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Transportation injuries Dr. Ravi Nanayakkara 1. Transportation injuries. Road traffic injuries Railway injuries Aircraft Fatalities Navigational Injuries.

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Presentation on theme: "Transportation injuries Dr. Ravi Nanayakkara 1. Transportation injuries. Road traffic injuries Railway injuries Aircraft Fatalities Navigational Injuries."— Presentation transcript:

1 Transportation injuries Dr. Ravi Nanayakkara 1

2 Transportation injuries. Road traffic injuries Railway injuries Aircraft Fatalities Navigational Injuries 2

3 Objectives Discuss the role of a judicial medical officer in a case of road traffic accidents Describe the injury pattern of each road user Medico – legal investigation of a death due to transportation injuries Describe the injury pattern in victims of train accidents

4 Road Traffic Injuries 17 th August 1896 in London, Continued….. 4

5 The World's First Death by Motor Vehicle On 17 th August 1896, Bridget Driscoll, a 44 year old mother of two, became the first person ever killed by a motor vehicle. She and her teenage daughter were on their way to see a dance performance at Crystal palace in London. She was struck by a car as they crossed palace grounds. Witness said the car was going “at tremendous speed”. It may have been going at 8 miles/h (12.8 Km/h), though it was meant to be going no more than 4 miles/h (6.4 Km/h). A young man driving, giving free rides to demonstrate the new invention and, according to some, trying to impress a young female passenger. At the inquest, the coroner said, “This must never happen again”. Source: World’s first road death. London, Roadpeace. ( -accessed on 11 th December 2003. 5

6 Every day more than 3000 people die of RTA 1.2 million died from RTA, Over 70 % - age less than 45 2.1% of all global deaths - 11 th leading cause of global deaths 6

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10 10 Road Traffic Deaths Worldwide by Sex and Age Group

11 Global burden of disease and injuries 1990 rank for RTA 9 th 2020 rank for RTA 3 rd 50 million people injured each year. 85% deaths due to RTA are in Low income & Middle income countries. 11

12 Top 10 Leading Contributors to the Global Burden of Disease* 1990 Disease or Injury 1.Lower res. tract infections 2.Diarrhoeal disease 3.Perinatal conditions 4.Unipolar major depression 5.Ischaemic heart disease 6.Cerebrovascular disease 7.Tuberculosis 8.Measles 9.Road traffic injuries 10.Congenital abnormalities 2020 Disease or injury 1.Ischaemic heart disease 2.Unipolar major depression 3.Road traffic injuries 4.Cerebrovascular disease 5.COPD 6.Lower res. tract infections 7.Tuberculosis 8.War 9.Diarrhoeal disease 10.HIV continued….. 12

13 Every hour 34 RTI deaths take place in South East Asia. By 2020 this will rise by 144 % compared to 2000. Every second six persons across the world either die or suffer severe injuries due to RTI 13

14 Sri Lanka 2009 Every hour at least 6 road crashes 3 injured every hour - 1 killed every 4 1 / 2 hours 6 per day 33302 lives lost last 20 years - 1538 per year Each death costs US$ 1912 (60 times monthly per capita income of US$ 33) 14

15 Sri Lanka Road traffic deaths 2010- 2500 deaths 2011- 2400 deaths 2012- 2900 deaths 15

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18 Why should we know about transportation injuries? 1.To assess injuries for the purpose of treatment. 2.To evaluate the role of natural disease in the causation of accidents. 3.To reconstruct the accident. 18

19 4. To collaborate, evidence of eyewitnesses. 5. To assist in identification of the vehicle. 6. To predict the state of the person involved in the accident. E.g. drunk or drugged. 7. Identification of the victim. 19

20 8. Documentation of injuries for the purpose of compensation claims. 9. To determine the cause of death. 10. To evaluate the circumstances of death.  Homicide?  Suicide?  Accidental? 20

21 Factors affecting the outcome of a RTA  Road + Environment  Vehicle  Human Factors of the road user  Driver  Pedestrian 21

22 Road + Environment  Road Density ( Vehicle population on the road )  Condition Bends, narrow, Steep, Slippery, Pit holes  Environment Night, rain, mist, fog, Snow, Sand­stones, Smog, Poor lighting at night etc.) 22

23 Vehicle  Speed  Condition (whether road - worthy!) E.g. Absence of breaks Head lamps Horn Signal etc. Continued…… 23

24  Safety devices  They do not reduce the number of accidents, though will reduce the fatality rate and morbidity. E.g. Seat Belt Head Rests Crash Helmets (in motor - cyclist) Collapsible steering wheels Safety Windscreen glass Breaking system (ABS) Air Bags Locking system etc. 24

25 Human factors (Commonest cause in Sri Lanka)  Driver a) General Health Old age Poor vision Poor hearing Prolong reaction time Co-morbid factors such as HTN, DM, IHD etc. Continued……… 25

26 b. ) Alcohol Consumption/Intoxication  Alcohol is incriminated for > l/3 of all RTA  Legal Limit < 80 mg / dl in Blood 26

