First on Scene
At 11:10 p.m. you are the first to arrive at a two-car collision on Maliha Road. A sedan sits sideways in lane 2 with its hazard lights off and both airbags deployed; the driver is slumped over the wheel, breathing but not responding to your voice. A young man from the second car is walking about beside the road holding his bleeding right forearm and saying his neck hurts. You can smell petrol, traffic is passing at about 100 km/h, the street lighting is poor, and your phone battery is at 12%. The nearest hospital is 20 minutes away and you are alone.
1. What do you do in the first minute, in order, and why in that order?
Read the worked answer
Priority order: protect the scene, then call for help, then treat.
- Do not become a casualty. Park well before the wreck, off the carriageway if possible, hazards on, headlights on.
- Warn the traffic. Place your warning triangle a safe distance back along the road (further than usual, because approach speeds are around 100 km/h and lighting is poor). Do not stand in a live lane at any point.
- Call 999 immediately - phone battery at 12% makes this urgent. Give: road name and direction, nearest landmark, number of vehicles and casualties, that one driver is unresponsive, that there is a petrol smell, and that a lane is blocked. Ask them to stay on the line.
- Stop the walking casualty from wandering. He is mobile, which tempts people to leave him be, but he has neck pain and is walking in traffic beside a fuel spill.
Scene safety and a call for resources come before hands-on care. A second collision caused by an unmarked wreck is the classic way a two-car crash becomes a multi-casualty one.
2. How do you manage the unresponsive driver, and what must you not do?
Read the worked answer
Assess and support; do not extract.
- Check responsiveness and breathing. He is breathing, which is the key finding - he has an airway and circulation.
- Do not remove him from the car. Mechanism (deployed airbags, sideways impact) makes spinal injury likely, and moving a casualty without need risks converting a stable injury into a permanent one. The exceptions are fire, an immediate risk of being struck, or a casualty who is not breathing and must be removed to be resuscitated.
- Support the head and neck in the position found, and keep him still.
- Switch off the ignition if you can reach it safely and put the car in park - a fuel smell plus a running engine is an unnecessary ignition source.
- Monitor continuously: breathing can deteriorate. If breathing stops, that changes the plan entirely.
- Keep him warm and keep talking calmly; do not give food or drink.
The petrol smell does not, by itself, justify dragging a breathing casualty out of the car - but it does mean you stay alert to fire and are ready to move him only if that becomes the greater danger.
3. The young man is bleeding from the forearm and complaining of neck pain. What do you do for him, and what do you say?
Read the worked answer
Stop the movement first, then control the bleeding.
- Get him out of the traffic and seated at a safe distance from the wreck and the fuel spill - not standing beside the lane.
- Support his head and neck and ask him to keep still and not turn to look at the other car. Neck pain after a collision is treated as a spinal injury until proven otherwise; walking around is the worst thing he can do.
- Apply direct pressure to the forearm wound with the cleanest cloth available, firmly and continuously. Do not lift the cloth to check every few seconds; add another layer on top if it soaks through.
- Keep him talking and reassure him. Calm, still casualties deteriorate less than ones who are moving and agitated.
- Hand over clearly to the paramedics: time of the collision, that he was walking after impact, that he reports neck pain, and what you did and when.
Bleeding control is simple, teachable and buys time. Preventing unnecessary movement buys a spine.