How to Assist in a Crash Scene
The Basic of First Aid
As more cars occupy our roads, motoring accidents are likely to become one of the biggest killers. Delivery of effective first aid is essential for motorists and is a consequential determinant of the severity of injury, and assistance eventually received may drastically improve the chances of survival. It is indispensable for motorists and is a key determinant of how to manage oneself to be conversant with basic first aid. “During the golden hour – the time period lasting for one hour, or less, following traumatic injury being sustained through an accident or medical emergency – there is the highest likelihood that expeditious medical treatment will prevent death” – St. John. The first critical thing to remember, is to always keep calm! If you panic you cannot do a good job, what is much more important, instead of reassuring the patient you will add to his or her distress and aggravate any conditions of shock with possibility of serious consequences. And, in the unfortunate event of an accident, first check yourself for any injury.
Promptly, try to assess how well you can move your limbs, and if you experience symptoms such as dizziness etc. Remember you need to be fit enough to help the others. Keep in mind, there are serious risks in trying to assess and treat an accident patient on a roadway or where there is traffic. If the patient is lying on the road or in a position of danger from passing traffic, ensure oncoming traffic is warned. If the injuries are only minor, move the patient off the road. People screaming, crying and making a noise have to be breathing – and your initial priority is therefore to check anyone quiet and not moving. Quickly check if quiet casualties are responsive: – if there’s no response calmly check if they are breathing. If you have not stopped at the scene, and others have stopped, DO NOT call for an ambulance as you need to provide information about the crash.
Check the Vitals
1. Is the patient in danger of further injury? from drowning – if lying in water; from burns – or if trapped in a burning car; from suffocation – through fumes or strangulation; from weather – if lying in rain or hot sun or from any other cause? If so, you must remove the patient from the cause or the cause from the patient. While urgency is needed, try as much as possible to be tender.
2. Is he breathing? If not, artificial respiration must be started quickly and kept up. Never assume death unless it is one of those rare situations when it is obvious that the patient cannot be possibly alive. Artificial respiration (artificial ventilation) is an emergency procedure for maintaining a flow of air into and out of a patient’s lungs when the natural breathing reflexes are absent or dull. The simplest and most efficient procedure is mouth-to-mouth resuscitation. Schaffer’s Method: Lay the victim on his belly with one arm extended directly overhead and the other arm bent at elbow, with the face turned outward and resting on hand or forearm, so that the nose and mouth are free for breathing, pull the tongue forward, but do not hold it. Kneel, straddling on the victim’s thighs, with your hands on the small of the back with fingers resting on the ribs, the little finger just touching the lowest rib, with the thumb and fingers in a natural position and the tips of the fingers just out of sight. Keep your arms straight, lean forward slowly over the victim bringing the weight of your body gradually to bear on the victim for about 2–3 seconds, release the pressure slowly and return to the first position by sliding your palms sideways in a swift rhythm. Repeat this procedure about 12–15 times a minute. It will help victim to restore breathing gradually. A victim may require 1–3 hours to re-establish the natural breathing. After the victim starts natural breathing, the artificial respiration should be stopped, and watch on the victim till he breaths naturally.
3. Is he bleeding? If so, is it serious? Artificial bleeding (of a bright red blood issuing in spurts) must be stopped quickly. The only way to treat such injuries is through compression, and applying pressure to a wound until it stops bleeding. Venous bleeding (dark red blood flowing steadily) may not be serious but must be stopped. Capillary bleeding (oozing rather than flowing) can usually be left for a short while if more important work has to be done; if not, apply pressure.
4. Is there a fracture? Is so, or if a fracture is suspected, do whatever you can to avoid movement at or near the fracture and if the skull or spine is suspect to be injured take special precautions to avoid such movement. For features to the limbs, apply pressure to the wound (if bleeding) with a sterile bandage, a clean cloth or a clean piece of clothing. Immobilize the injured area. Don’t attempt to realign the bone or push a bone that’s sticking out back in. If you have training in how to splint and professional help isn’t readily available, do apply a splint to the area above and below the fracture. Padding the splints can help reduce pain.
