Transportation Injuries

Report
Transportation injuries
Dr. Ravi Nanayakkara
1
Transportation injuries.
• Road traffic injuries
• Railway injuries
• Aircraft Fatalities
• Navigational Injuries
2
Objectives
• Discuss the role of a judicial medical officer in
a case of road traffic accidents
• Describe the injury pattern of each road user
• Medico – legal investigation of a death due to
transportation injuries
• Describe the injury pattern in victims of train
accidents
Road Traffic Injuries
• 17th August 1896 in London,
Continued…..
4
The World's First Death by Motor Vehicle
• On 17th August 1896, Bridget Driscoll, a 44 year old mother of
two, became the first person ever killed by a motor vehicle. She
and her teenage daughter were on their way to see a dance
performance at Crystal palace in London. She was struck by a
car as they crossed palace grounds. Witness said the car was
going “at tremendous speed”. It may have been going at 8
miles/h (12.8 Km/h), though it was meant to be going no more
than 4 miles/h (6.4 Km/h). A young man driving, giving free
rides to demonstrate the new invention and , according to
some, trying to impress a young female passenger. At the
inquest, the coroner said, “This must never happen again”.
Source: World’s first road death. London, Roadpeace.
(http://www.roadpeace.org/articles/worldfirstdeath.html)
-accessed on 11th December 2003.
5
• Every day more than 3000 people die of RTA
• 1.2 million died from RTA,
Over 70 % - age less than 45
• 2.1% of all global deaths - 11th leading cause
of global deaths
6
7
8
9
Road Traffic Deaths Worldwide by Sex and Age Group
10
• Global burden of disease and injuries
1990 rank for RTA 9th
2020 rank for RTA 3rd
• 50 million people injured each year.
• 85% deaths due to RTA are in Low income &
Middle income countries.
11
Top 10 Leading Contributors to the
Global Burden of Disease*
1.
2.
3.
4.
5.
6.
7.
8.
1990
2020
Disease or Injury
Disease or injury
Lower res. tract infections
Diarrhoeal disease
Perinatal conditions
Unipolar major depression
Ischaemic heart disease
Cerebrovascular disease
Tuberculosis
Measles
9. Road traffic injuries
10. Congenital abnormalities
1. Ischaemic heart disease
2. Unipolar major depression
3. Road traffic injuries
4. Cerebrovascular disease
5. COPD
6. Lower res. tract infections
7. Tuberculosis
8. War
9. Diarrhoeal disease
10. HIV
continued…..
12
• Every hour 34 RTI deaths take place in South
East Asia.
• By 2020 this will rise by 144 % compared to
2000.
• Every second six persons across the world
either die or suffer severe injuries due to RTI
13
• Sri Lanka 2009
• Every hour at least 6 road crashes
• 3 injured every hour - 1 killed every 4 1/2 hours
6 per day
• 33302 lives lost last 20 years - 1538 per year
• Each death costs US$ 1912 (60 times monthly
per capita income of US$ 33)
14
Sri Lanka
Road traffic deaths
201020112012-
2500 deaths
2400 deaths
2900 deaths
15
16
17
Why should we know about
transportation injuries?
1. To assess injuries for the purpose of
treatment.
2. To evaluate the role of natural disease in the
causation of accidents.
3. To reconstruct the accident.
18
4. To collaborate, evidence of eyewitnesses.
5. To assist in identification of the vehicle.
6. To predict the state of the person involved in
the accident.
E.g. drunk or drugged.
7. Identification of the victim.
19
8. Documentation of injuries for the purpose of
compensation claims.
9. To determine the cause of death.
10. To evaluate the circumstances of death.
 Homicide?
 Suicide?
 Accidental?
20
Factors affecting the outcome of a RTA
 Road + Environment
 Vehicle
 Human Factors of the road user
 Driver
 Pedestrian
21
• Road + Environment
 Road Density ( Vehicle population
on the road )
 Condition
Bends, narrow, Steep,
Slippery, Pit holes
 Environment
Night, rain, mist, fog,
Snow, Sandstones, Smog,
Poor lighting at night etc.)
