Road Traffic Digest No.6

Road Traffic Digest No 6 How to reduce fatalities on Indian roads?
and What should be the road map to follow in the present scenario
www.tsunamionroads.org
Instead of discussing the ideal management for road accidents, here we will first consider What is practically possible in the present scenario of road traffic management in our country .
In broad terms reduction in fatalities can be achieved by two ways [A] By Preventing road accidents to occur and if occur [B] By providing better trauma care to accident victims
In the present and next couple of digests we would consider the post crash management. After that we would take up the issue How to prevent Road Accidents in our lives.
Some UNIVERSAL facts about results of Trauma care:
24% victims can be saved by SIMPLE trauma care 46% injured can be saved by ADVANCED trauma care
Rest 30% injured CAN NOT be saved even by the best available medical facility in the world !!
As the impact of the accident is so severe that death occurs on the spot immediately or within few minutes before medical facilities arrive.
Prevention is the only answer for this group !!
Some more reasons to believe why prevention is so important?

1. Prevention is much more cost effective as compared to post crash management [especially in India].
2. In India, we have world class medical facilities for most other diseases, though this quality care may not be accessible to all. However, trauma care for accident victims is still not available to even those who can afford it on their own.
3. At present trauma care is in embryonic stage in India. In a country where health budget is 1-2% of GDP, good trauma care on roads is a distant dream for at least next 20 years.
Trauma care in India
I am due in 202@#??*
So let us consider what is the best trauma care we can offer for accident victims in the present circumstances in our country.
The trauma care for accidents victims can be divided into two: [1] Pre-hospital care and [2] Treatment or care in hospitals.
[I] Pre-Hospital Trauma Care What should we do at the accident site ?? This basically includes an attempt to rescue the injured from the accident site, call for help, provide first aid and arrange for transfer of injured for definitive care.
Step 1: Rescue the injured from the accident site 1:

It means to remove injured person/persons who are trapped either inside or under a vehicle or lying on road so that much-needed first aid can be muchgiven and also to prevent any further trauma by other moving vehicles .
Dont forget to place this sign to safeguard yourself

Five policemen including station incharge, while rescuing two accident victims, were run over by a truck and died on the spot [Sitapur, 22nd June 2011
Who can do this rescue job? This rescue work can be initiated by any one not necessarily from a medical background like: Co-passengers
Bystanders Other drivers Dhaba/roadside restaurant owners Police Villagers, etc.
We don t expect trained paramedics or an ambulance immediately [within few minutes] so role of people just mentioned or first responders, even if they are not trained, cannot be overemphasized.
Step 2: Call for emergency help

Make a call for an ambulance or for patrolling or local police and to relatives of the injured by checking his identity.
In India, calling the police to accident site is equally important as that of an ambulance. The reason being the public reaction may be hysterical after accident, so controlling the crowd becomes important in such situations.
PLANNING AHEAD FOR DANGER CAN MEAN THE DIFFERENCE BETWEEN LIFE AND DEATH
Following precautions ensure better aid: Keep vital information like name, address, important phone numbers, readily available Information of medical insurance [e.g. contact details of insurer, hospitals on panel in that region, etc] Blood groups, history of major illness and drugs being used for it. Number of some ambulances and hospitals of that area, etc Where to keep this information? This information can be kept inside ones purse or along with documents of vehicle or as sticker on dashboard or in mobile phone Any one including you, co-passengers or rescuers can easily use it to provide medical treatment within the golden hour .
[2] Keep An Emergency Kit:
Besides a first-aid kit and tool kit, some more items may be of great help in such situations:
Emergency light, Fire extinguisher, flash light, extra batteries, etc.
Large screwdriver, pair of pliers, rubber hammer
Pointed iron rod to unlock the jammed door is especially helpful when it catches fire or plunges into water
Step 3:
Till formally trained paramedical personnel arrive, start providing some first aid:
If no ambulance or health facility is expected at the site then don t wait or waste time. Arrange some transportation to rush towards a hospital.
About First Aid

It is the initial medical help to an injured person at accident site and during transfer till a definitive medical help is available or casualty recovers
The purpose of first aid is to prevent deterioration in condition and to maintain vital functions during this period
The first hour after trauma is called golden hour . Even in this golden hour it is the initial four to five minutes [called platinum period] that are very critical
First Aid in the first hour after accident can increase the survival chances by 70%
Dont hesitate in such a situation on the premise of your limited knowledge and fear of causing more harm to the injured. Remember only the fact that your intentions are the best, you are the only one around to help him and something is always better than nothing and this something can really go a long way. [ ] Here we will discuss more about dealing with serious injuries as we all are used to dealing with minor wounds or cuts. The description about first aid that follows is basically for non-medicos or primary responders [commuters, bystanders, etc]
Steps for First Aid

