On-Scene Predictors of Injury Severity, Deterioration, and Death Following Road Injury
There is a huge amount of information available at the scene of a road accident: about the people involved, about the vehicles, the general area. The job of Ambulance and hospital teams is to try and use all this information to work out how hurt someone is. The problem is, we don’t know which information is the most helpful to quickly identify who is most injured and who is less injured. We also know that members of the public are commonly the first people there after an accident. We think they can be useful in helping people who are hurt after a crash but don’t really know how they can do this.
We performed a scoping review: this involved looking at all the research papers we could find on the topic of road traffic accidents to try and work out if there are certain bits of information to assess injuries which were more important than others.
Our review found things like heart rate (how fast a person’s heart is beating), respiratory rate (how fast someone is breathing), their blood pressure and how awake they are were all useful in helping us identify who was most injured. Unfortunately, these measures are not perfect every time; if we just used that information we would miss some dangerous injuries in some people. These vital signs also need special equipment to measure (like a blood pressure cuff) which members of the public would not have.
Other clues that can help us spot injured people early come from the crash itself, e.g. whether people were wearing seatbelts, whether airbags have gone off, which bits of the car are damaged. If someone is stuck in a vehicle after an accident, they are more likely to be injured. Phones and new car technology might help gather this information in the future, but they are not quite ready yet. The last thing we found was that people’s age, whether a person is male or female and how much they weigh can have an impact on the type of injuries they end up with.
There were some challenges with this research. First, most studies focussed on how people are when they arrive in hospital and not how they are at the scene of the crash. This means there isn’t as much research looking at people immediately after they have been injured. We need more research data from how people are immediately after their crash to understand what information matters. The second problem was that each study described things in different ways. This makes it difficult to compare research from the UK and Australia or America and to know what we can learn from people in other countries. The best way to improve this is for all of us to use the same names and descriptions so we can understand each other.
Authors
Jake Gluyas-Harris1, George Russam2, Nicholas Aveyard3, 4, Tim Nutbeam5, 6
1Emergency Department, Derriford Hospital, Plymouth, UK. 2Anaesthetic Department, Darlington Memorial Hospital, Darlington, UK. 3Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK. 4Faculty of Health & Life Sciences, University of Exeter, UK. 5IMPACT; Centre for Post-Collision Research Innovation and Translation, Exeter, UK. 6University of Plymouth, Plymouth, UK.