The document discusses ways to reduce fatalities from road accidents in India. It suggests that reduction can be achieved by (1) preventing accidents and (2) providing better trauma care. For trauma care, the focus should be on prevention since it is more cost effective than post-accident management given India's limited resources. The document then outlines steps for first aid at accident sites, including rescue, calling for help, providing CPR, and dealing with injuries like bleeding, fractures, and head injuries, while being careful with potential spine injuries. Prevention is emphasized as the most effective approach.

1. Road Traffic Digest No 6 How to reduce fatalities on Indian roads? and What should be the road map to follow in the present scenario www.tsunamionroads.org

2. Instead of discussing the ideal management for road accidents, here we will first consider ‘What is practically possible in the present scenario of road traffic management in our country’. In broad terms reduction in fatalities can be achieved by two ways [A] By Preventing road accidents to occur and if occur [B] By providing better trauma care to accident victims In the present and next couple of digests we would consider the post crash management. After that we would take up the issue ‘How to prevent Road Accidents in our lives’. www.tsunamionroads.org

5. The trauma care for accidents victims can be divided into two: [1] Pre-hospital care and [2] Treatment or care in hospitals. [I] Pre-Hospital Trauma Care What should we do at the accident site ?? This basically includes an attempt to rescue the injured from the accident site, call for help, provide first aid and arrange for transfer of injured for definitive care. www.tsunamionroads.org So let us consider what is the best trauma care we can offer for accident victims in the present circumstances in our country.

6. Step 1 : Rescue the injured from the accident site It means to remove injured person/persons who are trapped either inside or under a vehicle or lying on road so that much-needed first aid can be given and also to prevent any further trauma by other moving vehicles . Don’t forget to place this sign to safeguard yourself Five policemen including station in-charge, while rescuing two accident victims, were run over by a truck and died on the spot [ Sitapur, 22nd June 2011

7. Who can do this rescue job? This rescue work can be initiated by any one not necessarily from a medical background like: C o-passengers Bystanders Other drivers Dhaba/roadside restaurant owners Police Villagers, etc. www.tsunamionroads.org We don’t expect trained paramedics or an ambulance immediately [within few minutes] so role of people just mentioned or first responders, even if they are not trained, cannot be overemphasized.

8. Step 2: Call for emergency help Make a call for an ambulance or for patrolling or local police and to relatives of the injured by checking his identity. www.tsunamionroads.org In India, calling the police to accident site is equally important as that of an ambulance. The reason being the public reaction may be hysterical after accident, so controlling the crowd becomes important in such situations.

10. [2] Keep An Emergency Kit: Besides a first-aid kit and tool kit, some more items may be of great help in such situations: Pointed iron rod to unlock the jammed door is especially helpful when it catches fire or plunges into water Large screwdriver, pair of pliers, rubber hammer Emergency light, Fire extinguisher, flash light, extra batteries, etc. www.tsunamionroads.org

11. Step 3: Till formally trained paramedical personnel arrive, start providing some first aid: If no ambulance or health facility is expected at the site then don’t wait or waste time. Arrange some transportation to rush towards a hospital. www.tsunamionroads.org

13. Don’t hesitate in such a situation on the premise of your limited knowledge and fear of causing more harm to the injured. Remember only the fact that your intentions are the best, you are the only one around to help him and something is always better than nothing and this ‘something ’ can really go a long way. [ डूबते को तिनके का सहारा ही काफी होता है ] Here we will discuss more about dealing with serious injuries as we all are used to dealing with minor wounds or cuts. The description about first aid that follows is basically for non-medicos or primary responders [commuters, bystanders, etc] www.tsunamionroads.org

15. 2. Place the heel of one hand over the center of person’s chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your houlders directly above your hands. 3. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest for two inches. Push hard and push fast: give two compressions per second, or about 120 compressions per minute. Observe closely On full screen www.tsunamionroads.org

16. 4. Put your palm on the person’s forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open airway. 6. - - and breathe into the mouth for one second. [one rescue breath after every four chest compressions] 5. Kneel next to the person’s neck and shoulders. Pinch the nose shut - - - - www.tsunamionroads.org

19. On the other hand, automobile companies are encouraging dashboard dining by providing modifications like cup/bottle holders, folding tables or even small refrigerators. We feel this is a wrong trend and has to be discouraged. This not only complicates condition of victim after accident but is also an important cause of distraction during driving leading to actual accidents. Not only this, hyperglycemia due to excess calories may lead to dozing behind the wheel !! Are these automobile cos. aware of these facts?? www.tsunamionroads.org

