Highway Crash: Bystanders, a Helmet and a Bleeding Thigh
On a two-lane national highway at dusk, a motorcycle has collided with a truck at a T-junction. The truck driver has fled. The motorcyclist, a man of about 30, is lying on his back, unconscious but breathing noisily with a snoring sound; he is not wearing a helmet. The pillion rider, a woman of about 28, is conscious, has a deformed right thigh and arterial bleeding from a cut on the leg. Eight bystanders are filming on mobile phones; traffic is passing at speed within a metre of the casualties. The junction has a faded stop line, no working street light and an overgrown signboard on the approach. One bystander has already tried to lift the unconscious man by his arms.
1. Set the immediate scene actions in order, and explain what the bystander did wrong.
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- Scene safety first. Ask two bystanders to place warning triangles or branches about 50 m and 100 m before the junction, switch on hazard lights of any parked vehicle, and slow traffic. A rescuer who is hit becomes a second casualty.
- Call 108 and the police. Give the exact location, number of casualties, one unconscious and one bleeding, and the fleeing truck. Note the truck registration if visible.
- Stop the bystander from moving the casualty. Lifting an unconscious crash victim by the arms can worsen a cervical spine injury and can obstruct the airway. The correct approach is to leave him in the position found unless there is immediate danger, and to use a jaw thrust or head-tilt-chin-lift with spine control.
- Control the woman's bleeding with direct pressure and, if the bleeding is spurting and pressure fails, a tourniquet above the wound, noting the time.
- Keep the airway open and monitor breathing until help arrives.
The reasoning is that the first ten minutes are dominated by scene hazards, catastrophic bleeding and airway, not by diagnosis.
2. Explain how to manage the unconscious motorcyclist's airway given that he is not wearing a helmet, and how the woman's leg should be handled.
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Unconscious man with noisy breathing:
- The snoring sound suggests the tongue or blood is obstructing the airway. Kneel at his head, place one hand on the forehead and two fingers under the chin, and tilt the head back gently while lifting the chin. If a cervical injury is suspected, use a jaw thrust instead, keeping the head neutral.
- Look in the mouth and remove visible blood, vomit or a broken tooth with a finger sweep only if it is visible; do not blindly probe.
- If breathing stops, start CPR and ask for an AED.
- Because he has no helmet, there is no helmet to remove; still treat the neck as injured and avoid twisting.
Woman with deformed thigh and arterial bleeding:
- Apply firm direct pressure with a clean cloth over the bleeding point. If blood is spurting and does not stop, apply a tourniquet 5–7 cm above the wound, not over the knee, and write the time on her forehead or a paper.
- Do not try to straighten the deformed thigh. Support it in the position found with rolled cloth or a splint, and check the foot for pulse, warmth and movement before and after splinting.
- Keep her warm and reassure her; do not give food or water.
The judgement is to treat airway and bleeding as the two killers, while the fracture is immobilised but not manipulated.
3. The junction has a faded stop line, no street light and an overgrown signboard. Recommend practical prevention measures and explain how they address the crash pattern.
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The crash pattern is a night-time T-junction conflict with poor conspicuity and a truck failing to give way. Measures should target each factor:
- Restore the stop line and add 'STOP' and 'T-junction ahead' signs on the approach, with retroreflective sheeting. A faded stop line gives no legal or visual cue to stop.
- Improve lighting: a solar street light at the junction and reflective delineators on the median or edge. Most of these crashes occur when a turning vehicle is not seen.
- Clear the overgrown signboard and enforce a no-parking/no-encroachment zone near the junction so sight lines are open.
- Traffic calming: rumble strips and a speed limit reduction on the approach, plus enforcement against speeding trucks at night.
- Helmet enforcement and pillion helmet awareness, because the unconscious rider had no helmet and head injury is the likely cause of his coma.
- Road safety audit with the local road-owning agency, and a review of the junction layout, including whether a slip road or channeliser is needed.
The reasoning is that education alone will not fix a junction that hides itself at night; engineering and enforcement must change the exposure.