A. Ensure vital functions: Cardiopulmonary resuscitation The very first priority of first aid is to ensure a clear Airway, Breathing and Circulation [ABC]
Look for consciousness, breathing and pulse of injured. If there is no respiration and heart/pulse then start a Cardiopulmonary resuscitation (CPR) immediately CPR involves two activities: chest compressions and mouth-tomouth breathing [one after every four chest compressions]
Steps for CPR
1. Make the person lie on some hard

surface on his back.
2. Place the heel of one hand over the center

of persons chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your houlders directly above your hands.
3.
Use your upper body weight (not just your
arms) as you push straight down on (compress) the chest for two inches. Push hard and push fast: give two compressions per second, or about 120 compressions per minute.
Observe closely On full screen

4.
Put your palm on the
persons forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open airway.
5. 6.
Kneel next to the person s neck and
shoulders. Pinch the nose shut - - - -
- - and breathe into the mouth for one
second. [one rescue breath after every four chest compressions]

If the chest rises, give a second rescue breath. If the chest doesnt rise, repeat it. Continue CPR until there are signs of movement or until emergency medical personnel take over If you do not want a contact with victim, you may use a small piece of stiff rubber pipe to push the breath in. If there is one more person available to help, he can perform this mouth to mouth respiration
Some times a large number of injured may be there and more hands may be required to provide this first aid or to help paramedical staff
B. Choking or respiratory obstruction

Choking or blockage of airway or throat is a frequent complication after an accident. It is caused by aspiration of :
1. 2. 3. 4.
blood trickling down from the mouth or nose broken teeth or artificial dentures Recently ingested food Any food items present in the mouth at the time of accident [pan, gutkha, chewing gum, etc]
These above items in mouth can kill us instantly !!

The chances of death increase if the injured is unconscious, as he is not able to spit or cough it out www.tsunamionroads.org
On the other hand, automobile companies are encouraging dashboard dining by providing modifications like cup/bottle holders, folding tables or even small refrigerators. We feel this is a wrong trend and has to be discouraged. This not only complicates condition of victim after accident but is also an important cause of distraction during driving leading to actual accidents. Not only this, hyperglycemia due to excess calories may lead to dozing behind the wheel !! Are these automobile cos. aware of these facts??
What should we do in case of choking?

To clear the air passage, turn the injured on to his side with head end little low so that blood or other contents come out with gravity. It will also relieve any tongue fall that frequently aggravates chocking in an unconscious patient. If it is a complete obstruction owing to presence of some material inside the wind pipe or trachea, then use the Heimlich maneuver where you give five quick upwards thrusts over the upper abdomen above the umbilicus. If still airway is not cleared and the person remains choked, then start cardiopulmonary resuscitation (CPR). Sometimes chest compressions used in CPR may dislodge the material from the trachea.
C. Bleeding Wounds: what to do?

The best way is to apply direct pressure over the wound by hand using a piece of clean cloth
Please note, usually it requires more pressure than we expect, so instead of fingers, use heel of palm to apply pressure. Usually bleeding takes 4-5 minutes to stop.
Do not look frequently to confirm whether bleeding has stopped or not as this may dislodge fresh clot that has just formed. Instead, wait patiently. Sometime it may require 15-20 minutes.
In case of bleeding from limbs or head, you can apply a tight bandage or clean cloth around it for sustained pressure.
If still bleeding does not stop then instead of removing the dressing, apply more over it and try to rush the victim to hospital.
If there are multiple wounds, priority should be given to the ones that are bleeding profusely
D. Fracture
Fracture is the most common type of injury in accidents [40-50%] When to suspect:
[a] A fracture or dislocation of a limb is suspected

when there is abnormal mobility, limb deformity, A grating feeling due to movement between two fractured segments of bone. [b] In case of fracture, even a slight movement causes severe pain. What to do in case of fracture?: Immobilization or splinting of fractured limb is the basic aim during first aid of fractures. One should not try to correct alignment of fracture as this may cause injury to underlying vessels & nerves. Instead do splinting with the help of some available wooden stick or metallic bar and apply a gentle pressure bandage. www.tsunamionroads.org
Sometimes the underlying fractured segments of bone can come out after piercing the skin. Cover this exposed part with a clean cloth or bandage.
In cases of total detachment or amputation of a limb:

Sometimes it is possible to join amputated part with the body with the help of microvascular surgery. Collect this severed body part in a clean polythene bag but do not add water [if available normal saline may be used] and place this bag in another bag with cold water.
The remaining wound on the body from which a part has been severed may bleed profusely. In such cases tie a tourniquet just above the site of the amputation.
F. Chest or Abdomen injury

Open wounds of the chest can affect respiration severely by sucking in air through the wound. It can be minimized by covering the wound with a piece of polythene and putting a bandage over it. This may help to reduce air being sucked into the chest. In case of abdominal wounds the intestines may come out. Dont try to push them back into place. Cover the wound with a wet clean cloth dressing.
Do not remove large or deeply embedded objects from wounds.

