First aid in road traffic accidents

Factors and scope of care at the scene of a road traffic accident

The type of medical care provided directly depends on expediency, time, and location of the action. Key factors include the availability of medical equipment, the qualification of the rescuer, the number of victims, and the time and possibility of transportation to a specialized hospital.

If an experienced traumatologist without instruments happens to be at the scene of the accident, they provide only first aid or initial pre-medical care. Making a preliminary diagnosis in such conditions is pointless — it will not change the rescue algorithm, but will waste time. For comparison: an urban polyclinic surgeon without specialized training will provide primary medical care and refer the patient to a hospital, while a doctor at a remote rural outpatient clinic (if rapid evacuation is impossible) will be forced to make a clinical diagnosis and perform available therapeutic manipulations.

Who and when makes the diagnosis

According to the standards for diagnosing musculoskeletal injuries, at the stage of providing first aid and initial pre-medical care, no diagnosis is made at all.

A preliminary diagnosis is formulated when providing:

• Primary health care.
• Primary specialized care in the outpatient setting.
• Emergency medical care.

The final clinical diagnosis is established only at the stage of specialized medical care in a hospital setting.

Suspected spinal injury

Any road traffic accident participant is considered a patient with a spinal injury until proven otherwise by instrumental methods. A special risk group includes unconscious people, as well as victims of falls from a height (catatrauma), beatings, and diving into shallow water.

• Ambulance equipment: EMS crews are required to have rigid cervical collars and immobilizing stretchers (rigid or vacuum).
• Immobilization rules: Fixation is carried out strictly at the place of discovery. The most effective combination is a rigid collar, a long spine board under the back, and straps.
• Routing: Transportation must be prompt and careful. The patient is taken to a multidisciplinary hospital with round-the-clock admission for severe polytrauma, a neurosurgical (vertebralogical) department, and spine surgery specialists.
• Transferring: EMS crews may remove the transport cervical collar only after the patient has been transferred to a gurney in the emergency department or to an intensive care bed.

Chest injuries: closed and open

Chest injuries are divided into closed (contusions, compressions, lung ruptures) and open (penetrating and non-penetrating).

The most common closed injury is a rib fracture. It occurs as a result of a severe blow or compression. The main danger lies in the fact that displaced bone fragments can tear the lung tissue and provoke internal bleeding.

Symptoms of a fracture:

• Local pain that sharply intensifies with coughing.
• Tenderness when compressing the chest in the anteroposterior direction.
• Short, superficial respiratory movements.
• In a sitting position, the victim feels significantly better than lying down.

Symptoms of an open injury: Severe general condition, pronounced shortness of breath, obvious signs of a wound. Hissing, bubbling, or whistling sounds are heard during breathing, and foamy blood is released from the wound.

First aid algorithm for chest injuries

In case of closed trauma:

1. Give the person a semi-sitting position.
2. Prohibit any movement, do not move unless absolutely necessary.
3. Apply a cold compress (ice) to the injury site.
4. If there are concomitant wounds, stop the bleeding and wash them.

In case of open trauma:

1. It is strictly forbidden to feed, give water to the patient, or allow them to speak.
2. Unbutton or remove clothing that interferes with breathing.
3. Seat the patient in a semi-sitting position. If this is not possible, lay them in a recovery position on their side, mandatory injured side down.
4. Seal the wound as quickly as possible (cover with a hand, foil, or plastic wrap) to prevent air aspiration during inhalation.
5. Do not remove foreign objects from the wound.

Further monitoring and follow-up

After providing care and treatment, strict dispensary monitoring is required.

• Under conservative treatment: Monitoring is performed at 3, 6, and 12 months using CT or MRI of a single spinal segment. The goal is to rule out the progression of kyphotic deformity and late spinal cord compression.
• After surgical treatment: Outcome evaluation is performed after 1 year via patient questionnaires.
• General monitoring: Carried out at the place of treatment at 4, 8, 12, and 24 months with mandatory radiography of the thoracic or lumbar spine.

Class and exam questions

What else to study on this topic

• Tasks and limitations of outpatient trauma centers.
• Factors determining the volume of medical care at the pre-hospital stage.
• Timing and methods of dispensary follow-up after spinal injuries.
• Criteria for choosing a multidisciplinary hospital for hospitalization with polytrauma.
• Operating room equipment for the surgical treatment of cervical dislocations.

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.