Transportation injuries. Dr. Ravi Nanayakkara. Transportation injuries. Road traffic injuries Railway injuries Aircraft Fatalities Navigational Injuries. Objectives. Discuss the role of a judicial medical officer in a case of road traffic accidents
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Transportation injuries Dr. Ravi Nanayakkara
Transportation injuries. • Road traffic injuries • Railway injuries • Aircraft Fatalities • Navigational Injuries
Objectives • Discuss the role of a judicial medical officer in a case of road traffic accidents • Describe the injury pattern of each road user • Medico – legal investigation of a death due to transportation injuries • Describe the injury pattern in victims of train accidents
Road Traffic Injuries • 17thAugust 1896 in London, Continued…..
The World's First Death by Motor Vehicle • On 17th August 1896, Bridget Driscoll, a 44 year old mother of two, became the first person ever killed by a motor vehicle. She and her teenage daughter were on their way to see a dance performance at Crystal palace in London. She was struck by a car as they crossed palace grounds. Witness said the car was going “at tremendous speed”. It may have been going at 8 miles/h (12.8 Km/h), though it was meant to be going no more than 4 miles/h (6.4 Km/h). A young man driving, giving free rides to demonstrate the new invention and , according to some, trying to impress a young female passenger. At the inquest, the coroner said, “This must never happen again”. Source: World’s first road death. London, Roadpeace. (http://www.roadpeace.org/articles/worldfirstdeath.html) -accessed on 11th December 2003.
Every day more than 3000 people die of RTA • 1.2 million died from RTA, Over 70 % - age less than 45 • 2.1% of all global deaths - 11th leading cause of global deaths
Global burden of disease and injuries 1990 rank for RTA 9th2020 rank for RTA 3rd • 50 million people injured each year. • 85% deaths due to RTA are in Low income & Middle income countries.
Top 10 Leading Contributors to the Global Burden of Disease* 1990 Disease or Injury 2020 Disease or injury Ischaemic heart disease Unipolar major depression Road traffic injuries Cerebrovascular disease COPD Lower res. tract infections Tuberculosis War Diarrhoeal disease HIV continued….. • Lower res. tract infections • Diarrhoeal disease • Perinatal conditions • Unipolar major depression • Ischaemic heart disease • Cerebrovascular disease • Tuberculosis • Measles • Road traffic injuries • Congenital abnormalities
Every hour 34 RTI deaths take place in South East Asia. • By 2020 this will rise by 144 % compared to 2000. • Every second six persons across the world either die or suffer severe injuries due to RTI
Sri Lanka 2009 • Every hour at least 6 road crashes • 3 injured every hour - 1 killed every 4 1/2hours 6 per day • 33302 lives lost last 20 years - 1538 per year • Each death costs US$ 1912 (60 times monthly per capita income of US$ 33)
Sri Lanka Road traffic deaths • - 2500 deaths • - 2400 deaths • - 2900 deaths
Why should we know about transportation injuries? • To assess injuries for the purpose of treatment. • To evaluate the role of natural disease in the causation of accidents. • To reconstruct the accident.
4. To collaborate, evidence of eyewitnesses. 5. To assist in identification of the vehicle. 6. To predict the state of the person involved in the accident. E.g. drunk or drugged. 7. Identification of the victim.
8. Documentation of injuries for the purpose of compensation claims. 9. To determine the cause of death. 10. To evaluate the circumstances of death. • Homicide? • Suicide? • Accidental?
Factors affecting the outcome of a RTA • Road + Environment • Vehicle • Human Factors of the road user • Driver • Pedestrian
Road +Environment • Road Density ( Vehicle population on the road ) • Condition Bends, narrow, Steep, Slippery, Pit holes • Environment Night, rain, mist, fog, Snow, Sandstones, Smog, Poor lighting at night etc.)
Vehicle • Speed • Condition (whether road - worthy!) E.g. Absence of breaks Head lamps Horn Signal etc. Continued……
Safety devices • They do not reduce the number of accidents, though will reduce the fatality rate and morbidity. E.g. Seat Belt Head Rests Crash Helmets (in motor - cyclist) Collapsible steering wheels Safety Windscreen glass Breaking system (ABS) Air Bags Locking system etc.
