unnecessary deaths and disabilities to a large extent by giving pre-hospital care.
When attending an accident victim, check that the scene of the accident is safe. Your personal safety is paramount or you may add to the problem rather than contributing to the solution. If you have access to high visibility clothing, wear it.
Assess the situation
If there are many people injured, triage will be necessary to order priority. Triage is a matter of putting demands in order of priority. It is used to divide the injured into 3 colour-coded groups:
* Immediate colour-code RED, will die in a few minutes without treatment, e.g. obstructed airway, tension pneumothorax etc. so it needs immediate treatment.
* Urgent YELLOW, may die in an hour or two without treatment e.g. severe fluid and blood loss.
* Delayed GREEN, can wait e.g. minor fractures.
Triage is a dynamic process. If someone deteriorates suddenly this will change the assessment. If you are present, not as a fully equipped expert in trauma and emergency but as a passers by, your assessment may still be very helpful in terms of helping the ambulance crews decide who needs urgent transfer to hospitals, who can wait and who does not need the services of an emergency department.
Talk to the patients if conscious. Come over as competent and reassuring as they will be very anxious and ask where it hurts to get an idea of injuries.
If there is any doubts about fracture apply a splint in order to support the fracture site as even a well fitted and applied splint allows some movement.
Fractures and abdominal trauma may produce considerable concealed haemorrhage. They need to transfer nearby hospital as soon as possible.
Identify the time-critical patient. Some will die unless rapidly removed from the vehicle, at whatever cost. Entrapped patients should be removed in less than half an hour.
When the patient is unconscious remember the ABC — airways, breathing, circulation. If there is sudden deterioration check ABC again for a possible cause.
Principles of extrication
* Stabilise the vehicle where it lies as movement may exacerbate injury.
* Make the vehicle safe. Switch off the ignition, disconnect the battery, swill away any petrol.
* The easiest way to enter a car is through the door, so try this before removing the windscreen or the roof.
* Remove the wreckage from the casualty, not the casualty from the wreckage. Do not try to manoeuvre the casualty through too small a hole.
* Do not move from one entrapment situation straight into another. If necessary spend a short time stabilising the patient before moving into the back of the ambulance.
Fire
* Fewer than 5 percent of road traffic accidents result in fire, and less than 1 in 500 results in significant burns.
* Switch off the ignition of your and any other vehicle.
* Ensure nobody at the scene of the accident is smoking or produces a naked flame.
Chemical
Lorries carrying hazardous loads are required to display an orange board that will reveal information on how to fight a fire, what protective equipment to wear, if the chemical can be safely washed down the storm drains, and whether to evacuate the area.
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