A road crash with several casualties

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Scene 1 · Opening

23.15, a country road crossroads in the rain. Two vehicles across the road, one door open, a headlight lighting up the hedges.

Somebody is screaming in the first car. Further on, between the two vehicles, a shape on the ground is not moving.

Three cars have stopped behind you. Nobody has got out.

Scene 2 · Protect

The road is still running in both directions. Cars slow down, look, and drive on.

You have your hi-vis jacket in the glovebox and two vehicles whose ignition nobody has switched off.

Two people are waiting for you. What do you start with?

• Right move : My jacket, my hazard lights, theirs, and I switch off the ignition in both vehicles.
  Protect, alert, help, in that order : The fire and rescue services sum up any crash in three words, and the first is protect. Jacket on before you get out, hazard lights on, ignition off in every vehicle involved, nobody smoking nearby. And at night, light up the vehicles involved with the headlights of the other vehicles present, the ones that have stopped behind you. None of that treats anybody, and without it there are six casualties instead of two inside a minute.
• Mistake : I run to the one who is screaming, she needs somebody right now.
  Nothing is marked out and the road is still running : The Croix-Rouge is plain: only approach the scene if it puts you at no risk. And the fire and rescue services start with protection, precisely because a second crash is what turns two injured people into carnage. The one screaming is breathing; the road is not waiting.
• Not the best choice : I take two photos for the insurance before anything gets moved.
  The flash helps nobody, and it dazzles the drivers arriving : Claim forms get filled in later, and never by the bystander. What your phone has to do tonight comes down to two numbers and a location.

Scene 3 · Call

All four sets of hazard lights are flashing. Both ignitions are off. You have your jacket on.

The three cars stopped behind still have not sent anybody.

You have the phone in your hand. What do you do?

• Right move : I call 18 and give the number of vehicles, the number of people hurt and how each of them is.
  The number, and how they look : The fire and rescue services ask you to say how many vehicles are involved and what kind, then how many people are hurt and what state they appear to be in. That is what decides what they send: two casualties, one of them not responding, does not call out the same resources as a bent wing.
• Mistake : There are three cars stopped: somebody must have called already.
  Nobody has called : It is written in those words in the fire and rescue guidance: never assume somebody else has already called for help. Everybody assumes the same thing at the same moment, and that is how a crash goes ten minutes without a call with fifteen witnesses standing round it.
• Mistake : I call and tell them the whole thing from the start, they will understand better.
  He cuts across you to ask how many are hurt : The guidance comes down to three things: stay calm, be brief, be precise. The exact location, how many vehicles and what kind, how many people are hurt and what state they appear to be in. The story is for afterwards, and mostly it is no use to anybody.

Scene 4 · Who first

The dispatcher has hung up. Two people, one of you, and four onlookers filming.

The one in the first car is calling to you over the noise. The other one, on the ground, has not moved since you got here.

Which one do you go to?

• Right move : I give two of the onlookers a job, and I go to the one saying nothing.
  The one talking to you is conscious, and she is breathing : Somebody who answers and reacts is conscious: the guidance keeps the word unconscious for the person who answers and reacts to nothing at all. So she is the one you know nothing about. And the fire and rescue services add the instruction that doubles your hands: ask bystanders to help you or to move away.
• Mistake : I go to the one screaming: she is in pain, that much is obvious, the other one may just be frightened.
  Noise is not the same as severity : Screaming takes air, so breathing, so consciousness. The one who answers nothing is the one nobody knows is breathing, and the fire and rescue services list actions for her that cannot wait: loosen her clothing, clear her airway, do compressions if needed.
• Mistake : I pull both casualties out of the vehicles to get them somewhere safe.
  You leave casualties in the vehicles : The fire and rescue services put it without hedging: leave casualties in the vehicles, unless there is fire or some other risk. And do not move an injured person unless the danger is immediate. An improvised extraction moves a spine nobody knows the state of.

Scene 5 · The silent one

You kneel beside her on the wet tarmac. You talk to her, you take hold of her shoulder.

She does not answer. But her stomach is rising, steadily, and that is the best news of the evening.

She is not responding and she is breathing. What do you do?

• Right move : I loosen her collar, I clear her airway, and I leave her on her back, watching her breathing.
  On her back, because this is an injury : The national syllabus separates two situations, and it is that separation which decides. After a non-traumatic event: recovery position. After an injury or an event of unknown origin: leave the casualty on her back, have someone call for help, follow the instructions the emergency service gives, watch her breathing continuously. She is on the ground between two crashed vehicles, so this is an injury. If she vomits or brings anything up, then you roll her onto her side, keeping the head-neck-trunk line if you can. The fire and rescue page printed further down writes the roll onto the side without that condition: the two sources diverge, and on a question of position it is the national syllabus that settles it.
• Mistake : I drag her by the arms to get her out of the middle of the junction.
  Her head followed on its own : Do not move an injured person unless the danger is immediate. And if moving her really is unavoidable, the guidance says how: do not pull her by the limbs, avoid any twisting of the spine. The junction is marked out and the ignitions are off: there is no immediate danger left, so no reason to move her.
• Mistake : I wet her lips from my water bottle, her mouth is open.
  Nothing to eat, nothing to drink : It is one of the four bans the fire and rescue services list after a road crash, along with the helmet and moving people. Somebody who is not responding does not swallow: what you pour into her mouth goes down into her lungs.

Scene 6 · The wait

She is on her back and she is breathing. The one in the car has stopped screaming and is asking questions.

The onlookers have moved three metres closer. It is raining, it is seven degrees, and the crew says eight minutes.

Eight minutes. What do you do with them?

• Right move : I cover them both, I talk to them, including the one who is not answering, and I move the watchers back.
  Cover, talk, clear : The three instructions are in the same list: cover the casualties, talk to the injured and reassure them, ask bystanders to help you or to move away. Talking to somebody who is not answering is not absurd: nobody knows what she can hear, and it makes you keep looking at her.
• Mistake : I let the onlookers come closer, they are not in anybody's way.
  They have put themselves between the vehicles and the road : The instruction is to ask bystanders to help you or to move away: there is no third option. A crowd in the middle of a junction at night becomes the next casualty, and it gets in the way of the crew arriving, which the guidance expressly tells you to avoid.
• Mistake : I get back in my car, it is raining, they will be here in eight minutes.
  From in there, you cannot see whether she is breathing : The guidance asks you to watch for signs of things getting worse, and to call back to report them. From inside a car, ten metres away, with mist on the windows, nothing getting worse is visible. Eight minutes is exactly the length of time you have to stay.

Scene 7 · The crew

Two appliances come in from both ends of the junction and park across it, exactly the way you had tried to with your car.

They ask you which one first. You point to the one still on her back, and you say she never answered.

You touched nobody, except to loosen a collar. You put on a jacket, switched off two ignitions, gave two numbers and moved four people back. That is all of it, and that is the whole thing.