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
 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.

Pre-Hospital Trauma Team

Different skills are

pooled to ensure that
mortality and
morbidity trauma
figures are decreased
overall.
 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
 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.

• Airway Obstruction was identified in 51(33%) cases and

particularly common with associated head injuries

In 14 cases (9%), the primary injury was unlikely to

result in death.

L M Hussain, A D Redmond : BMJ 1994; 308

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. Pn.thorax failure
Cause of  Spinal cord
Injury  Ruptured spleen
Death
Cardiothoracic  Liver laceration
injury
( McCoy 25%)  Blood loss
injuries

 Airway
obstruction
 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
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
 3 Impacts

1. Vehicle with object

2. Casualty with interior of vehicle
(or pedestrian with road)
3. Casualty’s internal organs with
abdominal wall or thoracic cage
 Increased Risk of Injury if...

• 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

 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....