Christmas is coming; Dos and Don’ts at an accident scene

A patient told me of his ordeal when he was injured in an accident. He fell from a ladder while working on a church building, fracturing his right arm in the process. While writhing in pain, his co-workers approached in the typical compassionate-Ghanaian fashion, ready to help. As some prayed for him, the most muscular of the lot yanked him out of the rubble by his arms and legs, causing a previously simple, aligned fracture to become displaced. He didn’t lose his arm; he actually made a very good recovery.

Nonetheless, in their haste to help this young man, these co-workers worsened his plight, albeit temporarily. Had that displaced bone severed a major vessel during the “rescue”, this young man would probably have lost his life.

So, if you chanced on an accident, would you know what to do or not do? The Christmas season is known to be a period where, rather unfortunately, road traffic accidents increase. If you find yourself as a first responder to an accident scene, do you know what to do? You may not have the skills of an emergency room physician, but there are a few dos and don’ts that you should have in mind.

DOs:

1. Call for help immediately you arrive on the scene. Two hands are better than one.
2. Calm the victim and reassure them- but even before this, make sure you are calm (take a few deep breaths and make sure you are thinking clearly before you do anything). Talk to every victim you attempt to help, even if they are not responding- they may just be disoriented. Let them know they have been in an accident and that help is on the way. Assure them that you will do your best for them.
3. Remove victim(s) – and yourself- from immediate danger if present. E.g. if there is a fuel leak, do not try to resuscitate victims in the vicinity of the vehicle. Also get someone to alert on-coming traffic of the accident ahead.
4. Make sure you are protected. Wear gloves to attend to bleeding victims. If you do not have gloves, cover your hands with an intact polythene bag.
5. Check the airway (mouth and nostrils) for obstruction, look out for breathing (chest movements must be present) and check the pulse for circulation. Clear all airway obstruction and if there is no breathing or no pulse, proceed to do cardiopulmonary resuscitation (CPR) – that is, if you are trained to perform it.
6. Be careful with the spine as a whole, and the neck in particular. A partial cervical spine fracture may be made complete by wrong manipulation, and this may be fatal. Whether or not the victim complains of pain in the neck, keep the neck, and indeed the whole spine, straight when moving the victim.
7. Apply firm pressure to any obvious bleed. Keep at it until the bleeding ceases.
8. Turn any victim bleeding from the mouth or vomiting on the side to prevent choking.
9. For broken limb bones, try to keep the part straight- you can tie the limb to a straight object like a wooden plank or a firm stick to achieve this.
10. Remove all constricting articles like rings, belts and necklaces. It may be difficult to take of rings later if the fingers swell, and releasing belts and necklaces ensures proper circulation. NB: If the patient is conscious seek their consent before you take off any item, and remember to place all removed articles in the victim’s pocket- not yours- for safe-keeping.
11. Keep the victim warm. Most accident victims will feel cold if they are in shock. Anything dry can be used to cover the victim- a blanket, a jacket, even dry plantain leaves (Please, do not cover the face, lest someone else assumes they are dead).

Don’ts:

1. Do not try to feed the victim. Giving even water is not advised. It is of no benefit in that acute state. What it can rather do is cause choking, which can lead to the person’s death.
2. Do not try to pull out any object impaling a victim. The placement of the object, may actually be controlling a bleeder, and keeping the person alive.
3. Do not blindly pull a trapped victim out of the rubble. This is extremely dangerously and can cause more harm than good. You should rather lift the offending objects off, one after the other, and gently.
4. Do not try to be a hero. People have lost their lives trying to pull out a victim from a car wreck on a train track, while a train approaches. Others have drowned in their attempt to save a victim drowning in a fast-flowing river. Do not try dangerous feats that can end you up as a victim too.
5. Do not do what you are not skilled in doing: do not try to perform a cricothyrotomy (emergency airway puncture) on a choking patient just because you have seen it on ER, Grey’s Anatomy or Royal Pains, when a Heimlich maneuver is simpler to perform, not as dangerous and more likely to succeed.
6. Be circumspect in your utterances around severely injured victims. Do not scare the victim with statements like “It will be a miracle if you survive.” or “That is a huge hole in your abdomen!” Keep all your inauspicious thoughts to yourself: at best, they help no one.
7. Do not crowd around the victims if you have no help to offer; it just makes them needlessly anxious.

No one wishes for ill, but if you find yourself in a position to help with an unfortunate accident, you should know what to do and what not to do. Let us try to be safe during the yuletide. Happy holidays!