Transcript R.T.A. Casualty Care

Service Delivery 2
Road Traffic Accident Procedures (5)
RTA (5)
Casualty Care.
Aim
To provide students with information
to allow them to deal with casualties
at Road Traffic Accidents safely and
efficiently in the absence of dedicated
medical practitioners.
Learning Outcomes
At the end of the training session students will
be able to:
• Define kinematics
• Understand the importance of
‘The Golden Hour’
• Describe the principles of ‘ABC’
• State the types of casualty
handling techniques.
Kinematics
The ability to understand the
‘mechanism of injury’ at an incident
enables personnel to pass on to
medical staff vital information that
can identify life threatening injuries
that could go undetected.
Kinematics.
Kinematics
In any incident involving deceleration forces
there are three identifiable impacts;
1 Impact of the vehicle hitting an object
2 Occupants striking the interior fixtures
3 Occupants internal organs impacting
on the bodies hard structures.
Front impact.
Side impact.
Rear impact.
Common indicators
• Front impact
Chest, head
• Side impact
Pelvis, head
• Rear impact
‘C’ spine, lumbar
• Roll over
‘C’ spine, limbs.
The ‘Golden Hour’
The time of impact to the patient
reaching definitive medical treatment.
The background
• Trauma is one of the most common
causes of death
• Many of these trauma deaths occur in
road accidents
• The Fire Service is involved in many
incidents every year where casualties
require rescue.
Trauma
Death is TRIMODAL;
Minutes
40%
Hours
30%
Days
30%.
Deaths
Minutes
Hours
Days
Time.
First phase
Death within minutes and seconds
• Brain
• Heart and great vessels
• Cervical spinal cord
Prevention and education.
Second phase
Death within minutes and hours
•
•
•
•
Brain
Lungs
Abdomen
Fractures
clots
haemo/pneumothorax
haemorrhage
long bones and pelvis
Treat within the ‘GOLDEN HOUR’.
Third phase
Death within days, weeks and months
• Infection
• Multiple organ failure
Specialist medical care.
Airway management
The leading cause of death at an RTA is
cerebral hypoxia, usually caused by an
obstructed airway.
Airway management
Following a study, conducted in 1994, the British
Medical Association published the statements;
• Death was potentially preventable for at
least 39% of those who died before they
reached hospital
• Up to 85% of those had survivable injuries
but may have died with airway obstruction.
Airway management
• Look
• Listen
• Feel.
Airway and cervical spine
• Check airway is open and clear
• Check for obstructions
• Open the airway if necessary
• Try not to move the ‘C’ spine more than
necessary, if at all
• Airway must take priority over ‘C’ spine.
Airway and cervical spine
• If the airway is compromised, use chin
lift or jaw thrust
• Remember excessive movement may
cause neurological damage
• In line stabilisation of the Cervical spine
generally must take place for any airway
manoeuvres unless;
Airway and ‘C’ spine
• In line neutral positioning of the head
may be inadvisable if;
• Movement results in muscle spasm or
pain
• Movement itself compromises the airway
• Movement results in numbness,tingling or
loss of limb movement.
Oxygen therapy
• Vitally important that full flow 100%
oxygen is provided to trauma victims at
the earliest opportunity and maintained
until the casualty arrives at the point of
definitive care
• Of great value in offsetting the casualties
susceptibility to hypovolaemic shock.
Breathing
• Ventilation is the next priority
• Provide ventilatory support for a casualty
who is not breathing or if it is inadequate
• Rate below 10/min or above 30/min,
assisted ventilation may be required.
Breathing
Make an assessment of the chest
and check;
• Rate between 10 and 30/min
• Movement
• Equality.
Circulation
• Check pulse and capillary refill time
• Note the external signs
• If possible check blood pressure
• Use the blood control measures as
required.
Handling techniques
• Manual handling
• Extrication devices
• Spinal boards and blocks.
Spine board
Cervical
collar
Casualty carer
providing ‘C’
spine support.
History
Information gathered at the scene and
passed on to attending medical
personnel is invaluable in improving the
casualties short and medium term care.
History
Type of information that can and, if possible,
should be obtained;
• Level of consciousness on arrival
• Pulse and breathing rates
• Obvious injuries
History
• Medication regimes
• Last meal
• Recollection of events before ,during
and after accident.
Assisting
Maintaining vehicle stability
• Allows procedures such as cannulation
and intubation to take place effectively
Intravenous drip sets
• Holding drip sets
• Squeezing ’bags’ to increase flow
• Keeping fluids warm.
Summary
• Medical and rescue operations are
inter linked
• Casualty centred approach
• Actions should do no further harm
• Space creation
• Liaison
• Re-evaluation.
Confirmation
Assessments will be based on this lesson and
the corresponding study note
Learning outcomes
• Define kinematics
• Understand the importance of the
‘Golden Hour’
• Describe the principles of ‘ABC’
• State the types of casualty handling
techniques.
THE END