5. Check for shock and feel the patient’s pulse. If the pulse is strong, between 65 and 80 beats per minute) the case may not be too serious, but if the pulse is rapid and feeble, exercise the greatest care. Signs of shock include: Trembling or shaking, pounding heart, rapid breathing, lump in throat, feeling choked up, stomach tightening or churning, feeling dazzed, cold sweat and racing thoughts.
6. Do not remove clothing unnecessarily nor do more than is needed.
7. Do not give alcohol, where the case appears serious, and if the patient is unconscious or likely to be in the need of anesthetic; when medical help arrives or is availed; meanwhile do not attempt to administer food (s) or drink to them.
How to Help
1. Remembering the danger of further injury (ies), you can only do what seems to be the best in the circumstances of each case. Keep in mind it is better to do nothing that cause harm. If the patient is to be moved, remember the use of utmost care in cases of suspected head, neck or spinal injury. In all the latter cases, lay the patient on his back with a little support under the knees, small of the back and neck and keep them still thereafter. Move as carefully as possible.
2. Where artificial respiration is required you must know one of the key recognized methods to help. Loosen clothing and make sure the mouth is clear.
3. Where bleeding is of any severity, it must be stopped quickly. Nearly all bleeding, even though severe, can be controlled by direct pressure with a firm pad which should be placed on top of a clean dressing and firmly bandaged on. If no specially prepared dressing is available, use the cleanest material to hand like the inside of a clean handkerchief, freshly laundered clothing, even clean paper if nothing better is available. Do not undo the bandages over a wound. If there is substantial oozing through it, add further bandage over it. Wherever possible, the patient should lie down and the injured limb should be raised if it is not broken. Never remove a blood clot from a wound, it could make it worse.
4. Foreign body in the wound: you should remove foreign or lodged body on the surface of a wound. Avoid removing any article that is deeply embedded in the wound and instead build up dressing or bandage round the foreign body so that no further damage or bleeding is done when the final bandage is placed.
5. Where fractures have occurred it is important that no further damage is done. Immobilize and support the arm or leg to the best of your ability by tying it to the body or to improvised supports. If the split bone is protruding through a wound, cover it with clean dressing to keep out infection; and bandage it well.
6. In suspected case of spinal or head fractures (particularly if there is bleeding from the ear) exercise the greatest care, do not move the patient more than is absolutely necessary and support the head and body at all times during such movements. If at all possible, do not transport the patient until medical help is available; but if transport becomes essential try to use any type of flat support which will have the effect of using a stretcher, moving them cautiously.
7. Shock is evinced by pallor, clamminess of skin, nausea and giddiness. If the nausea turns to vomiting, do not allow the patient to lie on his back. Loosen clothing, keep the patient warm and reassure him to the best of your ability. If the condition deteriorates (faster and more feeble pulse and unconsciousness) remove the patient to hospital as quickly as possible; and give nothing to drink.
8. Where the injured person is unconscious, you ought to: ensure there is plenty of air around the patient, remove false teeth, undo tight clothing, do not allow the patient to lie on his back if breathing is noisy, keep patient warm, give nothing to eat or drink, do not leave the patient until help is available, get the patient to a doctor, or a doctor to the patient, whichever is quickest option.
9. In dealing with burns and scalds do not handle the affected area, do not apply any liquids, do not remove burnt clothing to break any blisters. Cover the whole area with a clean dressing and bandage. Remove jewelry, belts and other restrictive items – especially from around burned areas and the neck. Burned areas swell rapidly. Elevate the burned area. Raise the wound above heart level, if possible. Watch for signs of shock, which may arise thick and fast. Signs and symptoms include fainting, a pale complexion or breathing in a shallow fashion.
If signs of severe shock are present and internal bleeding is suspected, the condition is serious and the patient should be taken a doctor as quickly as is possible. Internal bleeding is often accompanied by air hunger (gasping for breath) severe thirst (do not give anything to drink) and acute restlessness.
Responsibilities in an Accident
While it’s the aim of all good drivers to reduce and manage risk by making good decisions and taking responsibility for their actions on the road, it is inevitable that accidents will happen on the road. The most important thing is to ensure that everyone is safe. Driving comes with an important responsibility of making sure that you and your passengers arrive safely to your destination. Yet, driving involve risks – a risk that you may crash and that you or other may be injured. In Kenya, about 15% of all accidents are caused by motorists who are under the influence of alcohol. In the unlikely event of an accident, one cardinal things to do is to document as much information as you can – in photographs and notes. Document the time of the incidence, the details of the other vehicle – including insurance details – names and contacts of the people involved, and notes of any injuries you or others sustained. The determination of who is erroneous in an accident is decided by the traffic officers, although the violation of traffic rules may be obvious in most cases. Remember to also call your insurance agent to make their determination and where possible come to the scene of the accident.