27 c) Fatigue DROWSINESS TIREDNESS LACK OF ALERTNESS SLEEPINESS Taking more risks Frequent yawning, nodding, blinking Disinterest in carrying on a conversation 27

28 FATIGUE RELATED TRAFFIC ACCIDENTS Common examples: Pilgrimages Airport drops Weddings Holidaymakers Taxi drivers Long distance bus drivers Van drivers

29 FATIGUE RELATED TRAFFIC ACCIDENTS Alcohol Fatigue Particular group Every driver Measurable No tests Preventable No warning Curable Very few treatable

30 Pedestrians  Intoxicated (Alcohol, Drugs)  Impaired Vision / Hearing  Incapacitation due to, Extremes of age. Illness Injuries  Breech of road rules 30

31 Road traffic injuries Pedestrians Car / Vehicle drivers and occupants Motor cycle users Pedal cycle users Three wheeler drivers and occupants Others - Heavy vehicles, Tractors Bullock carts and hand carts users 31

32 Pedestrians account for more than half of the road fatalities. 32

33 Pedestrian injuries. The commonest RTA fatalities How ?  Towards vehicle  Opposite Direction  Crossing the road Continued…… 33

34 Nature and severity depend on, 1. Nature of the vehicle (car/ van/ bus etc. )  Height of the vehicle. Below the centre of the gravity of the victim Above the centre of the gravity of the victim  Type of the vehicle (Heavy lorry, van…)  Speed of the vehicle.  Nature of the striking surface of the vehicle. 34

35 2. Victim  Orientation of the victim.  Height of the victim (Centre of gravity).  Personal factors.  Movements after impact (thrown on to path of moving vehicle) 35

36 3. Road surface  Nature of the surface  Objects – stationary / moving 36

37 Injuries. 1. Impact injuries  Primary impact  Secondary impact 2. Secondary injuries 3. Tertiary injuries  Run over injuries  Run under injuries  Drag injuries 37

38 Primary impact injuries  As a result of first contact with the vehicle. 38

39 Types of injuries  Imprint abrasions  Lacerations  Fractures  Contusions 39

40 Area of the body Knee level Thigh Hip Elbow Shoulder Chest or head 40

41 When the impact is below the center of gravity E.g. Car Primary impact at knee level Bumper fractures occur at 14 MPH in young adults. Victim is scooped up  Secondary impact injuries.  Speed > 25km/h 41

42 Secondary impact injuries (not a must)  Small cut injuries due to shattered windscreen glass  Skull fracture  Rib fracture  Lacerations  contusions 42

43 When the Impact is above the center of gravity E.g. Van, Bus  Injuries to pelvis, abdomen, arms, head  Victim may be projected forward ( forward projection ) or run over. 43

44 Secondary injuries  As a result of victim falling on the ground after the Primary or Secondary impact.  Found in impact with any vehicle.  Are often more lethal, esp. to head, chest, pelvis Distance thrown : Throw distance Continued….. 44

45  Depends on, Force of the fall. Nature of the object struck.  Injuries, Grazed abrasions Contusions Lacerations Fractures Contre-coup injuries to the brain Internal injuries 45

46 Run over injuries  A wheel passes over the body  Chest and abdomen - tire marks imprinted  Limbs, Tears of skin & muscles De-gloving injuries Continued……. 46

47  Features, Clothes - Tire marks, grease, oil Skin - Tire marks - Flattening of affected area - Soft tissue ooze Crushing and degloving of limbs Multiple fractures. Internal injuries 47

48 Run under injuries  Vehicle goes over the body but no run over by tires  Body gets pinned between under surface of the vehicle & road  Any type of fracture, crush injuries 48

49 Drag injuries  Victim gets entangled and dragged along the road  Grazed abrasions with mud and dirt from road. 49

50 Injuries to vehicle occupants  80% are frontal impacts – with another vehicle or object Severe deceleration  Less commonly vehicle is hit from behind Acceleration  Side impacts  Roll over 50

51 Occupants of vehicles Driver Front seat passenger Rear seat passengers / other occupants Tissue injury depend on G force applied per unit area - Larger the area lesser the injury G=C(V) 2 C =0.0039 V – Velocity km/h 51

52 Additional injuries depend on subsequent behavior of the victim and vehicle. 52

53 Injuries depend on,  Change in rate of movement ( G forces )  Speed of the vehicle.  Speed of the offending vehicle.  Nature of the impact.  Design or the interior of the vehicle / cabin.  Availability / usage of safety devices.  Trapped within / thrown out.  Subsequent behavior of the vehicle  Vehicle catching fire 53

54 Injuries to the driver,  Head and face hit the windscreen glass, frame or side pillars. -Blunt and sharp injuries.  Neck - Whip lash injuries, Fracture dislocation of cervical spine. -Due to hyper flexion and hyper extension ( Hyperextension more serious ) Continued……… 54

55 Bleeding into surrounding muscles Rupture of anterior longitudinal ligament of vertebra Tear of intervertebral discs Compression of nerve roots Ischemic haemorrhages and pulping of spinal cord Commonest site upper two cervical vertebrae 55