Human factors (Commonest cause in Sri Lanka) • Driver a) General Health Old age Poor vision Poor hearing Prolong reaction time Co-morbid factors such as HTN, DM, IHD etc. Continued………
b. ) Alcohol Consumption/Intoxication • Alcohol is incriminated for > l/3 of all RTA • Legal Limit < 80 mg / dl in Blood
c) Fatigue • DROWSINESS • TIREDNESS • LACK OF ALERTNESS • SLEEPINESS • Taking more risks • Frequent yawning, nodding, blinking • Disinterest in carrying on a conversation
FATIGUE RELATED TRAFFIC ACCIDENTS Common examples: Pilgrimages Airport drops Weddings Holidaymakers Taxi drivers Long distance bus drivers Van drivers
FATIGUE RELATED TRAFFIC ACCIDENTS Alcohol Fatigue • Particular group Every driver • Measurable No tests • Preventable No warning • Curable Very few treatable
Pedestrians • Intoxicated (Alcohol, Drugs) • Impaired Vision / Hearing • Incapacitation due to, • Extremes of age. • Illness • Injuries • Breech of road rules
Road traffic injuries • Pedestrians • Car / Vehicle drivers and occupants • Motor cycle users • Pedal cycle users • Three wheeler drivers and occupants • Others - Heavy vehicles, Tractors • Bullock carts and hand carts users
Pedestrian injuries. • The commonest RTA fatalities • How ? • Towards vehicle • Opposite Direction • Crossing the road Continued……
Nature and severity depend on, 1. Nature of the vehicle (car/ van/ bus etc. ) • Height of the vehicle. • Below the centre of the gravity of the victim • Above the centre of the gravity of the victim • Type of the vehicle (Heavy lorry, van…) • Speed of the vehicle. • Nature of the striking surface of the vehicle.
2. Victim • Orientation of the victim. • Height of the victim (Centre of gravity). • Personal factors. • Movements after impact (thrown on to path of moving vehicle)
3. Road surface • Nature of the surface • Objects – stationary / moving
Injuries. 1. Impact injuries • Primary impact • Secondary impact 2. Secondary injuries 3. Tertiary injuries • Run over injuries • Run under injuries • Drag injuries
Primary impact injuries • As a result of first contact with the vehicle.
Types of injuries • Imprint abrasions • Lacerations • Fractures • Contusions
Area of the body Knee level Thigh Hip Elbow Shoulder Chest or head
When the impact is below the center of gravity E.g. Car • Primary impact at knee level • Bumper fractures occur at 14 MPH in young adults. • Victim is scooped up • Secondary impact injuries. • Speed > 25km/h
Secondary impact injuries (not a must) • Small cut injuries due to shattered windscreen glass • Skull fracture • Rib fracture • Lacerations • contusions
When the Impact is above the center of gravity E.g. Van, Bus • Injuries to pelvis, abdomen, arms, head • Victim may be projected forward ( forward projection ) or run over.
Secondary injuries • As a result of victim falling on the ground after the Primary or Secondary impact. • Found in impact with any vehicle. • Are often more lethal, esp. to head, chest, pelvis Distance thrown : Throw distance Continued…..
Depends on, • Force of the fall. • Nature of the object struck. • Injuries, • Grazed abrasions • Contusions • Lacerations • Fractures • Contre-coup injuries to the brain • Internal injuries
Run over injuries • A wheel passes over the body • Chest and abdomen - tire marks imprinted • Limbs , • Tears of skin& muscles • De-gloving injuries Continued…….
Features, • Clothes - Tire marks, grease, oil • Skin - Tire marks - Flattening of affected area - Soft tissue ooze • Crushing and degloving of limbs • Multiple fractures. • Internal injuries
Run under injuries • Vehicle goes over the body but no run over by tires • Body gets pinned between under surface of the vehicle & road • Any type of fracture, crush injuries
Drag injuries • Victim gets entangled and dragged along the road • Grazed abrasions with mud and dirt from road.
Injuries to vehicle occupants • 80% are frontal impacts – with another vehicle or object Severe deceleration • Less commonly vehicle is hit from behind Acceleration • Side impacts • Roll over