Avoid the Trouble
Slow down a bit and give yourself enough time to react to mistakes, including those made by other drivers. Leaving plenty of distance between your car and the cars around you can make the difference between stopping and crashing. Constantly remind yourself to leave a 30 meters space. Stay vigil on the road: Develop a habit of continually scanning the traffic scene around you. Look well into the distance, to both sides and in your mirrors. You may also need to think about what other road users may do. Drive slower during the night-time. The risk of accidents are higher at night. Pedestrians, motorcycles, and cyclists are harder to spot at night. Wear your seat belt, and obey all speed limits and signs.
Breaking: A Trend Alert
Most modern cars today come fitted with Anti-Lock Braking System (ABS), a system designed primarily to allow you to perform an emergency stop while still being able to steer. In the outmoded brake system, pressing hard on the brakes would cause wheels to lock, and consequently cars skidded out of control. Good use of ABS if performing an ‘hard-stop’ is simply to apply hard pressure on the brakes. Don’t pump on the brakes. Don’t be alarmed by the pulse-like vibration on the brake pedal, this is ABS in action as in rolls from locked to lightly rolling.
More Useful Hints
Clouds may be pleasant to look at from a distant, but at ground level they make driving exceedingly complex. Aside from creating dangerous driving conditions, fog comes with obvious difficulty in visibility which in some areas of Kenya can be dense to almost zero visibility. In these occurrences, always avoid using high beam lights because they reflect off the moisture droplets in the fog. In instead, turn to low beam, turn on your fog lights if your car has them, increase your following distance, and use the shoulder marking to guide you in the areas of poor visibility. Finally, if your tyre blows-out, do not make sudden changes in direction, don’t brake or use the clutch. Ease up on the accelerator and if the blow-out was a front wheel, use the handbrake (gently) to gradually slow down. A skid occurs when tire traction is lost with the surface of the road. Common causes include turning too sharply in corners, approaching corners at a high speed, braking too hard, accelerating too hard, and poor road conditions. The best way to get out of a skid is not to get into one in the first place. However, In the unlikely event that you find yourself in this situation, it is of great import to remember to keep your foot off the brake pedal. Steering aptly will depend on the direction of the skid. Steer to the direction that you want your vehicle to go.
Handling Motoring Breakdowns
If your vehicle breaks down while you are driving, it can be dangerous for you, your passengers, and other road users; remember safety always come first. No driver wants to experience motoring breakdowns. However, should it happen to you it’s important to remember safety comes first. Below are some useful hints:
- Change lanes safely and move off the road giving a slowing down signal to others. When it safe to, pull on the side of the road, as clear off the traffic.
- Try to get to the nearest exit off the highway.
- Don’t stop in a bridge.
- Turn on your hazard lights and raise your hood – warn other road users that you have broken down. The red warning triangles should be placed prominently atleast 75 paces behind your car. No warning is irrelevant, the unconventional method of placing branches along the road on both sides being a plus, if it will improve advance warning to other road users.
- Have all occupants leave the car and move to a safe distance, disembarking from the side off the traffic. Once disembarked keep a reasonable distance.
- Remember that some parts of an engine are hot, and you may want to wait for sometime before your handle anything in and on the engine of the car.
- Engage your handbrake especially if your car stalls on a hill.
- Fuel – Ensure you have enough gas plus reserve before you start a journey
- Lights – Check that your beam, fog, side lights and indicators are working
- Oil – Ensure that your oil levels are okay
- Water – Fill up wash reservoir and check the level on the radiator coolant.
- Electrics – Check battery, wipers, horn and fan
- Rubber – Check that your wheels have enough pressure. The number one cause of tyre bust is under-inflated tyres that blow-out due to excessive heat build-up at high speeds. Inflate your tires to the correct PSI tyre level
- Speed thrills, and speed kills