Road Traffic Accident Procedures (5)

Service Delivery 2

RTA (5)

Casualty Care.

Aim

To provide students with information to allow them to deal with casualties at Road Traffic Accidents safely and efficiently in the absence of dedicated medical practitioners.

Learning Outcomes

• Define kinematics

• Understand the importance of ‘The Golden Hour’

• Describe the principles of ‘ABC’

• State the types of casualty handling techniques.

At the end of the training session students will be able to:

Kinematics

The ability to understand the ‘mechanism of injury’ at an incident enables personnel to pass on to medical staff vital information that can identify life threatening injuries that could go undetected.

Kinematics.

Kinematics

1 Impact of the vehicle hitting an object

2 Occupants striking the interior fixtures

3 Occupants internal organs impacting on the bodies hard structures.

In any incident involving deceleration forces there are three identifiable impacts;

Front impact.

Side impact.

Rear impact.

Common indicators

• Front impact Chest, head

• Side impact Pelvis, head

• Rear impact ‘C’ spine, lumbar

• Roll over ‘C’ spine, limbs.

The ‘Golden Hour’

The time of impact to the patient reaching definitive medical treatment.

The background

• Trauma is one of the most common causes of death

• Many of these trauma deaths occur in road accidents

• The Fire Service is involved in many incidents every year where casualties require rescue.

Trauma

Death is TRIMODAL;

Minutes 40%

Hours 30%

Days 30%.

DeathsMinutes

Hours

Days

Time.

First phase

• Brain

• Heart and great vessels

• Cervical spinal cord

Prevention and education.

Death within minutes and seconds

Second phase

Death within minutes and hours

• Brain clots

• Lungs haemo/pneumothorax

• Abdomen haemorrhage

• Fractures long bones and pelvis

Treat within the ‘GOLDEN HOUR’.

Third phase

Death within days, weeks and months

• Infection

• Multiple organ failure

Specialist medical care.

Airway management

The leading cause of death at an RTA is cerebral hypoxia, usually caused by an obstructed airway.

Airway management Following a study, conducted in 1994, the British

Medical Association published the statements;

• Death was potentially preventable for at least 39% of those who died before they reached hospital

• Up to 85% of those had survivable injuries but may have died with airway obstruction.

Airway management

• Look

• Listen

• Feel.

Airway and cervical spine

• Check airway is open and clear

• Check for obstructions

• Open the airway if necessary

• Try not to move the ‘C’ spine more than necessary, if at all

• Airway must take priority over ‘C’ spine.

Airway and cervical spine

• If the airway is compromised, use chin lift or jaw thrust

• Remember excessive movement may cause neurological damage

• In line stabilisation of the Cervical spine generally must take place for any airway manoeuvres unless;

Airway and ‘C’ spine

• In line neutral positioning of the head may be inadvisable if;

• Movement results in muscle spasm or pain

• Movement itself compromises the airway

• Movement results in numbness,tingling or loss of limb movement.

Oxygen therapy

• Vitally important that full flow 100% oxygen is provided to trauma victims at the earliest opportunity and maintained until the casualty arrives at the point of definitive care

• Of great value in offsetting the casualties susceptibility to hypovolaemic shock.

Breathing

• Ventilation is the next priority

• Provide ventilatory support for a casualty who is not breathing or if it is inadequate

• Rate below 10/min or above 30/min, assisted ventilation may be required.

Breathing

• Rate between 10 and 30/min

• Movement

• Equality.

Make an assessment of the chest and check;

Circulation

• Check pulse and capillary refill time

• Note the external signs

• If possible check blood pressure

• Use the blood control measures as required.

Handling techniques

• Manual handling

• Extrication devices

• Spinal boards and blocks.

Spine board

Cervical collar

Casualty carer providing ‘C’ spine support.

History

Information gathered at the scene and passed on to attending medical personnel is invaluable in improving the casualties short and medium term care.

HistoryType of information that can and, if possible, should be obtained;

• Level of consciousness on arrival

• Pulse and breathing rates

• Obvious injuries

History

• Last meal

• Recollection of events before ,during and after accident.

• Medication regimes

Assisting

Maintaining vehicle stability

• Allows procedures such as cannulation and intubation to take place effectively

Intravenous drip sets

• Holding drip sets

• Squeezing ’bags’ to increase flow

• Keeping fluids warm.

Summary

• Medical and rescue operations are inter linked

• Casualty centred approach

• Actions should do no further harm

• Space creation

• Liaison

• Re-evaluation.

Confirmation

Learning outcomes

• Define kinematics• Understand the importance of the

‘Golden Hour’• Describe the principles of ‘ABC’

• State the types of casualty handling techniques.

Assessments will be based on this lesson and the corresponding study note

THE END