What to do at the scene of a car crash

These recommendations came to light after an interview with 33-year veteran Victorian paramedic Jim Wilkins, conducted by John Cadogan during a car industry event.

In order:

Protect the scene. This means ensuring there is a safe zone in which to support the injured, protected from the path of passing traffic. Ideally a vehicle would be placed 50m back from the crash, with the ‘hazard’ lights activated. Additionally, safety triangles (or witches hats) may be set up even further back, and a sensible bystander (preferably wearing and/or waving a hi-viz vest) could be employed to warn approaching traffic, provided they can do it from a safe location. (Everyone should have at least one reflective hi-viz vest and two safety triangles in the car. A torch, especially a head torch, which leaves both hands free and directs light wherever you move your head, and a first-aid kit aren’t a bad idea, either.)

You must ensure that the predicament doesn’t get worse because another motorist crashes into the crash scene. This is a real risk, which is why emergency services spend significant time protecting the scene before performing first aid. Basically, good Samaritans enjoy no magical protection. If you get cleaned up, it’s suddenly a bad day for you, and a worse day for the injured you can no longer help.

Call emergency services on 000 (in Australia). Expediting the call to emergency services is an absolute priority. Mr Wilkins told me the responsibility to call 000 is often ineffectively delegated, and the prevailing chaos means that everyone believes someone else has called 000. Result – everyone awaits the arrival of emergency services, which haven’t actually been called. This is a terrible result, as the outcome for the injured is often much worse if expert intervention is delayed. Take responsibility and call 000 yourself.

What to tell emergency services:

1. Start by saying “This is an emergency.” It’s an action trigger that presses the right buttons. It tells the operator you’re not kidding, and that you’re reasonably clear-headed.
2. Know where you are, and specify the location. Street name, suburb or town, and nearest cross street are ideal. (Or distance from nearest town, and which road you are on in the bush.) If you have GPS in your car or your mobile telephone, this can be very helpful if you are in an unfamiliar area. Otherwise, ask a local bystander for assistance.
3. Explain what has happened. Is it a single-vehicle rollover, a two-car head-on collision, a truck and a car? A rear-ender? Are dangerous goods potentially spilled (important if a truck is involved).
4. Tell the operator how many people are injured.
5. Give your observations about the injured. Can they walk? How are they walking (staggering, un-coordinated, tripping)? If they are not walking, can they talk? How are they talking? (Talking in sentences is good. Talking in single words or moving mouth with no words coming out often indicates a chest injury.) Are they unconscious?

Important Considerations:

• Disoriented people who have been in a crash may walk onto the road and into the path of traffic, and risk being hit. Tell them to sit somewhere safe and say “wait here – the ambulance is on its way”. If available, recruit a responsible bystander to make sure the ‘walking wounded’ remains in position.
• Vehicles that have rolled or that are off the road may be unstable. Do not place yourself at risk of becoming another casualty at the scene because an unstable vehicle slips or tips over.
• If possible/safe, reach in and turn off the ignition, which turns off aspects of the electrical system, reducing fire risk.
• Bear in mind that crash-involved vehicles are often unstable. This is especially true if the vehicle comes to rest on its side or roof, or on a cross-slope - never place yourself at risk by moving to the downhill side of an unstable vehicle.
• If crash-involved people cannot get out of the car on their own, leave them in place until emergency services arrive. Unless absolutely exceptional danger pertains, such as the vehicle being on fire, never remove crash-involved people from vehicles.

Basic first-aid: A, B, C – for Airway, Breathing and Circulation.

• Airway: If breathing sounds noisy, it indicates an obstruction. Snoring sounds often indicate a tongue obstruction; crackling or gurgling noises often indicate fluid. In these cases, gently grasp the chin and pull the jaw forward. If the sound gets quieter, good. Stabilise the head in an upright position (by holding it) and await emergency services.
• Breathing: Injured people who are not breathing or who have no pulse require CPR. (You know, basic first-aid training is a very good idea.)
• Circulation: Visible bleeding requires a pad (folded-up T-shirt or similar) and moderate pressure over the wound.

• Be mindful that modern cars are often fitted with multiple airbags, some of which may not deploy on impact. There is some risk that they might deploy (explode) with potentially lethal force in the aftermath of a crash, so always minimise your exposure to the interior of crashed vehicles.
• Keep uninvolved bystanders away. People not actively engaged providing support must be politely but firmly told to remain at a safe distance from the crash site.