Single-vehicle crash on an unlit bend
You are driving alone on a wet secondary road between two villages, about 3 km from the nearest town, at 18:40 in October. On a right-hand bend you come upon a single-vehicle crash: a small hatchback has left the road and struck a tree head-on. The bonnet is crumpled, the engine is still running and the hazard lights are flashing, and you can smell petrol. Your phone shows one bar of signal. The driver is lying half out of the driver's door, face up and motionless; when you check, she is not breathing normally, only giving occasional gasps. A teenager is sitting on the verge, conscious, holding a forearm that is bleeding steadily through his hoodie, and asking repeatedly where his mother is. No other vehicle has stopped. The road behind you is unlit and a further bend follows the one you have just come round.
1. Set out your actions in the first 60 seconds, in order, with the reason for each.
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- Stop safely before the scene, off the carriageway if possible, hazard lights on, and put on anything high-visibility you carry. Your vehicle becomes a warning marker for the bend behind you.
- Call 112 immediately, on speakerphone so your hands stay free. Give the road, the two villages, the distance from town, that you are on a right-hand bend, two casualties, one not breathing normally, one bleeding, and a strong smell of petrol. Ask them to send fire and ambulance.
- Assess the danger before the injury. Petrol plus a running engine is a fire risk, so switch off the ignition if you can reach it without putting yourself in the crush zone, and keep everyone away from smoking or any source of ignition.
- Airway and breathing for the driver. She is not breathing normally - occasional gasps are not breathing. Start CPR: 30 compressions to 2 breaths, 100–120 per minute, 5–6 cm deep, hard and fast in the centre of the chest.
- The teenager comes second only because he is breathing and talking; get him to press firmly on his own forearm with a clean cloth while you do compressions, and tell the dispatcher he needs a second crew.
2. The engine is still running and petrol is spreading towards the hot exhaust. Does that change whether you move the driver?
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Yes - this is exactly the situation in which moving a casualty is justified. The rule is that you do not move an injured person unless leaving them where they are exposes them to a greater and more immediate danger, and a fuel-fed fire next to a hot exhaust is that danger. If the fuel is reaching the engine bay or you see smoke or flame, move her: take her under the arms or by the clothing at the shoulders, keep her head and neck in line with her spine as far as you can, and drag her backwards to a point well clear of the vehicle and upwind of the spill. Then restart the assessment and continue CPR on the new spot. If the spill is not advancing and there is no smoke, leave her in place and keep working where she is, because movement carries its own risk to the spine.
3. How do you manage the teenager, and what information does the dispatcher need from you?
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The teenager: apply or direct firm direct pressure to the forearm wound with the cleanest cloth available, elevate the arm, keep him sitting and warm, and talk to him calmly in short factual sentences. Do not give him anything to eat or drink, because surgery may follow. Watch him for shock - pale, clammy skin, rapid weak pulse, restlessness - and do not let him walk back to the car to look for his mother; he will want to, and he must not see her in that state or become a second casualty on the carriageway.
The dispatcher: precise location including the direction you were travelling in, the road number or village names, that it is a single vehicle against a tree, the number of casualties and their condition, the fuel leak and the running engine, whether anyone is trapped, and your mobile number. Confirm whether they want you to stay on the line, and send someone to the far side of the bend to wave traffic down.