22
• Vehicle
 Speed
 Condition (whether road - worthy!)
E.g. Absence of breaks
Head lamps
Horn
Signal etc.
Continued……
23
 Safety devices
 They do not reduce the number of
accidents, though will reduce the
fatality rate and morbidity.
E.g. Seat Belt
Head Rests
Crash Helmets (in motor - cyclist)
Collapsible steering wheels
Safety Windscreen glass
Breaking system (ABS)
Air Bags
Locking system etc.
24
• Human factors (Commonest cause in Sri Lanka)
 Driver
a) General Health
Old age
Poor vision
Poor hearing
Prolong reaction time
Co-morbid factors such as HTN, DM,
IHD etc.
Continued………
25
b. ) Alcohol Consumption/Intoxication
 Alcohol is incriminated for > l/3 of all RTA
 Legal Limit < 80 mg / dl in Blood
26
c) Fatigue
•
•
•
•
DROWSINESS
TIREDNESS
LACK OF ALERTNESS
SLEEPINESS
• Taking more risks
• Frequent yawning, nodding, blinking
• Disinterest in carrying on a conversation
27
FATIGUE RELATED TRAFFIC ACCIDENTS
Common examples:
Pilgrimages
Airport drops
Weddings
Holidaymakers
Taxi drivers
Long distance bus drivers
Van drivers
FATIGUE RELATED TRAFFIC ACCIDENTS
•
•
•
•
Alcohol
Particular group
Measurable
Preventable
Curable
Fatigue
Every driver
No tests
No warning
Very few treatable
• Pedestrians
 Intoxicated (Alcohol, Drugs)
 Impaired Vision / Hearing
 Incapacitation due to,
• Extremes of age.
• Illness
• Injuries
 Breech of road rules
30
• Road traffic injuries
•
•
•
•
•
•
•
Pedestrians
Car / Vehicle drivers and occupants
Motor cycle users
Pedal cycle users
Three wheeler drivers and occupants
Others - Heavy vehicles, Tractors
Bullock carts and hand carts users
31
Pedestrians account for more than half of the road fatalities.
32
• Pedestrian injuries.
• The commonest RTA fatalities
• How ?
 Towards vehicle
 Opposite Direction
 Crossing the road
Continued……
33
• Nature and severity depend on,
1. Nature of the vehicle (car/ van/ bus etc. )
 Height of the vehicle.
• Below the centre of the gravity of the victim
• Above the centre of the gravity of the victim
 Type of the vehicle (Heavy lorry, van…)
 Speed of the vehicle.
 Nature of the striking surface of the vehicle.
34
2. Victim
 Orientation of the victim.
 Height of the victim (Centre of gravity).
 Personal factors.
 Movements after impact (thrown on to
path of moving vehicle)
35
3. Road surface
 Nature of the surface
 Objects – stationary / moving
36
• Injuries.
1. Impact injuries
 Primary impact
 Secondary impact
2. Secondary injuries
3. Tertiary injuries
 Run over injuries
 Run under injuries
 Drag injuries
37
• Primary impact injuries
 As a result of first contact with the
vehicle.
38
• Types of injuries
 Imprint abrasions
 Lacerations
 Fractures
 Contusions
39
• Area of the body
Knee level
Thigh
Hip
Elbow
Shoulder
Chest or head
40
• When the impact is below the center of gravity
E.g. Car
• Primary impact at knee level
• Bumper fractures occur at 14 MPH in young
adults.
• Victim is scooped up
 Secondary impact injuries.
 Speed > 25km/h
41
• Secondary impact injuries (not a must)
 Small cut injuries due to shattered
windscreen glass
 Skull fracture
 Rib fracture
 Lacerations
 contusions
42
• When the Impact is above the center of gravity
E.g. Van, Bus
 Injuries to pelvis, abdomen, arms, head
 Victim may be projected forward ( forward
projection ) or run over.
43
• Secondary injuries
 As a result of victim falling on the ground
after the Primary or Secondary impact.
 Found in impact with any vehicle.
