Intended for healthcare professionals

Clinical Review

Prehospital care for road traffic casualties

BMJ 2002; 324 doi: (Published 11 May 2002) Cite this as: BMJ 2002;324:1135
  1. T J Coats, senior lecturer in accident and emergency and prehospital care (,
  2. G Davies, consultant in accident and emergency and prehospital careb
  1. a School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AD
  2. b Bart's and the London NHS Trust, London E1 1BB
  1. Correspondence to: T J Coats

    For complex reasons, society seems to accept a lower standard of safety from road use compared with other forms of transport. Road traffic crashes cause some 320 000 injuries, 40 000 serious injuries, and 3400 deaths a year in the United Kingdom.1 This is equivalent to the Lockerbie air crash happening every four weeks or the Paddington rail crash happening every other day throughout the year. As road traffic crashes are so common, many doctors will give roadside treatment at some time during their career. A third of prehospital deaths may be preventable,2 so doctors have a duty to offer assistance at a crash scene, but this can be a frightening and distressing experience for those not trained to work in the prehospital environment.

    Summary points

    At some time in their career many doctors will have to deal with a road traffic crash

    Safety for yourself at the incident scene is the first priority

    Doctors untrained in prehospital care should concentrate on giving good first aid, working under the direction of ambulance service staff

    Providing excellent medical treatment at a road crash requires specific training and experience

    Patients with airway and breathing problems may need immediate (prehospital) advanced medical intervention

    Treatment should be aimed at promoting oxygenation and preserving clot, with rapid patient movement to a hospital with the appropriate facilities to provide definitive care


    This article was written from the authors' personal experience of working in prehospital care with the London Helicopter Emergency Medical Service, a review of articles in the Cochrane Library, a literature review, participation in internet discussion groups on prehospital care, and aggregated experience of colleagues from the Ambulance Service and the British Association of Immediate Care Schemes (BASICS).

    The evidence

    This article is based on our synthesis of best practice, but there is often controversy about …

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