3 ObjectivesDiscuss the role of a judicial medical officer in a case of road traffic accidentsDescribe the injury pattern of each road userMedico – legal investigation of a death due to transportation injuriesDescribe the injury pattern in victims of train accidents
4 Road Traffic Injuries17th August 1896 in London,Continued…..
5 The World's First Death by Motor Vehicle On 17th 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.(http://www.roadpeace.org/articles/worldfirstdeath.html)-accessed on 11th December 2003.
6 Every day more than 3000 people die of RTA 1.2 million died from RTA,Over 70 % - age less than 452.1% of all global deaths - 11th leading causeof global deaths
10 Road Traffic Deaths Worldwide by Sex and Age Group
11 Global burden of disease and injuries 1990 rank for RTA 9th 2020 rank for RTA 3rd 50 million people injured each year.85% deaths due to RTA are in Low income & Middle income countries.
12 Top 10 Leading Contributors to the Global Burden of Disease* 2020Disease or injury1990Disease or InjuryLower res. tract infectionsDiarrhoeal diseasePerinatal conditionsUnipolar major depressionIschaemic heart diseaseCerebrovascular diseaseTuberculosisMeaslesRoad traffic injuriesCongenital abnormalitiesIschaemic heart diseaseUnipolar major depressionRoad traffic injuriesCerebrovascular diseaseCOPDLower res. tract infectionsTuberculosisWarDiarrhoeal diseaseHIVcontinued…..
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
14 Sri Lanka 2009Every hour at least 6 road crashes3 injured every hour - 1 killed every 4 1/2 hours6 per day33302 lives lost last 20 years per yearEach death costs US$ 1912 (60 times monthly per capita income of US$ 33)
18 Why should we know about transportation injuries? To assess injuries for the purpose of treatment.To evaluate the role of natural disease in the causation of accidents.To reconstruct the accident.
19 4. To collaborate, evidence of eyewitnesses. 5 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.
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?
21 Factors affecting the outcome of a RTA Road + EnvironmentVehicleHuman Factors of the road userDriverPedestrian
22 Road + EnvironmentRoad Density ( Vehicle populationon the road )ConditionBends, narrow, Steep,Slippery, Pit holesEnvironmentNight, rain, mist, fog,Snow, Sandstones, Smog,Poor lighting at night etc.)
23 Condition (whether road - worthy!) E.g. Absence of breaks Head lamps VehicleSpeedCondition (whether road - worthy!)E.g. Absence of breaksHead lampsHornSignal etc.Continued……
24 Safety devicesThey do not reduce the number ofaccidents, though will reduce thefatality rate and morbidity.E.g. Seat BeltHead RestsCrash Helmets (in motor - cyclist)Collapsible steering wheelsSafety Windscreen glassBreaking system (ABS)Air BagsLocking system etc.
25 Human factors (Commonest cause in Sri Lanka) Driver a) General Health Old agePoor visionPoor hearingProlong reaction timeCo-morbid factors such as HTN, DM,IHD etc.Continued………
26 b. ) Alcohol Consumption/Intoxication Alcohol is incriminated for > l/3 of all RTALegal Limit < 80 mg / dl in Blood
27 c) Fatigue DROWSINESS TIREDNESS LACK OF ALERTNESS SLEEPINESS Taking more risksFrequent yawning, nodding, blinkingDisinterest in carrying on a conversation
28 FATIGUE RELATED TRAFFIC ACCIDENTS Common examples:PilgrimagesAirport dropsWeddingsHolidaymakersTaxi driversLong distance bus driversVan drivers
29 FATIGUE RELATED TRAFFIC ACCIDENTS Alcohol FatigueParticular group Every driverMeasurable No testsPreventable No warningCurable Very few treatable
30 PedestriansIntoxicated (Alcohol, Drugs)Impaired Vision / HearingIncapacitation due to,Extremes of age.IllnessInjuriesBreech of road rules
31 Road traffic injuriesPedestriansCar / Vehicle drivers and occupantsMotor cycle usersPedal cycle usersThree wheeler drivers and occupantsOthers - Heavy vehicles, TractorsBullock carts and hand carts users
32 Pedestrians account for more than half of the road fatalities.
33 The commonest RTA fatalities How ? Towards vehicle Opposite Direction Pedestrian injuries.The commonest RTA fatalitiesHow ?Towards vehicleOpposite DirectionCrossing the roadContinued……
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 victimAbove the centre of the gravity of the victimType of the vehicle (Heavy lorry, van…)Speed of the vehicle.Nature of the striking surface of the vehicle.
35 2. VictimOrientation of the victim.Height of the victim (Centre of gravity).Personal factors.Movements after impact (thrown on to path of moving vehicle)
36 3. Road surfaceNature of the surfaceObjects – stationary / moving
37 Injuries.1. Impact injuriesPrimary impactSecondary impact2. Secondary injuries3. Tertiary injuriesRun over injuriesRun under injuriesDrag injuries
38 Primary impact injuries As a result of first contact with the vehicle.
39 Types of injuriesImprint abrasionsLacerationsFracturesContusions
40 Area of the bodyKnee levelThighHipElbowShoulderChest or head
41 When the impact is below the center of gravity E.g. CarPrimary impact at knee levelBumper fractures occur at 14 MPH in young adults.Victim is scooped upSecondary impact injuries.Speed > 25km/h
42 Secondary impact injuries (not a must) Small cut injuries due to shattered windscreen glassSkull fractureRib fractureLacerationscontusions
43 When the Impact is above the center of gravity E.g. Van, BusInjuries to pelvis, abdomen, arms, headVictim may be projected forward ( forward projection ) or run over.
