Trauma is the leading cause of death of young people (15-29 years) Costs countries between 1–3% of their gross national product Considerable economic losses to victims, their families, and to nations as a whole

1. Road Traffic and Safety: Pre-
Hospital Care
Dr. Amit Agrawal, MCh

2. Key facts
1
2
3
Road traffic
WHO 2004
1.3
Malaria
WHO 2008

<1
Tuberculosis
WHO 2008
1.8
AIDS-related deaths
UNAIDS 2008
Numberofdeaths(millions)
1.3
• Nearly 1.3 million deaths
• 20-50 million injured


3.  The leading cause of death of young people (15-29
years)
 Costs countries between 1–3% of their gross national
product
 Considerable economic losses to victims, their
families, and to nations as a whole
Key facts

4. 46% of road traffic deaths are pedestrians, cyclists and motorcyclists
Road traffic deaths
46%
Pedestrian, cyclists and
motorized two-wheels
riders and passengers
6%
Others
48%
Car occupants

5. Common Injuries
• Head Injury
• Chest Injury
• Spinal Injuries
• Fractures & Soft Tissue Injuries
• External Wounds
• Burns
• Drowning

6.  Preventing the catastrophic effects of crashes
through an effective post crash response is critical to
reducing the fatality rate associated with road traffic
accidents
Pre-Hospital Care: Objective

7. Pre-Hospital Care
Road safety
management Safer roads
and mobility
Safer vehicles Safer road users
Pre-Hospital Care

8.  Crash site management
 Crash victims management
 Direct transfer
 Versus initial resuscitation
Post crash management

9.  Make the crash site safe
 Make sure that there are no hazards or risks to safety
: to the collapsed person or any other people nearby
 Make sure to support the neck and spine and avoid
bending or twisting the person’s neck and back
Crash site management

10.  Immediate phase
 Emergency medical care
 Therapeutic phase
 Medical care to treat and stabilize
 Rehabilitation phase
 Medical and non-medical assistance and support
Post crash management

11.  Triage
 Resuscitation
 A- Airway
 B- Breathing
 C- Circulation
 Safe evacuation (i.e. from vehicle)
 First Aid
 Safe transport
Crash victim management:
Immediate phase

12.  The goal of mass casualty triage is to prioritize
patients for treatment and/or transport
 Triage and resuscitation goes simultaneously
 START Algorithm
Triage

13.  Open the victims' mouth and look inside
 Clear the mouth of loose matter (i.e. food or broken
teeth)
 If required, turn the person on to their side to let fluid
drain from their mouth
 Tilt the person’s head back gently by placing one
hand on their forehead and lifting their chin with your
other hand
Airway

14. Keep in mind injury to the spine

15.  Check for breathing
 Look for movement of the chest
 Listen for the sounds of breathing, and feel for air
escaping from the person’s mouth and nose
Breathing

16. If the person is breathing normally:
roll them onto their side

17.  Make sure that their head is tilted back continue to
check for response and breathing stay with them until
ambulance paramedics arrive
Breathing

18.  Hemorrhage is the predominant cause of preventable
post-injury deaths
 Two large-bore intravenous lines are established and
crystalloid solution may be given
 External bleeding is controlled by direct pressure
 Think for occult blood loss (i.e. into the chest,
abdomen, pelvis or from the long bones)
Circulation

19.  Basics
 ABCD
Triage

20. School of Public Health
First aid
Aim of First Aid
• All Efforts Should be at Reaching the Nearest Hospital
Fast
• 2-3 minutes to revive at accident site
• 35-40 minutes to reach Hospital for saving the injured


21.  Pain, swelling
 Deformity, lesions, bleeding
 Altered mental status or unconscious
 Hypotension or shock
 Cardiac Arrest
Signs and Symptoms

22.  Time and mechanism of injury
 Damage to structure or vehicle
 Location in structure or vehicle
 Others injured or dead
 Speed and details of MVC
 Restraints / protective equipment
 Past medical history
 Medications
History

23. Life threatening
 Chest Tension
pneumothorax
 Flail chest
 Pericardial tamponade
 Open chest wound
 Hemothorax
 Intra-abdominal bleeding
 Pelvis / Femur fracture
 Spine fracture / Cord
injury
 Head injury
 Extremity fracture /
Dislocation

24. HEAD INJURY
Vomiting Convulsion Level of Consciousness
Semi-
ConsciousConscious Un-Conscious
•Generalized• Localized
Bleeding from Nose and Ear indicate fracture of skull.

25. Glasgow coma scale
http://www.glasgowcomascale.org/

26. Best eye opening
http://www.glasgowcomascale.org/

27. Best verbal response
http://www.glasgowcomascale.org/

28. Best motor response
http://www.glasgowcomascale.org/

29. SPINAL INJURY
Transportation on Back with Head Supported between Sand Bags without Flexion
Cervical Spine
SYMPTOM
• Pain • Swelling • Crepitius •Loss of sensation - Arms, Legs and Body

30. Cardio-pulmonary resuscitation
 CPR consists of the use of chest compressions and
artificial ventilation to maintain circulatory flow and
oxygenation during cardiac arrest
 If the person is not responding, not breathing or
making only occasional gasps make sure they are
lying flat on their back on a firm surface and start CPR

31. Challenges
 Initial management: How much and for how long?
 Knowledge of the facilities in the surrounding areas: where the
patient needs to go
 Simultaneous data collection, sharing and further analysis and
reporting
 Supporting medical centers along the project corridor
 Knowledge of available facilities in surrounding areas
 Communication with the ambulance network
 Communication with the relatives
 Affordability
 Chosen based on the Regional Trauma Plan with EMS pre-arrival
notification

32.  Field Stabilization and Prioritization of Injured Patients
 Managing the ABCs and determining the priority
 Controlling spinal alignment and stopping external
hemorrhage
 Selecting a efficient destination
 Consideration should be given to the patient’s location
within the region and time and distance to the trauma
center so the patient can be delivered to the most
appropriate level of care in the least amount of time
Conclusion

33.  Safe environment
 Safe patient
 A
 B
 C
 Safe evacuation
 Safe transport
Safety First!