Quite unfortunately, road traffic accidents have been a leading global cause of morbidity and mortality claiming countless lives on a daily basis, especially in the developing countries where notable risk factors abound. According to the World Health Organization (WHO), road traffic accidents account for no less than 1.2 million deaths and about 5 million injuries annually.
Furthermore, it is even more disheartening that productive young adults (15-44 yrs) in the prime of their lives are the worst hit by this menace and represent almost 60% of the annual death toll from vehicular accidents.
The increasing incidence of road traffic accidents has been attributed to a plethora of risk factors notable among which are over speeding coupled with the deplorable state of our highways, drunk-driving, failure to wear seat belts or helmets as well as flagrant disregard of road signs among others. However, the ability to take the right steps at the right time can make all the difference between life and death in the majority of these cases. Hence, this article highlights certain critical steps that must be taken by the rescue team and/or survivors in the event of a road traffic accident.
1. Adopt the principle of triage
Triage refers to the process of sorting and classifying accident victims in an attempt to prioritize based on severity of injuries sustained. This practice is highly expedient in emergency settings where you need to decide on who is to receive your attention first among multitudes of victims. Ironically, those that make the loudest screams rarely need as much urgent attention as the silent unconscious victims who are probably gasping for breath or the ones with profuse external or internal bleeding who have lost litres of blood. Hence, it behoves the emergency rescue team to be able to identify such critical life-threatening cases and attend to them first.
2. Administer First-aid treatments
Evidently, first aid treatments administered on time can go a long way to salvage some lives. For those with significant external bleeding, firm pressure must be applied over bleeding sites and secured with bandage to reduce further blood loss. Fractures should be immobilized/splinted and handled with care to minimize movements at fracture sites and risk of displacement. Also, rescuers must exercise caution in handling unconscious folks who may have suffered a fracture to the cervical spine that may become complicated with clumsy handling. In unconscious individuals who have stopped breathing or lack a pulse, early cardiopulmonary resuscitation (CPR) with measures like chest compressions and mouth-to-mouth breathing may just be life-saving.
Meanwhile, arrangements must have been made to transfer survivors to a nearby hospital facility that is equipped enough to properly manage such emergencies.
3. Replace lost blood without delay
Arguably, circulatory collapse sequel to excessive blood loss is the most important cause of death among multiple injured patients in a road traffic accident. Bleeding can be external (revealed) or internal (concealed) and the caregiver at the hospital must always bear this in mind. By the rule of the thumb, a falling blood pressure accompanied by a rapid pulse is an evidence of significant blood loss. However, patients who have lost up to 1.5 – 2 litres of blood will require blood transfusion whether or not they show typical signs of ‘shock’ such as low blood pressure, rapid thready pulse or cold clammy extremities. A double venous access must be secured with wide-bore cannula and fluid replacement commenced with plasma expanders pending availability of suitable blood. As soon as suitable blood is available (preferably O -ve where group and cross-matching is not feasible), it should be transfused without delay. A urinary catheter should be passed to monitor urine output and assess the adequacy of resuscitation.
4. Ensure and maintain good ventilation
For patients experiencing obvious difficulty with breathing, the airway may need to be suctioned or cleared of thickened mucus and any foreign body impeding air flow removed. The unconscious patient should be nursed in the left lateral position to prevent aspiration of secretions. Manoeuvres like jaw thrust or chin lift (after excluding cervical spine fracture) may be beneficial in case the tongue has fallen backwards to obstruct the airway. Subsequently, ventilation can be assisted with such measures as ambubagging and intranasal oxygen among others as the occasion demands.
5. Request for necessary investigations
Having stabilized the accident victim, the next line of action is to order necessary investigations to determine the extent of injury, discover any complications or even monitor the patient’s recovery. Radiographic (X-ray) investigations of the spine, chest, pelvis and limbs can help to detect fractures, dislocations or perforation. Furthermore, an abdominopelvic ultrasound is important especially for those who feel dizzy or experience marked abdominal pain and tenderness to exclude internal bleeding from ruptured viscus, especially the spleen or liver. Such patients would benefit from an emergency exploratory laparotomy and repair. Routine blood investigations are also important.
6. Follow-up Care
This should not be overlooked especially for survivors who suffered extensive injuries from accidents. For instance, regular physiotherapy is indispensable to prevent contractures following severe burns across joints or disuse atrophy in individuals on plaster (POP) casts. Those who sustained extensive soft tissue injuries would require regular wound dressing and medications until the wounds have healed. In the same vein, a number of accident survivors develop post-traumatic stress disorder (PTSD) that may warrant psychological therapy.
Finally, there is no gainsaying the fact that the steps outlined above will put us in a better position to avert a good number of deaths and disabilities recorded following road accidents.