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Injuries from road traffic accidents (RTA) are the leading cause of death for children and young adults worldwide. They account for approximately 1.3 million deaths worldwide each year as per the WHO facts. Out of these 1.3 million deaths, around 93% of fatalities on the roads, occur in low and middle-income countries, leading to considerable economic losses to individuals, their families, and nations as a whole.
The most common reasons for RTAs are human error, speeding, driving under the influence of alcohol and other psychoactive substances, non-use of 2-wheeler helmets, seat-belts, and child restraints, distracted driving due to increased mobile phone usage in current times, unsafe road infrastructure, unsafe vehicle, inadequate post-crash care most often due to lack of awareness among bystanders, and inadequate law enforcement of traffic laws. It requires a multi-sector approach to prevent road traffic accidents such as transport, police, health, education, and actions that address the safety of roads, vehicles, and road users.
This article focuses on bystander awareness of first aid and co-ordination at such accident spots which can markedly reduce the chances of worsening of victims' condition due to improper handling in transit to the Hospital. Call the emergency care services in Mysore if you wish to get immediate help or more information.
Steps to be Taken by Rescuers During an Accident to Help the Victims
Scene safety
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Rescuers need to assess the scene safety before approaching any victim due to the high chance of the rescuer being injured in the process of extricating the victims.
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There is the possibility of multiple vehicular collisions due to high speed, low visibility, and inadequate reaction time for passing vehicles with added risk from highly flammable fuel causing blast accidents of an already crashed vehicle.
Check for a response and call for help
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Immediately after extricating the victim from the crashed vehicle, move to a safer roadside area and check if the victim is responding and awake.
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Try to check the pulse and whether the victim is breathing or not. However, do not take > 10 seconds to assess.
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If the victim is responding, then call for an ambulance 108 or whichever ambulance service you can contact first with location and incident details and wait by the victim’s side.
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If the victim is unresponsive, call for help first or point out to one other bystander particularly saying for example - "Hey you with a white shirt, call for an ambulance (and advise to get an Automated external defibrillator/defibrillator preferably)".
Do's and Don’ts while helping victims
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While you wait for the Ambulance/Medical help, in a responding victim, keep a constant watch on any deteriorating signs like loss of consciousness, seizures, vomiting, drowsiness, and abnormal breathing.
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Simultaneously compress any bleeding part of the body with an available clean cloth or with your hands.
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Remember to NOT give anything orally like water, irrespective of whether the victim is conscious or not. This is to prevent choking/aspiration in a semiconscious person. Understand that the victim might need emergency medical and surgical interventions ASAP which might get complicated if the victim is given food/water in transit.
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While you wait for the Ambulance/Medical help, if it’s an unresponsive victim, start with high-quality chest compressions and ventilation in the ratio 30:2 (One needs to familiarise/take training for "Basic life support" and high-quality chest compressions).
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If one is unaware of how to ventilate, it is best to at least start chest compressions until medical help arrives. This can be done by placing one hand over the other on the lower 1/3rd of the victim’s chest bone, usually located at the centre of the chest and compressing down with a depth of at least 5 to 6 cm or 2 inches and maintaining the rate of 100 to 120/min in an adolescent and adults. Pediatric age group compressions come with a little modification which can be learnt by attending "Hands-on Training sessions for CPR" conducted at any centre near you. However, if untrained, begin with chest compressions in kids with a compression depth of at least 1/3rd of anteroposterior diameter or 4cm.
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Remember NOT to manipulate the neck of the victim as he/she may have suffered spinal cord injury which may worsen if the rescuer manipulates the neck.
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Take additional help from bystanders to stabilize the head and neck with their hands and forearms and another bystander to compress any active and visible bleeding site to prevent ongoing blood loss.
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Also, take any cloth long and tough enough (for example bedsheet, women's dupatta/scarf/veil, long towels etc.) to tie around the waist and hips tightly to align the hip bones and again aid in reducing blood loss.
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Handover to the Emergency medical services team upon arrival simultaneously gives a brief history of the event and your observations of the events and victim to the Ambulance/Medical team which can help in valuable decision-making for the team.
Special Circumstances
In certain situations, where the ambulance cannot reach a remote area in time or bystanders have to take the patient to the hospital, ensure that while you shift the victim into the vehicle:
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The spinal column is immobilised which can be done by placing a hard board/makeshift spinal board, beneath the victim.
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Ensure that you "log roll" the victim meaning, turning the entire body and head held in line, on one side with the help of 3 people and slide the spinal board beneath the victim and let the victim lie supine on board throughout the transit.
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Splint any broken and deformed limbs with any makeshift splint. Remember splinting not only aligns broken bones but also reduces blood loss.
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Many types of splints can be constructed for various extremities but they should all have these qualities: Be rigid to hold the weight and shape of the victim’s limb and padding adequately on the bony prominences, insulate from the cold, be lightweight, allow open spaces to assess feet or hands to check circulation abnormalities like bluish discolouration, increased swelling, shiny skin or anything abnormal.
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Some random materials that can be used for splint-making are straight tree branches, trekking sticks, puffer jackets, camping mattresses/tables, tarps, drawing boards etc.
Final Help
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Assist the victim to the nearest Hospital along with an Ambulance/Medical team if required, or else in another vehicle, and try reaching out to family members of the victim to inform the status and hospital where the victim is/is being taken, Alternatively can also inform the Police.
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As a good Samaritan, offer help as long as any family member takes over the situation.
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The Hospital’s Emergency Department is well equipped to handle trauma cases, however, they often can be overwhelmed by the unrequired and non-helpful crowds and the crowd must understand that the Hospital and Team of Doctors have the best interest of the victim/patients and the crowd to reduce any unnecessary interruptions towards the care provided.
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The nearest Hospital to the “Bangalore-Mysore Expressway” towards Mysore is "Manipal Hospitals Mysore" at Kempegowda Circle, which has an excellent "Emergency Medicine Department" backed by skilled Doctors from various specialities.
Caring for self
There could be a lot of apprehension about the chances of rescuers contracting infections by touching the blood/body fluids of victims and it should be understood that these chances are negligible.
However, standard cautions, a rescuer can bear in mind are:
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Avoid getting exposed to the victim’s blood on any skin cuts or injuries of the rescuer.
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Try wrapping the rescuer's hands with any available cloth, plastic or anything for a barrier between the rescuer and the victim.
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Use a face mask or tie a handkerchief to cover the rescuer's nose and face.
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Wear any eyeglasses available to prevent splashes to the eyes.
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Even if the rescuer comes in contact with a major volume of the victim’s blood, remove contaminated clothes and wash hands and exposed parts as soon as possible under clean running water and soap.
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Do not panic, and consult a healthcare professional regarding your concern as treatment is always case to a case-to-case basis. This can be done as an OPD Consultation with an appointment with the concerned Speciality.
Know Your Laws
India's Good Samaritan Law was passed as a Bill by the Supreme Court of India on March 30, 2016. This law gives protection to those who help an accident victim from legal interventions.
Take Home Message – Road traffic accidents (RTAs) are one of the most common causes of admissions to Emergency care or death before or during transit to the hospital from the accident site. Bystander awareness of first aid and coordination at accident spots can markedly reduce the chances of worsening victims' conditions that may arise due to improper handling in transit to the Hospital. Educating oneself with basic first aid and CPR can help save lives.
Consult emergency medicine specialists in Mysore to get assistance during accidents and emergencies.