Do not probe penetrating wounds or attempt to clean them at this point.
At present our principal concern is to stop bleeding
G. Head Injury
FACTS:
[1] It is the most common cause of mortality in road accidents and responsible for 75% deaths among two wheeler drivers.
[2] Among the total neurotrauma admissions, head injury sustained during road accidents constitutes about 60%. [3] Even if you survive the head injury; there may be significant neurological deficit, enough to make life miserable for you and your family. So never underestimate the role of a helmet .
When to suspect a head injury:

It should be suspected when there is a wound over scalp and there are associated symptoms like convulsions, evidence of paralysis or weakness in limbs, deterioration in the level of consciousness, state of confusion, bleeding from the nose or ear.
What to do in case of head injury ?

Patient should be kept in a lying-down position preferably turned to one side. In this position vomitus or bleeding from nose or mouth would come outside and chances of aspiration in to respiratory passages would be minimized. Keep a watch for any breathing irregularities, loss of consciousness or any convulsions.
Cover the wound over the head and the exposed brain matter if any by bandage or a clean piece of cloth
In case of bleeding from inside the ear, instead of plugging the ear, get the injured to lie down with injured ear facing down. If there is bleeding from nose, this could be from injury inside nose or due to head injury. A bleeding from nasal injury usually stops when you pinch the tip of nose for a few minutes while bleeding due to head injury rarely responds to this maneuver.
Spine Injuries
Road accidents contribute to 45-50% of total spinal injurie Please note, when someone has a spinal injury, any additional movement may dislocate a vertebra causing further damage to the spinal cord and thereby can paralyse the lower part of body permanently.
There are several examples where ignorance of this fact OR an overenthusiastic approach has caused complete paralysis that was not there after the accident.
What NOT to do in case of spine injuries

[a] DO NOT move, bend, twist, or lift a person's head or body even a little bit, unless it is absolutely necessary [e.g. if his surroundings or the vehicle in which he is trapped is not safe] Otherwise, wait for trained medical personnel to arrive and handle the situation.
[b] In case he needs CPR, do not tilt head back when attempting to open airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward.
[c] Do not remove a helmet if a spinal injury is suspected.
What to do in spinal injuries:

Thus the basic aim is that we do not hurt him more during resuscitation or shifting, by keeping the person immobile and safe until medical help arrives.
[a] For keeping a person absolutely immobile, place a tape across his forehead, and secure person to a board to keep head, neck, and back areas from moving AT ALL.
If a board in not available, you can remove a long seat of a bus or a top of some wooden bench from roadside dhaba/restaurant for this purpose
Place rolled towels on both sides of neck and body. While doing this, don't interfere with person's breathing. If necessary, use both of your hands, one on each side of person's head to keep the head from moving.
[b] If at all you need to move a person [e.g. choking by vomiting or blood], at least two people are needed. One person should be stationed at his head, other at person's side.
Move the person in the manner you roll a carpet i.e. whole body is moved as a single block without any twisting or tangential movements. Keep the person's head, neck, and back in a straight line while you roll him onto one side
[c] Extreme precautions are necessary while shifting such patients for definitive treatment. There are three possible stages in shifting where abnormal movements can occur. These are: [i] Rescuing the injured from vehicle to nearby place [ii] taking from this place to ambulance. [iii] taking him from ambulance to inside the hospital building
[II] Transportation of Victim to Hospital

The next course of action is transport of victim from accident site to an appropriate nearby hospital. If the ambulance team has already joined the rescuers, it will make an arrangement for transport, once the job of giving first aid is completed If no ambulance services are expected to reach there and condition of patient is deteriorating, some other transport may be arranged For this a van, bus or any vehicle having a long seat is preferred where there is enough space to keep the patient s back straight and accompanying persons are able to care for him.
Care inside ambulance

Paramedical staff can continue remaining part of the resuscitation procedures or can administer other therapy required .e.g. IV fluid line, oxygen, drugs, etc.
Sometimes owing to presence of a crowd, inadequate light outside and better facilities inside van, you feel more comfortable in giving first aid inside ambulance
Whether to feed or not:

This is a very common mistake that we allow injured to drink water etc or keep on pouring water into their mouths. It is safer not to give the victims anything to eat and drink. Even if person complains of thirst, give nothing by mouth. This is to protect patient from vomiting in case he needs anesthesia for some surgery or if he suffers a head injury. In an unconscious patient this water can go into his respiratory passages and can choke him. www.tsunamionroads.org
Choose a correct destination

