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Anatomy of an Accident

Dr. Jonathan Joslin MMCFD FIMC RCS ( Edin)
Consultant Emergency Physician
Accident & Emergency Department
Mater Dei Hospital

NSO Traffic Accident Statistics 2010 2011 Road Traffic 13727 14264 Collisions Minor Collisions 12897 13064 Serious Collisions 830 1200 Number of Casualties 1079 1577 Ambulance Dispatch RTC 2011 (Total 987) .

Injuries by Means of Transport 2011 Slight Grievous Fatal Total Motorcycles 164 53 5 222 (26%) Passenger Cars 1026 153 10 1189 (14%) Coaches / Buses 25 7 2 34 Goods Vehicles 110 22 0 132 1325 235 17 1577 NSO Day of the Week Statistics RTC Casualties RTC Number .

‘Standards of Pre- Pre-Hospital Emergency Care are a strong determinant of outcome’ outcome’ Donald Trunkey JAMA 1985 Preventable Trauma Deaths .

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. Pre-Hospital Trauma Team Different skills are pooled to ensure that mortality and morbidity trauma figures are decreased overall. Pre-Hospital Trauma Team The concept of a skilled Immediate Care Doctor and Emergency Nurse responding to major trauma has augmented the Multidisciplinary Team approach.

Challenges in Pre-Hospital Emergency Response • Unfamiliar environment • Working on your own • Multiple patients • Stressful environmental conditions • Hazards • Limited initial patient history RTC Injuries Classification 2011 AGE Slight Grievous Fatal Total 0 – 14 53 11 0 64 15 – 24 302 58 2 362 25 – 39 389 61 7 457 40 – 59 323 51 1 375 60 + 249 54 7 310 Unknown 9 0 0 9 Total 1325 235 17 1577 .

the primary injury was unlikely to result in death. • Airway Obstruction was identified in 51(33%) cases and particularly common with associated head injuries In 14 cases (9%). L M Hussain. 308 . A D Redmond : BMJ 1994. Trimodal Distribution of Death Are Pre-Hospital Deaths Preventable 152 pre-hospital deaths from accidental injury in the UK • Death was potentially preventable in at least 60 (39%)) of the Pre-Hospital Deaths.

Pn.thorax failure Cause of  Spinal cord Injury  Ruptured spleen Death Cardiothoracic  Liver laceration injury ( McCoy 25%)  Blood loss injuries  Airway obstruction .Time from Minutes Minutes to Days to Injury Hours weeks Site Pre- Pre-Hospital ED or OR ITU  Brain or  Sub/epidural  Sepsis brainstem injury hematoma ( McCoy 34%)  Multiple organ  T.

SPEED KILLS ! The speed that the vehicles are travelling when the impact occurred Kinetic Energy = 1/2 mass x velocity2 .

Mechanism of Injury KILL THE SPEED ! .

Entrapment Most significant entrapments involve high speed collisions with vehicle deformity and intrusion of the body panels into the passenger cell of the vehicle Entrapment Deformity restricts access of the rescuers to allow resuscitation of the patient .

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Lower limb entrapment injuries .

Concept of Immediate Medical Care • To provide skilled medical aid at the scene of any medical emergency especially when there may be a delay in getting the victim to hospital either due to the distance involved or when the patient is trapped. .

Physician Rapid Response Vehicle Year 2004 2005 2006 2007 2008 2009 2010 2011 Responses 41 45 59 65 85 104 55 68 .

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Vehicle with object 2. 3 Impacts 1. Casualty with interior of vehicle (or pedestrian with road) 3. Casualty’s internal organs with abdominal wall or thoracic cage .

. • There is a fatality in the same vehicle • The impact speeds are greater than 30 mph • The casualty has been involved in a roll over accident • There is significant deformity and intrusion of the vehicle • The casualty has been ejected from the vehicle Windscreen Bull’s Eye impact . Increased Risk of Injury if..

Double Bull’s Eye impact Rapid Deceleration Injuries Reading the wreckage Head Injuries Neck Injuries Massive chest injuries Ribs/ central flail chest Fracture Sternum Myocardial contusion Spleen / Liver laceration Mesenteric tear .

Dashboard Injuries .

Rollover Injuries Motorcycle Injuries .

Motorcycle Injuries Motorcycle Injuries .

Motorcycle Injuries Buses and Coaches .

Buses and Coaches Pedestrian Injuries .

.. Pedestrian Injuries Children...