Traffic accidents Lukáš Růžek ARK FNUSA Traffic accidents2 Presentation structure 1. Your safety/Making the accident area safe 2. Quick assessment of the circumstances, the environment, and number of injured 3. Call for help -emergency medical service (EMS) 4. Initial patient assessment 1. Control severe external bleeding 2. SSS cABC 3. Cervical spine protection 5. Special populations Traffic accidents3 Learning objectives ̶ Student will know, how to search for and evaluate the dangers of providing first aid in a traffic accident. ̶ Student will learn the priorities of examination and current treatment. ̶ Student will know the specifics of care for selected groups of patients. Traffic accidents4 Injury / trauma ̶ Injury ̶ Sudden health disorder - bodily injury that occurs independently of the will of the casualty by sudden and violent action of external forces. ̶ Polytrauma ̶ Simultaneous injury to at least two body systems ̶ The disability of at least one of them or their combination endangers the basic life functions of the affected person Traffic accidents5 Injuries – traffic accidents ̶ Frequent cause of death/disability of young people ̶ Who can be the casualty? ̶ Person in a vehicle, pedestrian, cyclist ̶ Mass-casualties events - bus, train, plane crash ̶ We can be direct participants or just bystanders ̶ Severity of the accident ̶ From none to death on the scene due to the injuries incompatible with life Traffic accidents6 Danger…. ̶ Your safety comes first ̶ Dead savior = useless savior ̶ Stay calm, act wisely ̶ Assess the circumstances of the accident site and identify possible sources of danger Zápatí prezentace7 Where to park your car safely • Hazard lights flashing • High-visibility jacket/vest • Immediately • In the door • Set up warning triangles Avaible: https://eforms.zpmvcr.cz/jforum/posts/list/87.page Traffic accidents8 Securing the accident site ̶ Stop your own vehicle after an accident ̶ Switch off the engine, brake, switch on the hazard warning lights ̶ Reflective vest ̶ Warning triangle ̶ The triangle must be placed on the edge of the road in such a way that it is clearly and clearly visible to oncoming drivers, at a distance of at least 50 m, on the motorway at least 100 m behind the vehicle. In the municipality, this distance may be shorter if circumstances so require. " ̶ Send helpers to warn oncoming drivers to slow down ̶ Securing a crashed vehicle ̶ Switch off the engine, remove the ignition key, apply the parking brake Traffic accidents9 Vehicle / surroundings fire • In case of fire - stay away • Call the firefighters 150 Avaible: https://globe24.cz/svet/49039-nehoda-v-sanghaji-do-chodcu-vjelo-horici-auto Labeling of dangerous goods ADR - Accord Dangereuses Route Class 1 Class 2.1 Class 2.2 Class 2.3 Class 3 Class 4.1 Class 4.2 Class 4.3 Class 5.1 Class 5.2 Class 6.1 Class 6.2 Class 7 Class 8 Class 9 Explosive substances and articles Gases Non-flammable and non-toxic gases Toxic gases Flammable liquids Flammable solids Self-igniting substances Substances in contact with water which cause flammable gases Flame retardants Organic peroxides Toxic substances Infectious substances Radioactive substances Corrosive substances Other dangerous substances and articles Avaible: https://www.fofrcz.cz/preprava-adr Traffic accidents11 Personal protective equipment - first aid kit ̶ Each vehicle is equipped with a first aid kit ̶ Your safety comes first ̶ ready-made bandage with one cushion, ready-made bandage with two cushions, patch smooth spool, rubber throttle bandage, gloves, scissors and isothermal foil ̶ Gloves ̶ prevention of contact with the patient's blood or body exudates ̶ bilateral protection of infection transmission ̶ Resuscitation mask Traffic accidents12 Call for medical help ̶ Call the ambulance 155 (112) l Where l What l When l Number of injured l Severity of injury l Who's calling l !! do not hang up!! Avaible: https://www.zzshmp.cz/prednemocnicni-pece/zdravotnicke-operacni-stredisko/ Traffic accidents13 Application Záchranka ̶ Simply press the emergency button to call line 155 ̶ Submit your exact location ̶ Help is on the way ... Traffic accidents14 Extrication from vehicles ̶ YES- If the vehicle poses an additional danger to the victim ̶ For example, it is smoking ̶ The patient is unconscious and not breathing normally ̶ Otherwise, leave in the vehicle ̶ Stop bleeding in the vehicle ̶ Psychological support Traffic accidents15 Extrication from vehicle ̶ Do not overestimate your own strength ̶ Do not cause secondary injury ̶ CAVE: ̶ Loosen or cut the seat belts ̶ Airbags - may be activated Avaible: https://eforms.zpmvcr.cz/jforum/posts/list/87.page Extrication Rautek maneuver Traffic accidents16 Inspection of the accident site ̶ So-called „tunnel vision“ ̶ not to pay attention to the first screaming or moaning wounded man ̶ usually there are far worse injured who are silent - unconscious, developing shock,… ̶ Casualties outside the vehicle ̶ ejection, cyclist, hit pedestrian CAVE: ̶ Confused / shaken people around the accident ̶ Children ̶ Persons under the vehicle Traffic accidents17 Inspection of the accident site ̶ Accident mechanism ̶ Mechanism of injury ̶ According to this information, the extent of the injury can be assumed Traffic accidents18 