 Are often more lethal, esp. to head, chest,
pelvis
Distance thrown : Throw distance
Continued…..
44
 Depends on,
• Force of the fall.
• Nature of the object struck.
 Injuries,
• Grazed abrasions
• Contusions
• Lacerations
• Fractures
• Contre-coup injuries to the brain
• Internal injuries
45
• Run over injuries
 A wheel passes over the body
 Chest and abdomen - tire marks imprinted
 Limbs ,
• Tears of skin & muscles
• De-gloving injuries
Continued…….
46
 Features,
• Clothes - Tire marks, grease, oil
• Skin - Tire marks
- Flattening of affected area
- Soft tissue ooze
• Crushing and degloving of limbs
• Multiple fractures.
• Internal injuries
47
• Run under injuries
 Vehicle goes over the body but no run over
by tires
 Body gets pinned between under surface
of the vehicle & road
 Any type of fracture, crush injuries
48
• Drag injuries
 Victim gets entangled and dragged along
the road
 Grazed abrasions with mud and dirt from
road.
49
• Injuries to vehicle occupants
 80% are frontal impacts – with another
vehicle or object
Severe deceleration
 Less commonly vehicle is hit from behind
Acceleration
 Side impacts
 Roll over
50
Occupants of vehicles
• Driver
• Front seat passenger
• Rear seat passengers / other occupants
Tissue injury depend on G force applied per unit
area - Larger the area lesser the injury
G=C(V)2
C =0.0039 V – Velocity km/h
51
Additional injuries depend on subsequent
behavior of the victim and vehicle.
52
• Injuries depend on,
 Change in rate of movement ( G forces )
 Speed of the vehicle.
 Speed of the offending vehicle.
 Nature of the impact.
 Design or the interior of the vehicle /
cabin.
 Availability / usage of safety devices.
 Trapped within / thrown out.
 Subsequent behavior of the vehicle
 Vehicle catching fire
53
• Injuries to the driver,
 Head and face hit the windscreen glass,
frame or side pillars.
-Blunt and sharp injuries.
 Neck - Whip lash injuries , Fracture
dislocation of cervical spine.
-Due to hyper flexion and hyper extension
( Hyperextension more serious )
Continued………
54
• Bleeding into surrounding muscles
• Rupture of anterior longitudinal ligament of
vertebra
• Tear of intervertebral discs
• Compression of nerve roots
• Ischemic haemorrhages and pulping of spinal
cord
Commonest site upper two cervical vertebrae
55
 Chest injuries
Fractures of ribs, contusions lacerations of lungs
Heart compressed between sternum and vertebra
 Abdominal injuries
Rupture of rectus abdominis , liver, duodenum, bowels
 Knee injuries due to hitting of dash board.
 Driver hit brake or clutch pedals
•
Posterior dislocation of hip
•
Fractures of pelvis , lower limbs, ankle
 Broken windscreen glass - superficial lacerations(sparrow foot
marks)
Continued………
56
 Tightly hold the steering wheel - upper
limb fractures ( shoulder, forearm,
humerus )
 Thrown out injuries – Fatality X 5
 Sudden deceleration cause a pendulous
effect on heart resulting in step ladder
tears of aorta
 Side impacts
57
Injuries to front seat passenger
•
•
•
•
Nothing between body and windscreen
Risk of thrown forward
Less anticipation than driver
Forward projection may hit front parts of
cabin.
58
• Injuries to front seat passenger
 Hyper flexion and hyper extension
resulting whip lash injuries.
 Injuries due to windscreen glass and
windscreen pillar. (Sparrow foot cuts)
 Knees hit the dashboard as in driver.
 Thrown out more common (unrestrained
without seat belt ).
 Side impacts.
59
• Rear seat passenger
 Injury to face and head due to impact on
front seats.
 Dislocation of hip if sitting legs crossed
 Thrown between seats and ejected to the
windscreen.
 Thrown out.
60
Passenger Vehicles
• Vans, Buses, etc.
• Passenger injuries depend on
Nature of impact
Relative position of the victim to impact
subsequent behavior of the vehicle.
