Responding to an Accident SceneNov 11, 2013
Dr. Troy Madsen: You're driving down the interstate. You see an accident. What do you do? I'm Dr. Troy Madsen, emergency physician at the University of Utah Hospital. That's what we're going to talk about today on The Scope.
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Dr. Troy Madsen: So I'm driving into work the other day, and this person just goes flying past me 90 miles an hour, going down Interstate 80. And then I come around the corner. This is about 5 miles later, and I see that same car overturned on the side of the road.
I think we've all had situations where we come upon a scene of an accident, and the big question we have is, "What do I do in this situation?" That's the question that ran through my mind in that scenario. You know, I'm used to seeing people in the ER who are brought in by the medics.
But when you're at the scene of an accident, it's a whole different situation there, and it's good to know what do I do, number one, to help this person, but more importantly, what do I do not to hurt this person. This is some harm in trying to do too much at these sorts of scenes.
The number one thing, of course, is get help. Call 911. Get an ambulance there because they're the experts in this situation. When you call 911, it's very helpful to let them know, obviously, where you are, kind of what's going on, how many people seem to be involved in the accident. If it's a multi-car accident, at least give them some information to work with so they know how much to send there in terms of resources.
If we've got a ten-car pileup, they're going to need to send a whole lot more than if it's a single car rollover and one person who got out of the car and walking around now and looks okay. A little bit of information goes a long way when talking to them.
But then the next question becomes, "What do I do while I'm waiting for the ambulance to get there?" The biggest piece of advice I would give is, number one, first of all, make sure you're safe. Don't put yourself in a situation where you are going to become a second victim in this accident. If there's a fire or anything like that, obviously, you want to help victims. You want to make sure everyone's safe, but keep yourself safe.
Number two. The next biggest piece of advice is something we always think about as physicians, and that is, "Do no harm." If this is not something that is absolutely necessary to do, don't do it. Don't be dragging people around and pulling them out, potentially making things worse with some sort of spine fracture if that's not something you need to do and if you've got time to get an ambulance there.
So let's kind of walk through them, what you would do. Let's say I come up to that car that's rolled over, the biggest thing I'm going to do is, number one, if that person's still inside their car, I'm going to go up to it and say, "Is this person safe in there? Can they get out of their car? What do I need to do to help them?"
If it's something where we can wait for the medics to get there, great. If it's something where there's imminent danger but I can get them out of the way safely, I'm going to help them get out of that car. Again, I always have to be careful about their spine. If it's something where I can wait for the ambulance to get there, it's better to wait and let them immobilize their spine and make sure everything's in the right position so we're not making things worse.
Probably the best thing you can do for anyone at an accident is to talk to them. This is going to accomplish a couple of things. First of all, it's going to help the person kind of calm down and know that there's someone there who's going to help them out.
The second thing it's going to do is, by talking to them, you know they're okay. If they can talk to you, if they can answer your question, I know they're breathing, I know their heart's beating, I know they've got enough blood profusion in their brain where their brain's working fine, then I can feel a little more comfortable that I don't have to jump in there and do something really quickly.
That can go a long way, just having a simple conversation. Now, if you're with this person and you find that they are not responding, again, assess the situation. If they need to get out of the car, get them out of the car to a safe place. If they can wait until the medics get there, then that's okay.
The next issue, of course, is if they're not breathing and they don't have a heartbeat. If they don't have a pulse, you want to do CPR. Do what you can. Do chest compressions. Give them the help they need until we get the ambulance there.
So if someone is in their car and they are not breathing, the spine is a secondary concern. My number one concern is airway, breathing, and circulation. If they don't have any of those, I need to get them out of there where I can start doing CPR on them to get them the help they need. The spine is a concern, but it's a secondary concern at that point.
So if we do get someone out of a car or let's say they're walking around and they're just, like, "My neck is just really hurting me," that's a good situation where we kind of want to sit them down. Again, talk to them. Help them calm down. Put them in a situation where they're just not walking around and moving their head around a lot because if they do have possibly a fracture there, that fracture can get much worse by moving their head around and then could potentially cause spinal issues and possibly affect their spinal cord.
The next thing we think about beyond all this stuff, beyond the airway, CPR, and spine injuries is bleeding. If someone's bleeding, put pressure on it. If you do put pressure on it, just hold that pressure there. You don't need to take that rag off every 30 seconds or so to see if it's still bleeding. Just hold the pressure there.
Make sure you're not holding so much pressure where it cuts off the blood circulation to their hand. You want to make sure they can move their fingers, their toes, or whatever the situation is. Just hold pressure, and once the ambulance gets there, they can do something more definitive.
When you're at the scene of an accident, these are the big things to think about. Like I said, number one, keep yourself safe. Number two, do no harm. But if you're in a situation where you can offer help, talk to the person and see if they're responding. If they need CPR, don't hesitate to give it, and help them out while you're waiting for the help to arrive.
Hopefully, you're never in this situation. Hopefully, you never come up on an accident, but if you are, these are some things to keep in mind to where you can give some help where help is needed.
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