The pre-hospital care team should assess the severity of injury properly so that they can transfer the injured to an appropriate hospital according to the level of care required. In cases of serious or multiple injuries , opt for a higher centre even if it is situated a little farther
Cases with simple wounds or fractures or where condition of injured is quite stable can be taken to smaller centres
There should be no confusion on the way!
To avoid confusion, the team should know about all government
and private hospitals in that region, not only in terms of distances but also regarding level or quality of care available. This will avoid an unnecessary referral from one centre to the other.
Sometimes cases of serious or multi-system injuries, requiring quality care with urgent surgical intervention, are first carried to small centres where nothing more than first aid is available and ultimately has to be taken to a higher centre causing loss of precious time
Be in touch with hospital
If the ambulance team is in contact with a hospital, it can inform them well in advance about the specialist/specialists who would be needed and also for any preparations to be made when patient arrives at the hospital. Even blood grouping can be done on the way so that the particular blood group can be arranged in advance.
The ambulance drivers should avoid over-speeding as this may not only be a cause of another accident but also the bumpy ride can be risky for injured.
[III] Treatment at hospital [1] Primary or Emergency care

A large number of trauma victims can be saved by a timely and correct emergency surgical intervention. We cannot deny important role of many minor BUT extremely useful procedures for saving trauma cases e.g. Inter costal intubation
Endotracheal intubation
treating shock with blood and IV fluids

These minor procedures can be performed with low priced equipment or facility, e.g. laryngoscope, endotracheal tubes, resuscitation bag, airways, suction apparatus, etc.
It has been seen that many times it is not the availability of funds that is a problem but the lack of an organized approach or drill or lack of will instead!
[2] Specialized care

The spectrum of trauma among accident victims varies widely involving a wide range of specialities [orthopaedic, general surgery, neurosurgery, thoracic and vascular, plastic surgery, etc].
The definitive care is purely a job of the specialists, so a detailed description is not necessary here. However, prehospital care is really an area where every one of us can contribute, that is why this has been discussed here in greater detail
This was about the practical approach towards road accident victims that we all should know and follow in present circumstances in our country.
In the next digest we will discuss about the ground reality or present Status of trauma care in India. or What are the practical problems in management of road accident victims
Remember accidents can happen any time any where and not surprisingly at mid night in a lonely area where you dont expect any help. Even a little knowledge can be of immense help. So please go
through it seriously or join some first aid demo in your city. The description given here is basically for non-medicos or primary responders [commuters, laymen, bystanders, etc] until trained paramedical staff comes and joins them.
A detailed discussion of these actual measures from the point of view of paramedical staff is beyond the scope of these digests and need some formal training with detailed text.
You have received this message from 'Tsunami on Roads Organization' as a part of an awareness campaign against road traffic hazards. If you find merit in this message, please forward it to your contacts
From
Conscious Citizens, India

[www.tsunamionroads.org]
For previous digests please visit: http://www.tsunamionroads.org/rtd.html
or http://www.scribd.com To receive such digests in future please inform at consciouscitizensindia@gmail.com
Jai Hind

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Road Traffic Digest No.6

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Road Traffic Digest No 6 How to reduce fatalities on Indian roads?

Some UNIVERSAL facts about results of Trauma care:

Some more reasons to believe why prevention is so important?

Trauma care in India

Step 1: Rescue the injured from the accident site 1:

Dont forget to place this sign to safeguard yourself

Step 2: Call for emergency help

[2] Keep An Emergency Kit:

Emergency light, Fire extinguisher, flash light, extra batteries, etc.

Large screwdriver, pair of pliers, rubber hammer

About First Aid

Steps for First Aid

Steps for CPR

1. Make the person lie on some hard

2. Place the heel of one hand over the center

Use your upper body weight (not just your

Observe closely On full screen

Put your palm on the

Kneel next to the person s neck and

shoulders. Pinch the nose shut - - - -

- - and breathe into the mouth for one

second. [one rescue breath after every four chest compressions]

B. Choking or respiratory obstruction

These above items in mouth can kill us instantly !!

What should we do in case of choking?

C. Bleeding Wounds: what to do?

[a] A fracture or dislocation of a limb is suspected

In cases of total detachment or amputation of a limb:

F. Chest or Abdomen injury

Do not remove large or deeply embedded objects from wounds.

At present our principal concern is to stop bleeding

When to suspect a head injury:

What to do in case of head injury ?

What NOT to do in case of spine injuries

[c] Do not remove a helmet if a spinal injury is suspected.

What to do in spinal injuries:

[II] Transportation of Victim to Hospital

Care inside ambulance

Whether to feed or not:

Choose a correct destination

There should be no confusion on the way!

To avoid confusion, the team should know about all government

Be in touch with hospital

[III] Treatment at hospital [1] Primary or Emergency care

treating shock with blood and IV fluids

[2] Specialized care

Conscious Citizens, India

or http://www.scribd.com To receive such digests in future please inform at consciouscitizensindia@gmail.com

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