Reinhardt

No doubt an accident like this will cause others to stop and offer assistance. Since you have some training and others due look to those in charge here is what I recommend.

Make the scene safe; assign traffic control to someone to prevent further accidents. Put down road flares, or something similar to direct cars away from the “accident.” Send someone else to call 1-1-2, 9-9-9, or 9-1-1. Whichever works in your area. I was not aware of 1-1-2 being used in England, just Europe. <img src="images/graemlins/smirk.gif" alt="" />

Visually inspect for gross injuries and hemorrhage. Determine Level of Consciousness (LOC) DO NOT MOVE the injured unless absolutely avoidable i.e. threat of fire. Move a person only if you have training to do so. Be prepared to explain your reasons why you moved a person.

Since you mentioned it I will touch on the ABC’s briefly. ABCCDDE A= Airway, B= Breathing, C= Circulation and C-Spine (cervical spine) D= Disability and Degree of injury E= Expose to treat—Remove only enough clothing to treat any life threatening injuries. Immobilize and maintain neutral alignment of the head and neck. Check pulse (circulation) rate and rhythm. Respiration rate and depth. LOC= Alert, Stuporous, Arousable, Oriented/Disoriented or Unconscious. Ask if conscious and female if they suspect they could be pregnant. Check for any medical condition identifiers i.e. Med-Alert Bracelets. Never treat outside of your level of training. I do not know if countries outside the US and Canada have anything like the “Good Samaritan Laws” which means you have some protection from stopping to help.

A person who is thrown across the bonnet (car hood) is probably going to have significant head and other injuries. Maintain and protect the airway first and foremost. Follow the ABC’s, treat gross hemorrhage and gross deformities (broken bones) finally treat for shock. With head injuries you will most likely have a “combative patient.” Any attempts at proper immobilization will usually be rewarded with the person fighting your best efforts. Do the best that you can and maintain Head, C-Spine immobilization and the ABC’s.

Since I spend time volunteering for a local ambulance service, I am always grateful to the first responders on the scene. I must however say that others I work with are not at all thankful, be prepared for this "attitude." IMHO these paramedics have over an developed bicep from pushing a first responder out of the way. Either way be prepared to give a oral report to the ambulance, or fire crew. Ask if you are needed further, or if they need your help. Leave only when you have been excused. I have had people walk off who began basic first aid and I either did not get to thank them or never had a chance to ask them what they saw before I arrived on the scene. In cases like this (major trauma) things always tend to happen very fast and we forget to ask simple things on the patient. Did you note extremity movement for example, when they now have none. This is crucial in properly assessing degree of injuries.

Take care,
Stargazer

ASAP= Always Suspicious Always Prepared

Okay, to start with, I'm not a paramedic or a doctor, I'm a First Aid Instructor.

I would say, follow your first aid training, or treat to whatever level you have been trained to. Depending on the location, and how long they expected to take, I would probably not bother with a splint unless I planned to transport the casualty myself, and I would only do that if it was a minor break (a broken arm, wrist, or ankle, possibly a lower leg or knee fracture) and then probably only if it was a friend or relative.

Under no circumstances would I move a casualty, especially a pedestrian struck by a car, unless there was absolutely no other way to ensure their safety. The number of people who are killed every year by well-meaning bystanders who "move them to safety" is something I prefer not to contemplate. Without an X-ray machine or similar apparatus, I doubt you're qualified to make a judgement as to whether there are spinal injuries, and there could well be other non-spinal but life-threatening internal injuries that could be aggravated by moving them.

Your three priorities in First Aid, in order, are:

1. Preserve life.
2. Prevent further injury.
3. Promote healing and recovery.

If you have a pedestrian hit by a car, with the attendant possible life-threatening plus head and/or spinal injuries, I strongly suspect that the ambulance will be there before you can even start to splint a broken bone.

