30 October, 2008

It Irks! Oh, how it irks...

So I'm a bit of a news fan myself, and for the umpteenth time while reading about a car accident, I was annoyed to read that a witness had YET AGAIN tried to help by dragging the occupants out of the wreck.


On one hand, I can understand it's a natural urge. When a person gets hurt, the natural train of thought is to get them away from what hurt them. But please stop and think. The accident is over. The car isn't moving anymore. They're not going to get more injured by sitting still. In fact, you NEED to leave them still if it is possible. There is a very real risk of spinal injury, even if the person is sitting up and telling you they feel fine. There are also internal injuries that can be very, very serious if the person is moved.

Contrary to popular belief, cars catching on fire is rare. The vast majority of accidents do NOT end up in a fire. There are only a few instances where you should move someone, or let anyone move themselves.

1. You smell or see fuel leaking AND there are sparks or a flame. Fuel alone is not a good enough reason to move someone. After all, we see and smell fuel at garage when we fill up, and nobody panics and runs away from it.
2. The person is NOT breathing or does not have a pulse, and you need to move them to do CPR. This one's obvious. Better to take a small risk of injury than to watch them certainly die with their spinal cord intact.
3. Leaving them in the car presents a serious danger to them. An example might be a truck that looks like it's about to fall on the car, or the car is in an extremely dangerous position in the middle of a highway bend, or the car might be flooded and drown them etc.

So what DO you do? Talk to them. If they answer, good. Tell them your name, ask them questions about themselves and their lives, do everything possible to calm them down. If they're freaking out about another injured occupant, LIE if you have to. Tell them the friend is ok/breathing/whatever. While you're doing this call the ambulance and tell the occupants to stay as calm and still as they can for their own good. If you are trained in first aid, you know the rest...

KIDS, PLEASE GO DO A FIRST AID COURSE. Again, contrary to popular belief, it's unlikely you'll need it to assist a stranger, or to help some colleague at work having a heart attack. The most likely place you will use it is on a close friend or a FAMILY MEMBER. Imagine watching a relative that needs your help, and you don't know how. GO DO A FIRST AID COURSE.

I was also thinking about a really cool (but not cool) scenario I was given during my most recent training. I'd also been given it when I was 16 and learning the first time. I got it right the second time; the vast majority of people get it wrong the first time they hear it. Before you can attempt it, there's something you must keep in mind. When it comes to First Aid, you can't save everyone. If there's more than one patient, you MUST prioritise rationally, and if someone has a low chance to survive while someone else desperately needs you for a less serious problem... well... you have to accept you may not be able to save them both, and go help the person who has a chance to survive. It's cruel, and awful to think about, but the trainer told me he once had a train crash on his hands (literally) and had to decide who was too far gone to save. What an awful decision, but if he had worked hard on those people, the less serious ones would have died, and the serious ones would probably have died anyway. So he did what he had to, and left the ones too far gone.

So the scenario.

You're living on a country road and you're the only house for miles. You do have a mobile phone though. One afternoon, you hear a huge BANG outside as a car runs headfirst into a tree. You run outside and get to the car within 20 seconds, and you find there are three occupants.

The driver is unconscious, not breathing, and has no heartbeat.
The passenger is screaming and freaking out that she can't feel her legs.
The guy in the back seat has a huge gash in his lower thigh, and it is spurting a LOT of blood. He is awake, but quiet and pale.

You only have two hands... and the ambulance will take at least 15 minutes to arrive after it's been called... how many of these people can you help and how many have a chance of survival? What do you do, and in what order?

highlight the text below to see the answer

~ Elisa

1. The second you see the car, you pull out the mobile phone from your pocket (you grabbed it when you heard the noise!) and you call an ambulance as you run out there.
2. The girl is awake, and breathing. While she may have a very serious injury to her spine, this will not kill her. She is the least urgent. Using your VOICE, you tell her your name, explain to her that you're getting help, and encourage her to calm down and keep her head as still as she can, so that she can help you. You hand her the mobile phone so that she can relay anything that the emergency operator has to say to you.
3. The driver is not breathing and has no heartbeat. His chances are GRIM. If you dropped everything to assist him, he may not live anyway AND your back seat guy WILL die from the blood loss. Leave the driver and assist the guy in the backseat. Use any cloth available, rip your shirt if you have to, to tie around his leg and slow the bleeding. He's awake, so get him to press down and hold it as tightly as he can.
4. You did this very quickly - the driver has been without oxygen for less than 3 minutes. This means he hasn't yet suffered any brain damage from loss of oxygen. Even at up to 6 minutes there is hope. If you can, lay the car seat down as flat as you can. If you can't move the seat, drag him out of the car. (While it's better not to move people, spinal injury again won't kill him, and not breathing will.) Commence CPR. DO NOT give up and stop CPR until the emergency crews take over.

Scarily, most people get this wrong. The most common response is to concentrate exclusively on the driver. Those that think about the fact his survival chances were low still generally get it wrong and conclude that they should leave him to die.

While you can't decide what internal injuries the driver might have had, you've now done everything you could to save all three.