Responding to a road traffic crash - further advice.
I applaud Coates and Davies for their informative article which
includes practical advice for doctors (untrained in pre-hospital care)
assisting at the scene of a road traffic crash.
They correctly state that personal safety is key, and that the emergency
services should be requested (by telephoning 999 or 112) if they are not
already in attendance. They further highlight the need to give precise
location details to assist the emergency services.
I would like to supplement their advice with the following practical
suggestions:
1) Consider obtaining a high visibility jacket and a doctor's green
flashing beacon as additions to any medical kit you already carry in your
car. These are, however, only an adjunct to safety, and should not imbue
the user with a false sense of security.
2) When assessing personal safety at an incident:
a) If the emergency services are present - the incident scene may well be
being 'protected' by an emergency service vehicle using its flashing
warning lights - in this case it is worth driving past the scene and then
walking back to the incident (keeping out of the way of any traffic).
b) If the emergency services are not present - one should make an
assessment of whether it would be safer to use one's vehicle to 'protect
the scene' by stopping in front of the incident.
This is more likely to be advisable if the vehicle can be placed where
very visible (to avoid it being hit!), and if a warning device such as a
doctor's green flashing beacon can be used to increase the vehicle's
visibility. One needs to weigh up the risk of one’s vehicle being struck
(causing damage and a further crash) against the protection it may afford
to rescuers and the original incident scene.
3) At a motorway incident - using the emergency telephone on the
'hard shoulder' will indicate the location of the incident to the
emergency services by stating the telephone's identification number,
printed on the side of the housing of the emergency telephone.
4) When a mobile telephone is used:
a) Precise location details become even more relevant, as although the
number is passed to the emergency services, its location cannot be derived
from the telephone number unlike a fixed line telephone.
b) Whilst the memorable '999' has been in use in the UK for longer than
'112' - there is a theoretical advantage to using '112' from a mobile
telephone. If the cellular base transmission station (BTS) is in full use,
and a 999 call is attempted - the call will fail as the BTS has no
available space for it.
If '112' is dialled, the GSM (mobile phone) specification calls for the
BTS to drop one of its existing non-emergency calls, and carry the '112'
call instead, so a '112' call may succeed where a '999' call might fail.
5) Many paramedics are wary of doctors offering assistance 'in the
street'. I have found that when I offer assistance I am better received
if:
a) I offer my identification - confirming I am a doctor,
b) I give them some indication of my level of expertise, and
c) I make it plain I respect their skills and knowledge, and that they are
more specialised in pre-hospital care than I am. However, doctors will
have skills complementary to the paramedics - I try to present myself as a
resource they can use as an adjunct to their skills.
As an example I may be able to use a bougie at a difficult intubation
where their protocols do not allow for use of a bougie, or I can allow
ketorolac to be given for analgesia when it is not a drug usually
available for them to use.
Competing interests: None.
I am a member of a voluntary aid society, undertaking occasional duties
with them on an unpaid basis. I have in the past assisted on a voluntary
basis at incidents I have come across whilst driving.
Rapid Response:
Responding to a road traffic crash - further advice.
I applaud Coates and Davies for their informative article which
includes practical advice for doctors (untrained in pre-hospital care)
assisting at the scene of a road traffic crash.
They correctly state that personal safety is key, and that the emergency
services should be requested (by telephoning 999 or 112) if they are not
already in attendance. They further highlight the need to give precise
location details to assist the emergency services.
I would like to supplement their advice with the following practical
suggestions:
1) Consider obtaining a high visibility jacket and a doctor's green
flashing beacon as additions to any medical kit you already carry in your
car. These are, however, only an adjunct to safety, and should not imbue
the user with a false sense of security.
2) When assessing personal safety at an incident:
a) If the emergency services are present - the incident scene may well be
being 'protected' by an emergency service vehicle using its flashing
warning lights - in this case it is worth driving past the scene and then
walking back to the incident (keeping out of the way of any traffic).
b) If the emergency services are not present - one should make an
assessment of whether it would be safer to use one's vehicle to 'protect
the scene' by stopping in front of the incident.
This is more likely to be advisable if the vehicle can be placed where
very visible (to avoid it being hit!), and if a warning device such as a
doctor's green flashing beacon can be used to increase the vehicle's
visibility. One needs to weigh up the risk of one’s vehicle being struck
(causing damage and a further crash) against the protection it may afford
to rescuers and the original incident scene.
3) At a motorway incident - using the emergency telephone on the
'hard shoulder' will indicate the location of the incident to the
emergency services by stating the telephone's identification number,
printed on the side of the housing of the emergency telephone.
4) When a mobile telephone is used:
a) Precise location details become even more relevant, as although the
number is passed to the emergency services, its location cannot be derived
from the telephone number unlike a fixed line telephone.
b) Whilst the memorable '999' has been in use in the UK for longer than
'112' - there is a theoretical advantage to using '112' from a mobile
telephone. If the cellular base transmission station (BTS) is in full use,
and a 999 call is attempted - the call will fail as the BTS has no
available space for it.
If '112' is dialled, the GSM (mobile phone) specification calls for the
BTS to drop one of its existing non-emergency calls, and carry the '112'
call instead, so a '112' call may succeed where a '999' call might fail.
5) Many paramedics are wary of doctors offering assistance 'in the
street'. I have found that when I offer assistance I am better received
if:
a) I offer my identification - confirming I am a doctor,
b) I give them some indication of my level of expertise, and
c) I make it plain I respect their skills and knowledge, and that they are
more specialised in pre-hospital care than I am. However, doctors will
have skills complementary to the paramedics - I try to present myself as a
resource they can use as an adjunct to their skills.
As an example I may be able to use a bougie at a difficult intubation
where their protocols do not allow for use of a bougie, or I can allow
ketorolac to be given for analgesia when it is not a drug usually
available for them to use.
Competing interests: None.
I am a member of a voluntary aid society, undertaking occasional duties
with them on an unpaid basis. I have in the past assisted on a voluntary
basis at incidents I have come across whilst driving.
Competing interests: No competing interests