1. Road Traffic Accident Procedures (5) Service Delivery 2

2. RTA (5) Casualty Care.

3. 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.

4. 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:

5. 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.

6. Kinematics.

7. 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;

8. Front impact.

9. Side impact.

10. Rear impact.

11. Common indicators Front impact Chest, head Side impact Pelvis, head Rear impact ‘C’ spine, lumbar Roll over ‘C’ spine, limbs.

12. The ‘Golden Hour’ The time of impact to the patient reaching definitive medical treatment.

13. 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.

14. Trauma Death is TRIMODAL; Minutes 40% Hours 30% Days 30%.

15. Deaths Minutes Hours Days Time.

16. First phase Brain Heart and great vessels Cervical spinal cord Prevention and education. Death within minutes and seconds

17. Second phase Death within minutes and hours Brain clots Lungs haemo/pneumothorax Abdomen haemorrhage Fractures long bones and pelvis Treat within the ‘GOLDEN HOUR’.

18. Third phase Death within days, weeks and months Infection Multiple organ failure Specialist medical care.

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

20. 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.

21. Airway management Look Listen Feel.

22. 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.

23. 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;

24. 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.

25. 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.

26. 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.

27. Breathing Rate between 10 and 30/min Movement Equality. Make an assessment of the chest and check;

28. Circulation Check pulse and capillary refill time Note the external signs If possible check blood pressure Use the blood control measures as required.

29. Handling techniques Manual handling Extrication devices Spinal boards and blocks.

30. Spine board Cervical collar Casualty carer providing ‘C’ spine support.

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

32. History Type of information that can and, if possible, should be obtained; Level of consciousness on arrival Pulse and breathing rates Obvious injuries

33. History Last meal Recollection of events before,during and after accident. Medication regimes

34. 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.

35. Summary Medical and rescue operations are inter linked Casualty centred approach Actions should do no further harm Space creation Liaison Re-evaluation.

36. 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

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