56  Chest injuries Fractures of ribs, contusions lacerations of lungs Heart compressed between sternum and vertebra  Abdominal injuries Rupture of rectus abdominis, liver, duodenum, bowels  Knee injuries due to hitting of dash board.  Driver hit brake or clutch pedals Posterior dislocation of hip Fractures of pelvis, lower limbs, ankle  Broken windscreen glass - superficial lacerations(sparrow foot marks) Continued……… 56

57  Tightly hold the steering wheel - upper limb fractures ( shoulder, forearm, humerus )  Thrown out injuries – Fatality X 5  Sudden deceleration cause a pendulous effect on heart resulting in step ladder tears of aorta  Side impacts 57

58 Injuries to front seat passenger Nothing between body and windscreen Risk of thrown forward Less anticipation than driver Forward projection may hit front parts of cabin. 58

59 Injuries to front seat passenger  Hyper flexion and hyper extension resulting whip lash injuries.  Injuries due to windscreen glass and windscreen pillar. (Sparrow foot cuts)  Knees hit the dashboard as in driver.  Thrown out more common (unrestrained without seat belt ).  Side impacts. 59

60 Rear seat passenger  Injury to face and head due to impact on front seats.  Dislocation of hip if sitting legs crossed  Thrown between seats and ejected to the windscreen.  Thrown out. 60

61  Passenger Vehicles Vans, Buses, etc. Passenger injuries depend on Nature of impact Relative position of the victim to impact subsequent behavior of the vehicle. 61

62 Function of seat belts  It restrains the body against severe deceleration.  It spreads the deceleration over a considerable area – G forces.  The strap stretches appreciably during severe deceleration.  The belt prevent ejection into the road. 62

63 Function of Air bags  These are designed to interpose itself between the occupant and frontal structures of the passenger cabin.  It helps to cushion the impact and prevent forceful contact and hyper flexion. 63

64 Injury to motor cycle users  Rider / Pillion rider  Traveling openly  Balancing on two wheels  Risk of thrown forward  Easily can speed, maneuver  Risk of run over by other vehicles  Mostly used by young people  Pillion rider has a greater risk of being thrown off on impact Continued……. 64

65 Injuries  Fall on ground  Projection forwards  Side impacts  Run over injuries Continued…… 65

66 Rider Injuries to Head,chest and abdomen Upper limb injuries Fracture femur, tibia, fibula Pelvis injuries Ankle injuries 66

67 Head and neck injuries  In spite of usual wearing of crash helmet.  Worse when riders are not wearing crash helmets.  Skull fractures and intracranial injuries Chin hitting the ground causing hinge fracture Contre-coup injuries  Cervical spine fracture dislocation 67

68  Limb injuries Grazed abrasions Contusions Lacerations Fractures Silencer burns 68

69 Pillion rider Nothing to hold on Risk of thrown forward Often escapes from primary impact from front Similar injuries as rider 69

70 Pedal cycle users  Injuries are very common  Less severe due to low speed  Primary injuries occur from impacts by other vehicles – speed of other vehicle  Secondary injuries due to fall on ground  Run over injuries 70

71  Impact injuries from the offending vehicle  Secondary injuries due to hitting on road surface, sliding across the road  Run over injuries by same vehicle or another  Head injuries with intracranial injuries Unlikely wear helmet  Bicycle spoke injuries 71

72 Three wheeler users  More hazard to other road users  The offending vehicle of the most pedestrian injuries  Lively hood of many adult males – Attempt to get more hires as possible during rush hours Continued….. 72

73  Head on collision  Can topple  Passengers can thrown out 73

74 Injuries are more prone Small and compact nature of the vehicle Overloading No safety devises Drivers are young and takes more risks 74

75 Medico legal investigation of a case of Road Traffic Accident (Hit & run) 1.History 2.Scene visit 3.Identification 4.Preliminary procedures 75

76 5.Examination of clothing 6.General external examination 7.Specific external examination 8.Complete internal examination 9.Specific investigations 10. Documentation 76

77 Railway accidents Impact with the train Injuries to passengers Falling from train 77

78 1.Impact with a train Suicide Jump to moving train Accident Walking or crossing the rail tract Vehicles crossing unprotected rail tract Homicide Push to the moving train (rare) Post mortem disposal Murder and leave on the tract(PM injuries) 78

79 2. Injuries to the passengers Collide with another train Derails 3. Persons falling from train Accidental Homicidal Suicidal 79

80 Injuries following impact are usually fatal. Extensive musculoskeletal injuries. Decapitation Dismemberment / Amputation Bizarre injuries 80

81 Investigation of a body found in Rail tract ? 81

82 Unrelated to impact the train Electrocution from overhead cables Natural diseases (IHD, Epilepsy…) Snake bite Lightening 82

83 Rail tract injuries Aviation injuries Navigational injuries Read….. 83

84 Mechanisms of injury in an adult pedestrian struck by a car at high speed 84

85 Summary Statistics Pedestrian injuries Vehicle occupants (car/passenger vehicle) Motor cycle rider Pedal cycle user Three wheeler occupants Train accidents Medico legal investigation 85

86 Case 1 86

87 Case 2 87

88 Thank you. 88

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