However, in the event that you have gone through your scene survey and your primary survey and have treated any obvious life-threatening injuries, and the paramedics are still stuck in traffic or whatever, then I would say (as a First Aid instructor), to hell with what the paramedics "want", do what you've been trained to do. If you have a triangular bandage in your FAK, go ahead and put a sling on that broken clavicle. Put a dressing on that cut and tape or bandage it in place. The paramedics will probably whip out their shears and remove it when they arrive, because they have an obligation to examine the injury themselves; that doesn't mean you were wrong. Making the patient as comfortable as possible before the ambulance arrives, even if it's only for 30 seconds, is not something to be dismissed.

If I have a bystander on the scene when I get to ped struck call I want to know everything about the events. How fast the car was going, how she was hit, did the body moved, did she passed out. If I have you around and you are willing to help I will employ you with small skills. If there is a lot of blood I will ask you to pass me equipment so my bag doesn’t get contaminated. Plus when making a call be as specific as you can be. More info I have on the way it gives me more time to get my equipment list ready. Also from the legal point of view if she was day dreaming and she walked into intersection, help the driver out. Go over to him and offer yourself as a witness. Or if the driver runs a light than stick around and tell PD what you’ve seen.

You shouldn't do any splinting and bleeding control should be limited to the minimum. I have to examine all the wounds and if you cover them I have to look under your dressing which may open up the hemorrhaging again. Since this is a trauma call to open airway you are doing jaw trust not head tilt, chin lift and it's a difficult task. Patient should be intubated and lines should be run. Any movement compromises the spine and proper techniques should be use to get patient on the long board. But in this case it's a simple scoop and go. Patient needs hot lights and cold steel not me.

But most important thing is scene safety. Don’t run into the street to check if she is all right and get hit by another car.

Matt

Polak: Quick, what is the number for 911?

Matt

if both your 1 and 9 keys are broken you could always get into contact with your local "broken 1 and 9 keys movement" in your area and start a petition to get the emergency number '888' in operation. <img src="images/graemlins/grin.gif" alt="" />

1) First and most importantly don't add yourself to the casualty list!

2) Stay out of the road and call the medics. Give them as much info as possible

3) Establish a safe scene! If you can put some sign or indicator 'round the bend in the direction from which traffic is comming it would be extremely helpful. Yes do all of this before approaching the victim. The location of the victim is very dangerious - that is why they got hit in the first place. If possible, flag down another vehicle and have it stopped with it's flashers on round the other side of the bend.

4) If all of this is done and your are certain that you can approach the victim and be safe from approaching traffic and the medics or police still haven't arrived then treat things in this order - Airway, Breathing, Bleading. Ignore broken bones! Don't move the victim. Alone, there is no way to adequately protect the spine from further damage. two with inadequate training is even more dangerous. two with adequate training may be able to immobilize the spine without damaging things further.

5) If you must treat for airway or breathing issues then use the jaw-thrust manuveur. If you don't know this or can't manage it alone (it is not that easy to do alone) then pray. What good to get breath into them if you snap their neck while trying?

6) If they are breathing and conscious then encourage them to stay put and stay still look to their bleeding issues. Direct pressure on large flows but otherwise don't worry about it.

7) If they have stood up and are moving about then encourage them to lay down and stay put. The shock that will soon engulf them could cause them to pass-out unexpectedly and fall backward and crack their head on the pavement - further injuring themselves. (have them lay down somewhere safe - not in the middle of the road.)

8) Don't bother trying to set and splint broken bones. If you are within reach of an ambulance service they will be much better equipped to handle this issue and will appreciat that they don't have to remove your splint to inspect the wound.



IFF and only if this happens where someone is going to have to carry them out or they are going to have to walk out then you should continue beyond these efforts. The side of the road doesn't qualify for this but the side of a hiking trail may.

It's that other key, the one located in the bottom middle, usually says "0" (numeral) and may have the letters "OPER" on it! <img src="images/graemlins/smile.gif" alt="" />