The shocking truth about road trauma

Key text

This topic is sponsored by NRMA – ACT Road Safety Trust.
For every person killed on Australian roads, another eleven lie hurt in the trauma wards of the nation's hospitals.

Road crash fatalities are something we hear a lot about – newsreaders give us the road toll almost as often as the cricket score. Less talked about are the survivors: yet for every death on the roads another eleven people are injured badly enough to need hospital treatment. The shocking truth about road trauma is that recovery from these injuries can take years, and the pain may never go away. Trauma is the hidden tragedy of the road.

The word 'trauma' is especially appropriate to describe the injuries inflicted by road crashes. The medical profession uses it for any bodily injury or wound, but more literally it means 'a powerful shock that may have long-lasting effects' – an apt description for the sudden violence of a road crash.

Types of injuries

There is almost no limit to the type of injury that might be inflicted in a road crash: from ruptured spleens to severed limbs, broken skulls and fractured ribs. Often, a single individual will suffer several traumas. One example among thousands: the Melbourne Age recently reported the injuries received by a woman involved in a collision in rural Victoria: fractured hip and femur, lacerations to her face, arms and legs, stabbing wound to the throat, broken index finger, puncture wound below her elbow, and a 'de-gloving' injury to her hand (in which the skin had been peeled back when it hit something hard).

Another example: a West Australian motorcyclist, the victim of a driving error by another road user, struck an electricity pole head-on; he was in a coma for two weeks and will be in a wheelchair for life, brain-damaged and paralysed below the neck.

Spinal injury is perhaps the most feared of all injuries. According to a recent report by the Australian Institute of Health and Welfare, 50 per cent of the 261 spinal-cord injuries recorded in Australia from July 1999 to June 2000 were caused by road crashes: 31 per cent of victims were occupants of motor vehicles and 19 per cent were motorcyclists, pedestrians or cyclists. Of the vehicle occupants, more than 66 per cent suffered injuries to the cervical (upper) segments of the spine, resulting in tetraplegia, the impairment or loss of movement in the arms, trunk, legs and pelvic organs.

Trauma care

The best way to reduce the number of people hospitalised is to decrease the number of road crashes, but an effective system of trauma care is also essential. This must be quick and effective – unnecessary delays or errors in medical treatment can be fatal.

One of the tasks of ambulance paramedics when they arrive at a crash site is to assess the extent of injuries to victims and decide where they should be sent and by what means of transport. Those with severe injuries might not survive a long road trip, but local hospitals might not be equipped to treat them effectively; a helicopter may be needed to transport the victim to a more appropriate hospital. Once the victim is in the hospital, a nurse conducts what is known as triage – a preliminary assessment of the patient to determine the urgency with which he or she must receive treatment. Australian hospitals use the Australasian Triage Scale for this purpose.

The Australasian Triage Scale

Related site: Guidelines for the implementation of the Australian Triage Scale
Presents the general principles of triage and gives explanations of the different triage categories.
(Australasian College for Emergency Medicine)
Triage category Maximum waiting time
1 patient requires immediate treatment
2 patient should be treated within ten minutes
3 patient should be treated within 30 minutes
4 patient should be treated within 60 minutes
5 patient should be treated within 120 minutes

Primary survey of the trauma patient

When a severely injured road trauma patient arrives at the emergency department, the medical team carries out what is called the primary survey, which is based on the ABCDE system.

  • First, the airway (A) is checked for blockages: if necessary, a tube is inserted into the trachea to bypass difficult-to-remove blockages.

  • Next, breathing (B) is assessed: is the patient experiencing any difficulties breathing? Breathing can be assisted by using a mask, or a machine called a ventilator. A punctured lung is treated by draining air from the chest.

  • Third comes circulation and haemorrhage control (C): pressure bandages might be applied to control major bleeding; the patient's blood type is determined and transfusions made if necessary.

  • D is for disability: the neurological status of the patient is assessed – awake and alert, responding to voices or pain, or unresponsive.

  • Finally, E is for exposure: the patient's clothes are removed (usually by cutting) so that injuries are not missed in the assessment; the ambient air temperature is controlled to ensure the patient doesn't become hypothermic.

Secondary survey

The primary survey is followed by a secondary survey. This includes a complete physical examination and usually involves a range of tests, such as X-rays, CT scans, angiograms, focused abdominal sonography for trauma (FAST) and blood tests. One of the procedures performed in the secondary survey is called the log roll. This is the controlled turning of the patient to allow a detailed examination of the back of the head, neck and legs, and of the back, buttocks and rectum. The patient's ABCDE is continually monitored during this secondary phase.

After the emergency department

Some road trauma patients can be discharged from the hospital soon after treatment, but most require further care such as surgery or admission to an intensive care unit. Treatment and rehabilitation of severe injuries can take months or even years.

Trauma care in Australia

Australia's trauma care is of a generally high quality, but there's still plenty of room for improvement: one 6-year study estimated that improved diagnosis of road trauma victims might have saved 30 or more lives each year in Victoria alone.

Road trauma care is often particularly inadequate in rural areas. There are several reasons for this:

  • rural crashes often involve higher speeds and are therefore more severe;

  • the time taken for emergency services to be notified and to reach the crash scene is usually longer than in urban areas;

  • rural ambulances are less well equipped to deal with road trauma, reducing the standard of care that can be administered at the crash site and during transportation; and

  • rural hospitals are often less well equipped to deal with major road crashes, which may include several people with severe injuries.

The National Road Safety Strategy for the period 2001–2010 makes several recommendations for improving road trauma care. These include:

  • installing emergency alert systems in cars to automatically notify emergency services of the location and severity of the crash;

  • adopting common procedures for treatment to streamline the transfer of patients from rural to major hospitals;

  • improving the number and training of doctors, paramedics and other emergency services personnel in the early management of severe trauma; and

  • increasing the level of first-aid training among the general public.

Preventing road trauma

Related site: Designing road vehicles for pedestrian protection
Discusses changes in car design to reduce pedestrian injuries in a pedestrian-vehicle crash.
(British Medical Association, UK)

Improving car safety will also help. Seatbelts, airbags and other car-design features have increased the safety of car occupants and reduced the severity of the injuries, but more can be done. Car and safety-equipment manufacturers are continually trying to improve safety – for example, pedestrians hit by cars often receive severe head injuries when they collide with the car's bonnet. One European car-safety company is developing a rear-opening bonnet that pops up in collisions with pedestrians to reduce this risk.

In addition to improved car safety, other measures to help prevent road trauma include improvements in roads (eg, black spot programs), tougher enforcement directed at drink-driving and speeding, and educational programs for new and existing drivers.

Inevitably, though, people will continue to be hurt on Australian roads. When you next hear the lament of an ambulance siren, know that a system of care is going into action. Paramedics and rescue workers are rushing to the scene, and a team of doctors is standing by. But no matter how quick and efficient the system is, it can't fix broken backs, or damaged brains, and it can't take away the pain, although it might numb it a little. The sound of the siren is the start of something that may not have an end.

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Page updated September 2004.