Unresponsive rider, fuel leak, and a filming crowd
At 7:20 a.m. on National Road 2 south of Phnom Penh, a rider comes upon a crash that has just happened. A scooter has collided with a hand tractor. The scooter rider, a man in his 30s, lies face-up on the asphalt with his helmet still on. He is breathing but unresponsive; blood is coming from his mouth, and his left leg is pinned under the scooter. Fuel is dripping from the scooter near the hot exhaust. A crowd of about 15 people is gathering; several film with phones, two people argue about who caused the crash, and no one has directed traffic. Vehicles are passing at 60 km/h. The rider has no first aid kit, but he has a phone, a clean cloth, and work gloves in his box. He has basic first aid training and is unsure whether to remove the casualty's helmet.
1. What should the rider do in the first 60 seconds, in order, and why?
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First 60 seconds, in order:
- Protect the scene. Switch off the scooter ignition, keep smokers away, and position people and a vehicle with hazard lights upstream to slow traffic. Do not let the crowd stand in the live lane.
- Call for help. Dial 119 for an ambulance and 117 for police. Give the road, direction, number of casualties and the fuel leak.
- Assess without moving. Check responsiveness and breathing. The man is breathing but unresponsive, so maintain an open airway and monitor continuously. Do not give water.
- Control visible bleeding with the clean cloth, using direct pressure. Wear the gloves if time allows.
- Do not move the leg or the bike unless the fuel ignites or traffic poses an immediate threat. Moving a casualty with a suspected spinal or pelvic injury can worsen it.
2. Should the rider remove the casualty's helmet? Explain the decision criteria.
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Default: leave the helmet on. A helmet holds the head in line with the neck, and removing it can convert a stable spinal injury into a paralysed airway. The fact that the casualty is unresponsive does not by itself justify removal.
Remove only if: the helmet blocks the airway, the casualty is vomiting and cannot be positioned safely, or breathing has stopped and the helmet prevents rescue breathing. Removal requires two trained people: one supports the head and neck from below while the other expands the helmet sides and lifts it straight off. Never twist the neck.
If not removing: Loosen the chin strap only if it is tight enough to obstruct breathing or circulation, but keep the head still. Continue to monitor breathing and be ready to turn the casualty as a unit if vomiting occurs. The rider's basic training is enough to support, call and monitor, not to attempt a solo helmet removal.
3. What legal duties and communication rules apply to the rider as a helper and witness?
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Legal duties: Under Cambodian road traffic rules, a person involved in or present at a crash should stop, help persons in danger, protect the scene, exchange details where applicable, and report to police. Leaving an injured person without assistance can create legal exposure. The rider should give his name, contact and a factual account.
Communication: He should describe what he saw, not who he thinks was at fault. He should not admit fault, sign a statement he cannot read, or join the argument in the crowd. He should ask the officer for a case reference and the hospital name.
Witness role: He is a helper and witness, not the investigator. His priority is the casualty's airway, bleeding and traffic protection until the ambulance arrives.