Person in a vehicle ̶ High speed ̶ In a head-on collision, the speeds add up ̶ Rotation through the roof ̶ Unrestrained person in the vehicle ̶ Ejection ̶ Unsecured objects in the vehicle ̶ Protective elements ̶ The vehicle is equipped with deformation zones ̶ Restraint system - belts ̶ Airbags ̶ Child car seat Traffic accidents19 Motorcyclist ̶ Often high speed ̶ High momentum of the motorcycle ̶ CAVE: passenger ̶ Protective elements ̶ Head protection - helmet ̶ C spine protector ̶ Spinal belts ̶ Protective clothing Traffic accidents20 Cyclist ̶ Even higher speeds up to 50km / h ̶ No rider protection ̶ Collision with a vehicle ̶ Tight vehicle passage ̶ Cyclist's own mistake ̶ Protective elements ̶ Head protection - helmet Traffic accidents21 Pedestrian ̶ Highly vulnerable ̶ No protection ̶ Often at a pedestrian crossing ̶ Little children ̶ Side impact ̶ Lower limb trauma ̶ Bumped by vehicle ̶ Ejection ̶ Protective elements ̶ None Traffic accidents22 Public transport Places of occurrence of a higher number of people, higher number of injured in one event ̶ Buses, trams, trains, planes, ships… Mass-casualties events ̶ 1. Look at the overall situation ̶ 2. Call for help ̶ 3. DO NOT treat the first injured person ̶ Go through all the injured Consciousness - breathing (head tilt) - stop massive external bleeding - go to the next one !!!! ̶ START system Traffic accidents23 SSS cABC algoritmus ̶ S – Safety… … Your safety first ̶ S – Stimulate… Ask, shake, painful stimulus ̶ S – Shout for help Control severe external bleeding ̶ A – Airway + cervical spine protection ̶ B – Breathing ̶ C – Circulation + bleeding Traffic accidents24 A = Airway = Cervical spine protection ̶ Airway obstruction ̶ Maintain airway ̶ Chin lift/jaw thrust ̶ 10 seconds !!! ̶ Look ̶ chest motion ̶ Listen ̶ breath sounds ̶ Feel ̶ person's breath on your cheek and ear Avaible: https://www.firstaidforfree.com/a-guide-to-airway-management-for-first-aiders-and-responders/ https://www.shutterstock.com/cs/image-vector/first-aid-listening-breath-unconscious-man-176524565 Traffic accidents25 Cervical spine protection ̶ In most traffic accidents, it is necessary to think about a possible injury to the cervical spine ̶ Especially in unconscious patients ̶ If it is not necessary, do not move with the patient ̶ If it is necessary to move the patient ̶ Sufficient number of rescuers ̶ According to the situation (position of the victim, state of consciousness, necessity of CPR) ̶ To rotate the whole body, including the head, synchronously in the long axis of the body Traffic accidents26 Cervical spine protection – biker, motorcyclist ̶ Helmet removal is a potentially risky maneuver for C spine injuries ̶ Consider the need before ambulance arrive ̶ Sure: motorcyclist - unconscious ̶ YES: unconscious cyclist, not breathing ̶ Rather NO: conscious motorcyclist, cyclist Traffic accidents27 Cervical spine protection – biker, motorcyclist ̶ Protective helmet removal technique ̶ Cooperation of two rescuers ̶ MILS technique - manual in-line stabilization ̶ One rescuer carefully takes off helmet ̶ Second: stabilizes the head by holding the mastoid and the lower jaw by both hands Avaible: https://www.tytozvladnes.cz/sundavani-helmy Traffic accidents28 C = Circulation ̶ Not trained person ̶ Don't delay looking for a pulse Traffic accidents29 Treatment of conscious victim ̶ Ask the patient- state of consciousness ̶ What hurts you? ̶ What is your name? ̶ Look for bleeding ̶ Control massive external bleeding ̶ If there is no reason - do not pull out of the vehicle ̶ Maintain contact with the casualty until the EMS arrive ̶ Calm him down Traffic accidents30 Regularly check the vitals ABC Traffic accidents31 Hand over to EMS ̶ Stay at the scene until the EMS arrival ̶ Hand over patient/s ̶ Pass the necessary information: ̶ Accident mechanism ̶ Condition of the injured ̶ Detected injuries ̶ Performed therapeutic actions ̶ Anamnestic data Traffic accidents32 Special populations I ̶ Pregnant woman ̶ Mother's life is a priority ̶ Risk of abdominal injuries (placenta, fetus) - always examination in a hospital ̶ Syndrome vena cava inferior elevate of the pregnant right's side by about 10-15 cm or 15 ° inclination ̶ Small child ̶ Different anatomical-physiological conditions ̶ More difficult to estimate blood loss ̶ Faster loss of body heat ̶ More difficult to establish communication ̶ Seniors ̶ Impaired adaptive abilities of the organism ̶ Pre-existing comorbidities Traffic accidents33 Special populations II ̶ Obese patients ̶ Smaller reserves of the organism ̶ Difficult and prolonged extrication from vehicles ̶ Athletes ̶ Higher compensation ability ̶ The risk of underestimating the severity of blood loss ̶ Injuries under the influence of narcotics ̶ Non-cooperation or aggression of the patient ̶ Inadequate patient response Traffic accidents34 Learning outcomes ̶ Student is able to evaluate safety risks in a traffic accident. ̶ Student knows when it is necessary to extract the patient from the vehicle. ̶ Student is able to describe the extraction method from the vehicle. „Be energetic in action, however keep calm“ Traffic accidents35 Thank you for your attention Email: ruzek@fnusa.cz Simulation Centre, Faculty of Medicine, Masaryk University 2020