Post-crash Management & Data Needs

1. Post-crash Management & Data
Needs
Dr Amit Agrawal, MCh
Professor of Neurosurgery
Narayana Medical College and Hospital, Nellore (AP),
India

2.  According to available data, the rate of permanent disability
among children aged 1 to 17 years injured as a result of a
road traffic crash was 20 per 100 000 children
 Significant numbers of children required hospitalization or
missed school as a result of their injuries
 Road Traffic Injuries in school-going children remain a
problem and we do not have specific related data
Introduction
https://www.who.int/violence_injury_prevention/child/injury/world_report/Road_traf
fic_injuries_english.pdf

3.  Who are at risk?
 What are the type of transport modalities used?
 What are the mechanisms of injuries?
 What are the type of injuries?
 Who are the first responders?
 What is post crash care?
 What should be the first response?
 What are the warning signs?
 Who will be the stake holders, their roles and
responsibilities?
Outline

4.  School aged children (<18 years, 2-18 years) who are prone
to sustain transport related injuries during their travel from
home to school and vice versa
 This excludes
 Injuries to the children at home or at school or while
travelling for other reasons
Who are at risk?

5.  Bus
 Auto Rickshaw
 Cycle Rickshaw
 Powered Two Wheeler
 Bicycle
 Animal driven carts
 Pedestrian??
What are the type of transport
modalities used?

6.  Hits and falls
 Crush injuries
 Collisions
 Toppling of vehicle
 Behavior related injuries (putting hands or other body parts
out of the moving vehicle)
 Even a big bump at a speed breaker can result in injuries
(getting hit against the roof of the vehicle or to the side bar)
What are the mechanisms of injuries?

7.  Minor injuries
 Cuts
 Lacerations
 Bruises
 Major injuries
 Traumatic brain injury
 Fractures
 Chest injuries
 Abdominal injuries
What are the type of injuries?

8.  Parents
 Vehicle driver
 Vehicle attendants
 Teachers
 Senior students
 Passers-by (general public)
Who are the first responders?

9.  A series of time sensitive actions that are essential to
provide effective care for the injured, beginning with
activation of the emergency care system and continuing
with care at the scene, during transportation to a healthcare
center and hospital-based emergency care
What is post crash care?

10.  The first responders should be able to recognise that there
is an emergency (may be minor or major)
 Able to decide there is a a need for first aid (in cases of
minor injuries) and/or basic life support in cases of life-
threatening injuries
 Ability to make a decision that there is a need to transfer the
injured to the nearest health care facility
 Ensure the safety at the scene, safety to himself and safety
to other children
 To inform to the team coordinator
 Not all road crash incidents lead to a medical emergency
Recommendations: Training the first
responders

11.  Warning signs
 Unconsciousness
 No response or absence of breathing
 Chest pain or discomfort in breathing
 Absence of pulse
 Excessive bleeding
 Seizures
 Extensive burns or burns involving the head, neck, feet, hands,
and genital area
 Injuries caused by chemicals
Recommendations: Identifying the
warning signs

12.  Vehicles ferrying school-going children must carry first aid
material in a dust-proof removable metal box
 Needs to be properly labelled and placed in a well visible and
accessible location
 The first aid kit must contain leaflet elaborating the contents in
first aid box (including their use in local language) and how to use
the contents
 Emergency contact numbers
 School authorities
 Ambulance services
 Family members
 Nearby hospitals
Recommendation: First Aid Kit

13.  The contents of first aid box should be checked at regular
intervals for their use-by dates
 It should be clearly explained to the participants that the
purpose of first aid is not to make a diagnosis but is to
provide support in emergency situation
Recommendation: First Aid Kit

14. 1 2 3 4
2 1 3 4
3 1 2 4
4 1 2 3
Which one first?

15.  Children
 Parents
 School authorities
 Transport services
 Co-ordinating team
 Ambulance services
 Medical management response team
 Traffic police
 Healthcare facilities
 Passers-by and general public
Recommendations: Inventory of
stake holders

16.  Designing an appropriate crisis and emergency response
protocol
 Details of injury patterns
 Details of first response
 Details of first aid kit
 First aid training for first responders
 The details of stake holders
 Their contact numbers
 Identifying the sources to provide financial security
 Ensuring legal support to avoid delay in care (Samaritan
Law)
Recommendations

17.  A simple pre-hospital system that could provide timely care
at the scene with adequately equipped ambulances staffed
with certified care providers
 Health education
 Modes of transport
 Type of injuries and their consequences
 Baseline health care response
 Methods to promote self discipline and responsible
behavior on the roads by all road users
Summary