First on Scene: Unconscious Driver and a Bleeding Passenger
At 18:10 on a dry two-lane road near Madaba you are the first to reach a crash. A small car has left the road and stopped against a low stone wall. The driver is slumped over the wheel, unconscious, but you can hear noisy breathing. The front passenger is awake, sitting on the ground, with a blood-soaked sleeve pressed over a forearm wound and complaining of dizziness. A child in the back seat is crying but appears to be moving all limbs. There is a smell of petrol and the car's hazard lights are not on. Traffic is passing at about 80 km/h. Your mobile phone has 12% battery. You have a first-aid kit with gloves and gauze but no trauma dressing. A bystander is about to pull the driver out of the car.
1. What should you do in the first minute to make the scene safe and get help?
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Stop before the crash, not at it, and switch on your hazard lights. Put on gloves. Send a bystander to place a warning triangle or warning signal well back from the scene - at 80 km/h traffic, 50 m is a minimum and more is better on a bend. Call the emergency number and give the road, direction, number of casualties and the petrol smell. Do not smoke or use a naked flame near the car. Ask the bystander not to pull the driver out; movement can worsen spinal or internal injuries unless there is fire or another immediate danger. Keep other people back from the traffic lane.
2. How should you assess and manage the unconscious driver's breathing while waiting for the ambulance?
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The noisy breathing suggests a partly blocked airway. If it is safe to reach the driver and there is no fire, support the head and neck in line, open the airway using a jaw thrust rather than tilting the neck, and check for normal breathing. Do not remove the driver from the car unless there is fire, risk of explosion or the airway cannot be managed otherwise. If breathing is present, keep monitoring; if it stops, start CPR if you are trained and the position allows. Do not give water or try to sit the driver up. The petrol smell makes fire a real risk, so be ready to move only if that danger becomes immediate.
3. The passenger's sleeve is soaked with blood and they feel dizzy. What do you do, and how do you handle the child?
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Put on fresh gloves if available, expose the wound, and press gauze firmly on it with a gloved hand or ask the passenger to keep pressing. Do not remove a soaked dressing; add more gauze on top and keep pressure. Lay the passenger down if they feel faint, keep them warm, and do not give food or drink. Check the child visually: crying and moving all limbs is reassuring, but keep the child still and calm, do not pull them out unless there is danger, and tell the ambulance crew about the child. Reassure both casualties and keep monitoring the driver's breathing.