61
• Function of seat belts
 It restrains the body against severe
deceleration.
 It spreads the deceleration over a
considerable area – G forces.
 The strap stretches appreciably during
severe deceleration.
 The belt prevent ejection into the road.
62
• Function of Air bags
 These are designed to interpose itself
between the occupant and frontal
structures of the passenger cabin.
 It helps to cushion the impact and prevent
forceful contact and hyper flexion.
63
• Injury to motor cycle users








Rider / Pillion rider
Traveling openly
Balancing on two wheels
Risk of thrown forward
Easily can speed, maneuver
Risk of run over by other vehicles
Mostly used by young people
Pillion rider has a greater risk of being
thrown off on impact
Continued…….
64
• Injuries
 Fall on ground
 Projection forwards
 Side impacts
 Run over injuries
Continued……
65
Rider
Injuries to
• Head ,chest and abdomen
• Upper limb injuries
• Fracture femur, tibia, fibula
• Pelvis injuries
• Ankle injuries
66
• Head and neck injuries
 In spite of usual wearing of crash helmet.
 Worse when riders are not wearing crash
helmets.
 Skull fractures and intracranial injuries
Chin hitting the ground causing hinge
fracture
Contre-coup injuries
 Cervical spine fracture dislocation
67
 Limb injuries
• Grazed abrasions
• Contusions
• Lacerations
• Fractures
• Silencer burns
68
Pillion rider
•
•
•
•
Nothing to hold on
Risk of thrown forward
Often escapes from primary impact from front
Similar injuries as rider
69
• Pedal cycle users
 Injuries are very common
 Less severe due to low speed
 Primary injuries occur from impacts by
other vehicles – speed of other vehicle
 Secondary injuries due to fall on ground
 Run over injuries
70
 Impact injuries from the offending
vehicle
 Secondary injuries due to hitting on road
surface, sliding across the road
 Run over injuries by same vehicle or
another
 Head injuries with intracranial injuries
Unlikely wear helmet
 Bicycle spoke injuries
71
• Three wheeler users
 More hazard to other road users
 The offending vehicle of the most
pedestrian injuries
 Lively hood of many adult males – Attempt
to get more hires as possible during rush
hours
Continued…..
72
 Head on collision
 Can topple
 Passengers can thrown out
73
Injuries are more prone
•
•
•
•
Small and compact nature of the vehicle
Overloading
No safety devises
Drivers are young and takes more risks
74
• Medico legal investigation of a case of
Road Traffic Accident (Hit & run)
1. History
2. Scene visit
3. Identification
4. Preliminary procedures
75
5. Examination of clothing
6. General external examination
7. Specific external examination
8. Complete internal examination
9. Specific investigations
10. Documentation
76
Railway accidents
• Impact with the train
• Injuries to passengers
• Falling from train
77
1. Impact with a train
• Suicide
Jump to moving train
• Accident
Walking or crossing the rail tract
Vehicles crossing unprotected rail tract
• Homicide
Push to the moving train (rare)
• Post mortem disposal
Murder and leave on the tract(PM injuries)
78
2. Injuries to the passengers
• Collide with another train
• Derails
3. Persons falling from train
• Accidental
• Homicidal
• Suicidal
79
• Injuries following impact are usually fatal.
• Extensive musculoskeletal injuries.
• Decapitation
• Dismemberment / Amputation
• Bizarre injuries
80
• Investigation of a body found in Rail tract ?
81
• Unrelated to impact the train
Electrocution from overhead cables
Natural diseases (IHD, Epilepsy…)
Snake bite
Lightening
82
• Rail tract injuries
• Aviation injuries
• Navigational injuries
Read…..
83
Mechanisms of injury in an adult
pedestrian struck by a car at high
speed
84
Summary
•
•
•
•
•
•
•
•
Statistics
Pedestrian injuries
Vehicle occupants (car/passenger vehicle)
Motor cycle rider
Pedal cycle user
Three wheeler occupants
Train accidents
Medico legal investigation
85
Case 1
86
Case 2
87
Thank you.
88

similar documents