21. The best way is to apply direct pressure over the wound by hand using a piece of clean cloth Please note, usually it requires more pressure than we expect, so instead of fingers, use heel of palm to apply pressure. Usually bleeding takes 4-5 minutes to stop. Do not look frequently to confirm whether bleeding has stopped or not as this may dislodge fresh clot that has just formed. Instead, wait patiently. Sometime it may require 15-20 minutes. C. Bleeding Wounds: what to do? www.tsunamionroads.org

24. Sometimes the underlying fractured segments of bone can come out after piercing the skin. Cover this exposed part with a clean cloth or bandage. In cases of total detachment or amputation of a limb: Sometimes it is possible to join amputated part with the body with the help of microvascular surgery. Collect this severed body part in a clean polythene bag but do not add water [if available normal saline may be used] and place this bag in another bag with cold water. The remaining wound on the body from which a part has been severed may bleed profusely. In such cases tie a tourniquet just above the site of the amputation. www.tsunamionroads.org

26. G. Head Injury FACTS: [1] It is the most common cause of mortality in road accidents and responsible for 75% deaths among two wheeler drivers. www.tsunamionroads.org When to suspect a head injury: It should be suspected when there is a wound over scalp and there are associated symptoms like convulsions, evidence of paralysis or weakness in limbs, deterioration in the level of consciousness, state of confusion, bleeding from the nose or ear. [2] Among the total neurotrauma admissions, head injury sustained during road accidents constitutes about 60%. [3] Even if you survive the head injury; there may be significant neurological deficit, enough to make life miserable for you and your family. So never underestimate the role of a helmet .

29. What NOT to do in case of spine injuries www.tsunamionroads.org [b] In case he needs CPR, do not tilt head back when attempting to open airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward. [a] DO NOT move, bend, twist, or lift a person's head or body even a little bit, unless it is absolutely necessary [e.g. if his surroundings or the vehicle in which he is trapped is not safe] Otherwise, wait for trained medical personnel to arrive and handle the situation. [c] Do not remove a helmet if a spinal injury is suspected.

30. What to do in spinal injuries: If a board in not available, you can remove a long seat of a bus or a top of some wooden bench from roadside dhaba/restaurant for this purpose Thus the basic aim is that we do not hurt him more during resuscitation or shifting, by keeping the person immobile and safe until medical help arrives. [a] For keeping a person absolutely immobile, place a tape across his forehead, and secure person to a board to keep head, neck, and back areas from moving AT ALL. www.tsunamionroads.org

31. Place rolled towels on both sides of neck and body. While doing this, don't interfere with person's breathing. If necessary, use both of your hands, one on each side of person's head to keep the head from moving. [b] If at all you need to move a person [e.g. choking by vomiting or blood ], at least two people are needed. One person should be stationed at his head, other at person's side. www.tsunamionroads.org

32. [c] Extreme precautions are necessary while shifting such patients for definitive treatment. There are three possible stages in shifting where abnormal movements can occur. These are: [i] R escuing the injured from vehicle to nearby place [ii] taking from this place to ambulance. [iii] taking him from ambulance to inside the hospital building Move the person in the manner you roll a carpet i.e. whole body is moved as a single block without any twisting or tangential movements. Keep the person's head, neck, and back in a straight line while you roll him onto one side www.tsunamionroads.org

35. Cases with simple wounds or fractures or where condition of injured is quite stable can be taken to smaller centres The pre-hospital care team should assess the severity of injury properly so that they can transfer the injured to an appropriate hospital according to the level of care required. In cases of serious or multiple injuries , opt for a higher centre even if it is situated a little farther Choose a correct destination www.tsunamionroads.org

38. A large number of trauma victims can be saved by a timely and correct emergency surgical intervention. We cannot deny important role of many minor BUT extremely useful procedures for saving trauma cases e.g. [III] Treatment at hospital [1] Primary or Emergency care Inter costal intubation Endotracheal intubation treating shock with blood and IV fluids www.tsunamionroads.org

39. These minor procedures can be performed with low priced equipment or facility, e.g. laryngoscope, endotracheal tubes, resuscitation bag, airways, suction apparatus, etc. It has been seen that many times it is not the availability of funds that is a problem but the lack of an organized approach or drill or lack of will instead! www.tsunamionroads.org

40. The spectrum of trauma among accident victims varies widely involving a wide range of specialities [orthopaedic, general surgery, neurosurgery, thoracic and vascular, plastic surgery, etc]. [2] Specialized care The definitive care is purely a job of the specialists, so a detailed description is not necessary here. However, pre-hospital care is really an area where every one of us can contribute, that is why this has been discussed here in greater detail www.tsunamionroads.org

41. This was about the practical approach towards road accident victims that we all should know and follow in present circumstances in our country. In the next digest we will discuss about the ground reality or present Status of trauma care in India. or What are the practical problems in management of road accident victims www.tsunamionroads.org

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