A presentation focusing on the common injury patterns seen in pedestrian vehicle accidents. By Dr. Nic Sparrow - Medical Director of phcworld.org

1. Pedestrian Vehicle Accidents ‘Common Injury Patterns’ By Dr. Nic Sparrow MBBS, BSc, MRCGP Medical Director – Pre-Hospital Care World www.phcworld.org

2. Overview / Aims To discuss some the common injuries patterns in Pedestrian Vehicle Accidents (PVA’s) To explore and review key medical literature surrounding this topic Conclude with a summary of useful things to remember when attending PVA’s

3. Background 1 Pedestrian is killed by a motor vehicle every 113 minutes and injured every 8 minutes in the USA PVA’s account for a significant number of trauma admissions and deaths in urban areas Patients can have multiple injuries & be difficult to evaluate initially Pedestrians Injured by Automobiles: Relationship of Age to Injury Type and Severity; DemetriosDemetriades et al: J Am CollSurg: V0l. 199, No. 3, September 2004

4. Key Research Paper Demetriades D et al. Pedestrians Injured by Automobiles: Relationship to Age to Injury Type and Severity. J AM CollSurg Vol. 199 No.3 Sept 2004 Trauma Registry-based study in Los Angeles included all trauma admission for PVA’s by automobiles over a 10 year + 4 month period From 1993 to 2003 = 5838 patient involved in this study ≤ 14 yrs – 19.4% (1136) 15-55 yrs – 64.1% (3741) 56 -65 yrs – 7.2% (420) > 65 yrs – 9.3% (541)

5. Continuation There were 972 patients (16.6%) with at least one body area with severe injuries, defined as an abbreviated injury score > 3 Head = 620 (10.6%) Most common area Chest = 156 (2.7%) Abdomen = 125 (2.1%) Extremities = 71 (1.2%)

6. Factors Affecting Injury Severity Age of the patient The speed and type of vehicle Objects carried at time of impact The main point of contact with the vehicle Hit at 65 km/hr - 80% chance of death Hit at 50 km/hr - 80% chance of survival

7. The ‘CALL – OUT’ Parking defensively protecting the scene Watch for traffic ! Assess & Approach ‘Read the wreck’ THINK SAFETY SELF, Scene, Survivor

8. Management of PVA’s First Responder / EMS Provider Think Spinal Control... Airway Breathing Circulation Disability Exposure Ask yourself 1) Head injury ? 2) Does this patient need intubating ? 3) Does this patient have a pelvic injury ?

9. Head Injuries Incidence of severe head trauma (AIS > 3) increased significantly with age:- 7.4% of the children ≤14 yrs 23.7% of the adults > 65 yrs Subdural and subarachnoid haemorrhages also increased significantly with age Spine Control Palpate the Skull Look in Eyes & ENT GCS < 9 consider intubation

10. Spinal Injuries Rapid Assessment of the Airway / C-Spine is required The overall incidence of Spinal Injuries was 5.1% (295 patients) No difference between the occurrences of C-spine / Thoracic/ Lumbar Spine injuries C-SPINE 3 POINT IMMOBILISATION

11. Spinal Injuries - Continuation Spinal Injuries increase dramatically with age Factors such as osteoarthritis and osteoporosis contribute to injuries Risk of spinal injury is x21 greater in > 65yrs (8.5% occurrence) compared with children (0.4%)

12. Upper Extremity Injuries Male 30 yrs - Hit by car on highway GCS 3/15, # L Humerus / Radius + Ulnar CT Head Normal IV access & BP monitoring impossible on L arm

13. Chest Injuries A Pneumo or haemothoraxwas present in 247 pts (4.2%) and rose steadily through the ages Incidence was 2.1% in children ≤ 14 yrs Incidence was 8.5% inpatients >65 yrs Thoracic aortic injury occurred in 16 patients (0.3%) – x7 times more likely in the over 65yrs, none occurred in the ≤ 14 yrs

14. Fractures of the first x3 ribs, or ≥ 3 rib #’s > 10% mortality

15. Abdominal Trauma Liver injuries occurred in 141 pts (2.4%) Splenic injuries occurred in 102 pts (1.7%) Renal injuries occurred in 44 pts (0.8%) Gastro injuries occurred in 237 (4.1%) There was no statistically significance difference across the age groups

16. Pelvic Injuries Requires massive energy transfer Occurred in 748 patients (12.8%) X3.5 likely in the >65yrs (22.6%) compared with children under 14 yrs (6.3%) Patient may complain of severe back pain, abdominal or suprapubicpain

17. Patient may become rapidly hypotensive > 3L of blood loss from pelvic #’s Widened Symphysis Pubis Sheet used to compress the pelvis

20. Lower Extremity Injuries Stop overt bleeding Check for peripheral pulses In the absence of pulses, exclude a pelvic fracture, provide analgesia & reduce Wrap in dressing + splint ~ 1000mls

21. Fatalities The overall mortality from PVA’s was 7.7% (449 deaths) This increased significantly with age 3.2% in the pediatric group 25.1% in the > 65 yr group

22. Points to remember (1) Tibial #’s are the most common injury ~ 25% Head injury increases significantly with age 7.4% in the ≤14 yrs to 23.7% in > 65 yrs Look out for pelvic fractures. Occurs in ~12% of patients (22.6% incidence in > 65yrs)

23. Points to remember (2) Spinal injuries occurred in 5.1% of pts; the elderly were x21 more likely to suffer spinal trauma Haemo / Pneumothorax occur in ~ 4% Mortality rate in >65 yrs = ~25% The older the patient the greater the risk of serious injury

24. THE END Visit www.phcworld.org for more information