First on Scene: Unresponsive Driver, Fuel Smell and -22°C
On a rural road about 40 km from town, you are the first person to arrive at a two-car collision. It is -22°C and snowing, with visibility about 80 m. One driver is out of his car, walking unsteadily and holding his wrist. The other driver is slumped over the steering wheel, unresponsive but breathing. You smell fuel. Your phone shows no signal. You have a first-aid kit, a warning triangle, a warm blanket and a torch. The road is a straight two-lane highway with light traffic. The crashed cars are partly in the driving lane, and it is dusk. You are alone. The walking driver says he is fine and tries to light a cigarette.
1. What is your first priority, and what is your sequence of actions?
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Your first priority is scene safety, not first aid. Stop well before the wreckage, switch on hazard lights, and place the warning triangle 50-100 m back on this straight highway; in poor visibility, place it farther if you can do so safely. Do not smoke, and stop the walking driver from lighting a cigarette. If you can reach an ignition switch without putting yourself at risk, turn it off, but do not create sparks.
Then assess the casualties and get help. Flag down a passing vehicle and ask the driver to call 112, giving the location, number of vehicles, number of injured, the unresponsive driver and the fuel leak. Do not move the unresponsive driver unless there is a fire or immediate danger. Keep yourself visible and out of the traffic lane.
2. How should you manage the unresponsive driver?
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Assume a spinal injury. Do not pull him out of the car. Support the head in a neutral position, check that the airway is open and that he is breathing. Keep him warm with the blanket and monitor his breathing continuously. If he vomits, clear the airway and turn him as a unit if you can do so without twisting the spine.
Do not give food or drink. If breathing stops, start CPR and send someone for help. Leaving him in the car is usually safer than dragging him out, unless there is fire, fuel ignition risk, or another immediate hazard.
3. How do you handle the fuel smell and the walking driver?
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The fuel smell means a fire risk. Keep everyone away from the vehicles, forbid smoking and lighters, and do not start any engine. Use the torch carefully and keep it away from any spill. Move the walking driver upwind and away from the traffic lane.
He may be in shock: sit him down, keep him warm, and check his wrist. Adrenaline can mask injury, so do not accept 'I'm fine' as a reason to let him wander near traffic or light a cigarette. Watch for confusion, dizziness or worsening pain until help arrives.