18.1: Trauma in Road Traffic Accidents

Trauma Sustained by Pedestrians

• Primary Impact Injuries: When a moving vehicle hits a person walking along the street, parts of the vehicle will come into forceful contact with the body of the pedestrian during the impact.

  • These produce patterned injuries and these constitute the primary impact injuries.

• Secondary Impact Injuries: These occurs after the primary impact.

  • After the primary impact, if the initial blow lies below the center of gravity of the person – which is the umbilicus – the feet of the victim slide away and the whole body is lifted forcibly off the ground and thrown onto the vehicle into its path of movement.

• Tertiary Impact Injuries: These injuries arise when the victim’s body then strikes the ground after the secondary impact.

  • Head injuries are the most common injuries of this group and death may be a result of the later ground-impact injuries.

  • Tire marks may be seen on the body if he or she is run over and if the thread of the tires is not worn out.

Trauma Sustained by Cyclist

• The injuries will be similar to those sustained by the pedestrian, but the primary impact will be usually against some part of the cycle or motorcycle.

• Secondary impact and tertiary injuries are more severe.

Trauma Sustained by Occupants of Vehicles

• During a collision, the occupants of a speeding vehicle will sustain different types of injuries on various parts of the body depending upon the force of deceleration and position in the vehicle.

• The driver may sustain an impact on to the front of the chest against the steering column, especially the horn boss resulting in several fractures of the ribs and sternum, contusions and lacerations to the lungs and heart. The head may strike against the windshield producing a head injury.

• The front seat occupants can sustain head and chest injuries by striking the windshield and dashboard.

• The back seat occupants can sustain head and chest injuries by striking the front seat.

18.2: Railway Disaster Trauma

• Collision and Derailment Trauma

  • The victim may show injuries to the head, spine, and legs similar to those found in automobile accidents.

  • Persons sleeping on bunks may be thrown forward and may sustain dislocation or fractures of the vertebral column.

  • Broken fragments of the carriage may produce penetrating injuries.

• Falling from a Speeding Train

  • The victim may sustain multiple injuries of different types in various parts of the body.

  • The bodies will be recovered from the outside of the track unless the victim fell in between the carriages.

• Hit by a Speeding Train: A speeding train will hit the victim while crossing the track or walking along the railway line or jumping in front of it.

18.3: Air Disaster Trauma

1. Crash Accident Injuries

   • During landing or take-off, the passengers are secured to their seats by seat belts.

   • The forward momentum developed due to crashing pushes the head and torso of the passenger onto the backrest/back of the seat in front and results in various injuries such as:

     • Fractures of the skull, cervical vertebrae

     • Laceration of abdominal viscera

     • Laceration of abdominal major blood vessels

     • Burn Injuries

2. Flight Accident Injuries

   • The flight cabins are usually pressurized to prevent anoxia.

   • If a door or window breaks, the pressure inside the cabin drops and results in anoxia leading to death.

   • The air that gets sucked out on such occasions can blow away the passengers from cabins tearing them into pieces.

18.4: Intoxication

• In all transportation incidents, it is essential to exclude intoxication with alcohol, medicinal compounds such as antidepressants, hypnotics, and antipsychotic drugs, and the illicit use of drugs.

• No transportation death investigation, including aircraft crashes, is completed without an examination of the victim’s blood and urine for such compounds.

• Drivers of any vehicles involved in such accidents should also be tested for alcohol and other drugs.