44 Found in impact with any vehicle. Secondary injuriesAs 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, pelvisDistance thrown : Throw distanceContinued…..
45 Depends on,Force of the fall.Nature of the object struck.Injuries,Grazed abrasionsContusionsLacerationsFracturesContre-coup injuries to the brainInternal injuries
46 A wheel passes over the body Chest and abdomen - tire marks imprinted Run over injuriesA wheel passes over the bodyChest and abdomen - tire marks imprintedLimbs ,Tears of skin & musclesDe-gloving injuriesContinued…….
47 Features,Clothes - Tire marks, grease, oilSkin - Tire marks- Flattening of affected area- Soft tissue oozeCrushing and degloving of limbsMultiple fractures.Internal injuries
48 Run under injuriesVehicle goes over the body but no run over by tiresBody gets pinned between under surface of the vehicle & roadAny type of fracture, crush injuries
49 Drag injuriesVictim gets entangled and dragged along the roadGrazed abrasions with mud and dirt from road.
50 80% are frontal impacts – with another vehicle or object Injuries to vehicle occupants80% are frontal impacts – with another vehicle or objectSevere decelerationLess commonly vehicle is hit from behindAccelerationSide impactsRoll over
51 Occupants of vehicles Driver Front seat passenger Rear seat passengers / other occupantsTissue injury depend on G force applied per unit area - Larger the area lesser the injuryG=C(V)2C = V – Velocity km/h
52 Additional injuries depend on subsequent behavior of the victim and vehicle.
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 vehicleVehicle catching fire
54 Head and face hit the windscreen glass, frame or side pillars. 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………
55 Bleeding into surrounding muscles Rupture of anterior longitudinal ligament of vertebraTear of intervertebral discsCompression of nerve rootsIschemic haemorrhages and pulping of spinal cordCommonest site upper two cervical vertebrae
56 Fractures of ribs, contusions lacerations of lungs Chest injuriesFractures of ribs, contusions lacerations of lungsHeart compressed between sternum and vertebraAbdominal injuriesRupture of rectus abdominis , liver, duodenum, bowelsKnee injuries due to hitting of dash board.Driver hit brake or clutch pedalsPosterior dislocation of hipFractures of pelvis , lower limbs, ankleBroken windscreen glass - superficial lacerations(sparrow foot marks)Continued………
57 Tightly hold the steering wheel - upper limb fractures ( shoulder, forearm, humerus ) Thrown out injuries – Fatality X 5Sudden deceleration cause a pendulous effect on heart resulting in step ladder tears of aortaSide impacts
58 Injuries to front seat passenger Nothing between body and windscreenRisk of thrown forwardLess anticipation than driverForward projection may hit front parts of cabin.
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.
60 Rear seat passengerInjury to face and head due to impact on front seats.Dislocation of hip if sitting legs crossedThrown between seats and ejected to the windscreen.Thrown out.
61 Passenger Vehicles Vans, Buses, etc. Passenger injuries depend on Nature of impactRelative position of the victim to impactsubsequent behavior of the vehicle.
62 Function of seat beltsIt 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.
63 Function of Air bagsThese are designed to interpose itself between the occupant and frontal structures of the passenger cabin.It helps to cushion the impact and preventforceful contact and hyper flexion.
64 Injury to motor cycle users Rider / Pillion rider Traveling openly Balancing on two wheelsRisk of thrown forwardEasily can speed, maneuverRisk of run over by other vehiclesMostly used by young peoplePillion rider has a greater risk of being thrown off on impactContinued…….
65 Injuries Fall on ground Projection forwards Side impacts Run over injuriesContinued……
66 Rider Injuries to Head ,chest and abdomen Upper limb injuries Fracture femur, tibia, fibulaPelvis injuriesAnkle injuries
67 Head and neck injuriesIn spite of usual wearing of crash helmet.Worse when riders are not wearing crash helmets.Skull fractures and intracranial injuriesChin hitting the ground causing hinge fractureContre-coup injuriesCervical spine fracture dislocation
69 Pillion rider Nothing to hold on Risk of thrown forward Often escapes from primary impact from frontSimilar injuries as rider
70 Pedal cycle usersInjuries are very commonLess severe due to low speedPrimary injuries occur from impacts by other vehicles – speed of other vehicleSecondary injuries due to fall on groundRun over injuries
71 Impact injuries from the offending vehicle Secondary injuries due to hitting on road surface, sliding across the roadRun over injuries by same vehicle or anotherHead injuries with intracranial injuriesUnlikely wear helmetBicycle spoke injuries
72 More hazard to other road users Three wheeler usersMore hazard to other road usersThe offending vehicle of the most pedestrian injuriesLively hood of many adult males – Attempt to get more hires as possible during rush hoursContinued…..
73 Head on collisionCan topplePassengers can thrown out
74 Injuries are more prone Small and compact nature of the vehicleOverloadingNo safety devisesDrivers are young and takes more risks
75 Medico legal investigation of a case of Road Traffic Accident (Hit & run)HistoryScene visitIdentificationPreliminary procedures
76 Examination of clothing General external examinationSpecific external examinationComplete internal examinationSpecific investigations10. Documentation
77 Railway accidents Impact with the train Injuries to passengers Falling from train
78 Impact with a trainSuicideJump to moving trainAccidentWalking or crossing the rail tractVehicles crossing unprotected rail tractHomicidePush to the moving train (rare)Post mortem disposalMurder and leave on the tract(PM injuries)
79 2. Injuries to the passengers Collide with another trainDerails3. Persons falling from trainAccidentalHomicidalSuicidal
80 Injuries following impact are usually fatal. Extensive musculoskeletal injuries.DecapitationDismemberment / AmputationBizarre injuries
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