Crash scene outside Kumanovo: fuel leak, an unresponsive driver and a bystander
It is 07:20 on a straight two-lane road outside Kumanovo. A small hatchback has left the road and stopped nose-first in a ditch about 2 m below the shoulder; both front airbags have deployed. The driver, a man of about 50, is slumped against his seat belt. He is unresponsive, but you can hear noisy, irregular breathing. In the passenger seat a woman is awake and screaming, with blood running down her face and her left forearm bent at an odd angle. Fuel is dripping from under the car and you can smell petrol. Another driver has already stopped and is trying to open the driver's door and pull the man out by the shoulders. Traffic is still passing at 80 km/h in the rain, and it is only just getting light.
1. What do you do in the first minute, and how do you handle the bystander?
Read the worked answer
Scene first, casualty second. Nobody else becomes a patient.
- Stop safely: park before the scene on your own side, hazard lights on, engine off, handbrake on.
- Protect the scene: warning triangle well back - further than usual because it is half light, raining and traffic is passing at 80 km/h - and keep yourself and others off the carriageway.
- Kill the ignition of the crashed car if it can be reached without entering the deformed area, and get anyone who is smoking well away. There is liquid fuel on the ground: no flames, no lighters, no smoking, and be alert to the risk of ignition.
- Stop the bystander. Say clearly: 'Don't pull him out - his neck and back may be injured, and pulling him could paralyse him or kill him.' Take over the door so he cannot continue. This is the single most important intervention in the first minute.
- Call 112 early - do not wait to finish assessing. If there are multiple casualties, say so.
Why the fuel matters: it changes your position, your reach into the car and your tolerance for waiting; but it does not by itself justify dragging a breathing casualty out, which is only for an immediate, unavoidable fire risk.
2. The driver is unresponsive but breathing noisily. What do you do for him, given he is still in the car?
Read the worked answer
Airway and breathing, with spinal caution.
- Unresponsive but breathing means the immediate threat is the airway, not the spine - but you still avoid unnecessary movement.
- Leave him in the seat, do not remove him, do not twist his head. Support the head in the position you found it, in line with the spine, with your hands if you have help.
- Loosen anything tight at the neck, and check that the seat belt is not cutting across his neck. Do not release the belt while he is slumped forward without support - he may fall.
- Noisy, irregular breathing is a warning. Re-check continuously: is the chest rising, is air moving, is the noise getting worse? If vomiting, gurgling or a snoring sound develops, the airway is at risk and he must be managed - reclining the seat and clearing the mouth, turning him as a unit if you cannot keep the airway open any other way.
- If breathing stops, he has to come out to be resuscitated: get him onto a firm flat surface, start chest compressions at 100–120 per minute, and use an AED as soon as one is brought.
- Keep him warm, keep talking to him, and stay with him until the ambulance crew takes over, handing over exactly what you saw and did.
Reasoning: the rule is not 'never move a casualty' - it is 'move only when the airway or resuscitation demands it, and then move as one unit'.
3. The woman is awake and screaming, with a bleeding scalp wound and a deformed forearm. What do you do, and what do you tell the emergency operator?
Read the worked answer
For the woman:
- Bleeding from the head: apply firm direct pressure with a clean pad or dressing. Scalp wounds bleed heavily and look worse than they are; pressure usually controls them. Do not press on a visibly deformed skull.
- Deformed forearm: do not straighten it, do not test it, do not let her wave it about. Support it in the position found with a sling or simply her own hand resting on her chest against a pad, and keep her still.
- Shock and cold: she is frightened, in pain, in the rain and likely losing heat. Reassure her, keep her warm, keep her sitting in the car rather than walking her around, and keep checking that she stays alert and her breathing stays normal.
- Do not give her anything to eat or drink - she may need surgery.
To the 112 operator, in this order:
- Exact location - road number and direction, nearest village or kilometre marker relative to Kumanovo; say the car is in the ditch below the shoulder.
- Number of casualties and their state: one unresponsive but breathing, one conscious with head and arm injuries.
- Hazards: fuel leaking from the vehicle, airbags deployed, traffic passing at 80 km/h.
- Your phone number and name, and stay on the line until told to end the call.
Reasoning: the operator dispatches the right resources and can talk you through resuscitation or bleeding control; a vague location sentence wastes the minutes that matter most.