50.2 Preventing trauma

Trauma—the tearing apart, burning, crushing, maiming, lacerating, and irradiating of the human frame is potentially one of the most preventable of mankind’s afflictions. Injuries are the result of accidents or of violence, either personal, communal, or international. Almost all of them could be prevented, so what we say now about the absolute importance of prevention, applies to all injuries in later pages. Common prudence would prevent most of the injuries described here.

Road accidents are a major cause of death and disability in the developing world, so that measures to prevent them are urgent. Among other things, this means: (1) Seat belts for all front and, if possible, back seat passengers also. (2) The absolute rule that nobody should ever drive after having taken any alcohol whatsoever, not even a single drink. (3) The strict enforcement of traffic regulations and the separation, where possible, of motorized traffic from pedestrians. (4) In many developing countries better driving instruction and more strictly examined driving tests are an urgent need. Most of us are much more likely to die early from trauma than from anything else, so the personal precautions in this list apply particularly to ourselves.

Accidents with agricultural machines are often gravely mutilating, especially in rural communities using such machines for the first time. Proper precautions would prevent many injuries, so would elementary preventive measures in factories. Very often the same hazard causes the same injury in a succession of patients, so always ask how an injury was caused. If it was caused by something that might injure someone else, do your best to see that the danger is removed.

Figure 50.2: ALL SET FOR TRAUMA, especially head injuries (63.1), crush injuries of the chest (65.6), and fractures of the pelvis (76.2), femur (78.4), and tibia and fibula (81.1). Adapted from a Kenyan newspaper.

Many injuries, particularly burns to children, happen at home, and these too can be prevented by simple precautions.

In many societies social disintegration is causing increasing violence. As the result, many of the injuries you see will be due to fists, teeth, bottles, knives, sticks, and bullets, many of them inflicted under the influence of drink.

No form of trauma is in such desperate need of prevention as the ’megatrauma’ from a nuclear holocaust. Many thoughtful people are now asking not if it will occur, but when it will occur. Preventing it is so important that it is considered separately in Chapter 59.

Figure 50.3: LIFTING AN INJURED PATIENT. When a shocked patient is waiting for transport, lie him as in A,—horizontal, his legs raised, and his head tilted backwards. Wrap him up for warmth, but don’t overheat him. B, lift him onto your thighs, kneel, and then slide him onto a blanket or a stretcher. If his arm is injured let it hang free. C, if both his arms are normal, lock your arms under both of his. These passers–by have no headboard to slide behind him and steady his cervical spine. Adapted from Hans Pacy with kind permission.