Helping bystanders give life-saving injections after road crashes: does a photo make a difference?
(A Randomised Controlled Trial of Verbal Guidance versus Verbal Guidance Supplemented by a Photographic Aid for Bystander Identification of Intramuscular Tranexamic Acid Injection Sites in a Simulated Road Injury Scenario)
What is the problem?
The most preventable cause of death for the casualty of a road traffic collision is bleeding from internal organs such as the liver or spleen. This bleeding is referred to as “non-compressible” as it cannot be stopped by direct pressure or a tourniquet, so we must use other methods to stop the bleeding.
Tranexamic acid (TXA) is a medication that helps your blood to form clots, helping to stop internal bleeding. In the UK, this medication can currently be given at the scene of a road traffic collision by Emergency Medical Services (EMS) personnel such as paramedics. It can either be given directly into a vein, or into a muscle (intramuscular) by an injection. Importantly, the earlier this medication is given, the better the outcome for the casualty.
A bystander is someone at the scene of a road traffic collision who is not a formal part of the clinical response. For example, this could be a member of the public with no medical experience, or a member of the Fire and Rescue Service with basic medical training.
Sometimes there is a delay to EMS getting to the scene of a collision, or they are just unavailable. By enabling bystanders on scene to give the TXA as an intramuscular injection, they may play a critical role in saving the casualty’s life. Bystanders may not know where it’s safe to give the injection, even with instructions over the phone. Therefore, we must better understand how to support and guide these bystanders to deliver this injection.
What did we do?
We wanted to find out whether showing bystanders a photo of where to inject (in addition to giving spoken instructions) helped them identify the correct injection site. We asked 64 people with no medical background to take part in a simulated road crash scenario. This remote guidance was either:
- Spoken guidance alone (via a simulated 999 call)
- Spoken guidance supplemented by a photograph (via a simulated 999 call with a photograph sent to the participants mobile phone)
The simulation involved approaching a vehicle containing a simulated casualty sitting in the driver’s seat of a car. Participants were guided to locate the injection site on the casualty’s arm and mark their chosen injection site with a red sticker.
What did we find?
- People who received both a photo and verbal instructions were much more likely to choose a safe injection site (88%) compared to those who had just verbal instructions (63%).
- They also gave fewer unsafe answers and felt more confident overall.
- The added photo seemed to make a real difference, regardless of the participant’s age, gender, or first aid experience.
Why does this matter?
In a real road crash, every minute counts. If bystanders can give TXA injections safely—with help from emergency dispatchers and a simple photo—it could save lives. This study suggests that adding a photo to spoken instructions makes a big difference in helping people act quickly and safely in an emergency.
What next?
We now need to test this in real-life situations and explore how to share these visual instructions—possibly through apps, SMS, or public training. Helping bystanders act with confidence could become a key part of improving trauma care in the vital first few minutes after a crash.
Authors
Tim Nutbeam, Emily Foote, Lauren Rodgers, Jessica Thomas-Mourne, Rob Fenwick
IMPACT; Devon Air Ambulance; University of Plymouth
