Before you cut that seat belt at an accident scene ask yourself it there a need to release the patient or are you jumping the gun. Seat belts are well known for saving lives and preventing serious injury during a motor vehicle collision. Originally introduced to automobiles decades ago, seatbelts are designed as a safety device to prevent occupants from being thrown against the interior of or fully ejected from a motor vehicle.
Here is what the professionals in Tri Services know and can show to you the worker and what you should be thinking about first aid and seatbelts on scene.
When the term the “Golden Hour” was first introduced in 1961 by R. Adams Cowley, rescue services tended to believe that it referred to the period from arriving on the scene to putting the casualty in the ambulance, rather than “crash to knife” time. The concept of the “Platinum Ten Minutes” was then proposed as an ideal for the on scene time, as it was realized that time had to be allowed for transit and emergency department assessment. Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed “the seat belt syndrome”.
The “Platinum Ten Minutes” has placed considerable pressures upon the emergency services to reduce the time taken to extricate casualties from wrecked vehicles. Increasing awareness of the way in which poor handling affects the casualty, increasing concerns about safe working practice, increasing sophistication in vehicle design, and improvements in rescue tools.
Bruising of the anterior abdominal wall is suggested to be due to the belt acting as a fulcrum on the soft muscles of the abdominal wall. It may sometimes result in a complete cut of these muscles, which happened in our second patient. Injury to abdominal viscera has been attributed to compression between the belt and the vertebral column, and the intestinal ischemia is primarily due to mesenteric tears .
Mesenteric tears usually occur due to the shearing force applied on the mesentery, which happens while the movable intestines continue moving with the same speed of the car, although the car is decelerated by the act of the brakes (described in physics as the inertia) . These tears can be so trivial that a frank intestinal ischemia would not be apparent immediately.
In all crashes, there are the same stages of the rescue: (a) establishment of scene safety and contact with the casualty to ensure airway control and protection of the cervical spine; stabilisation of the vehicle and glass management; gaining of entry to the vehicle and continuing stabilisation of the casualty; and (d) space creation to provide casualty extrication. Despite their effectiveness in preventing occupant ejection, serious injury and death following a motor vehicle collision, it became apparent some time ago that seat belts may actually cause injury, including Cauda Equina Syndrome (CES). This syndrome, though rare, can be a serious condition resulting in permanent and disabling conditions, and typically involves a large, space-occupying lesion affecting the bundle of nerve roots (cauda equina, or “horse tail”) at the lower end of the lumbar spine. The nerves which make up the cauda equina transmit and receive messages from the pelvic organs and lower extremities.
The most common causes of CES include trauma-related lumbar disk herniation, spinal canal stenosis, a spinal lesion, inflammation, hemorrhage or fracture of the lumbar spine, as well as non-trauma related causes such as tumors or birth defect involving abnormal connection between blood vessels (arteriovenous malformation).
Cauda Equina Syndrome is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. Full-blown CES includes urinary retention, saddle numbness of the perineum, bilateral lower extremity pain, numbness, and weakness. Physical exam findings consistent with CES include hyperactive reflexes in the lower extremities and positive Valsalva test. Nerve conduction velocity (NCV) and electromyography (EMG) testing of the lower extremities may demonstrate nerve root irritation, while CT and MRI imaging can reveal compressions of the spinal cord.
Cauda Equina Syndrome is a serious condition which can result in permanent paralysis, impaired bladder and/or bowel control, and/or loss of sexual sensation. Patients diagnosed with CES need urgent medical attention and surgery may be required immediately involving surgical decompression of the spinal canal. Prognosis for Cauda Equina Syndrome is dependent on a number of factors, including the degree of nerve damage, how quickly following injury the nerve root is decompressed, and the length of the delay in having the condition properly and fully evaluated.
A “snatch rescue” may be little more than a controlled pull from the wreckage, or it may be the use of hydraulic spreaders to give space to breathe to a crushed victim, or it may even be use of a hydraulic cutting tool to amputate a foot to release the casualty when fire cannot be controlled. The “snatch rescue” is only rarely required.
Seat belts protect people from needless death and injury. But whether it is because they are in a hurry, distracted, or they simply forget, many people don’t wear their seat belts, and thousands die as a result. Wearing a Seat Belt Correctly
In order to wear a seat belt safely, the following points should be adhered to:
- The belt should be worn as tight as possible, with no slack
- The lap belt should go over the pelvic region, not the stomach
- The diagonal strap should rest over the shoulder, not the neck
- Nothing should obstruct the smooth movement of the belt by trapping it
In many vehicles, the height of the top of the seat belt can be adjusted on the B-pillar. If you cannot get the seat belt to fit over you correctly, as described above, you should try adjusting the height.
Damaged Seat Belts
Seat belts should be regularly checked for damage. Common forms of damage to the seat belt that will reduce its effectiveness in an accident, and also lead to the vehicle failing an MOT/DOT test, are:
- Fraying or fluffing around the edges of the seat belt
- A cut which causes the fabric to split
- A hole in the seat belt
- Damage to the buckle
In an accident, the webbing of a seat belt stretches, which absorbs some of the energy in an impact. This helps prevent any injury from the contact between the seat belt and occupant. A seat belt that has restrained an occupant in an accident would be more likely to cause an occupant injury if it were involved in another accident, and must always be replaced.
If any forces are applied to a seat belt, which are larger than would be expected during its usual operational life, it may also be worth having it checked to see if the webbing of the belt has been strained.
If in doubt, take your car to a garage to have the belt inspected by an expert.
Pregnant Women and Seat Belts
All pregnant women must wear seat belts by law when travelling in cars. This applies to both front and back seats and pregnancy does not in itself automatically provide exemption from the law.
The safest way for pregnant women to wear a seat belt is:
- Place the diagonal strap between the breasts (over the breastbone) with the strap resting over the shoulder, not the neck
- Place the lap belt flat on the thighs, fitting comfortably beneath the enlarged abdomen, and over the pelvis not the bump
- The belt should be worn as tight as possible.
In this way the forces applied in a sudden impact can be absorbed by the body’s frame.
Pregnant women should not wear ‘Lap-only-Belts’ as they have been shown to cause grave injuries to unborn children in the event of sudden deceleration. Mother and unborn child are both safer in a collision if a lap and diagonal seat belt is being worn correctly.
Kids (babies) and seat belts
The webbing-pinch test
If you’d like to see for yourself how loose a puffy coat can make a child’s retraints, do this simple test on the next cold day. Put your child in his or her puffy jacket and strap them in to their car seat. Tighten the straps like you usually would. Now release the straps, take the child out and the coat off. Set the child back in the seat and see for yourself how loose the extra padding makes the straps.
“As many as three out of four car seats are installed improperly.”
Keep a blanket in the car
Fine and well, you might say. My child will be safer in an accident with his coat off. But what if he freezes without that coat? The solution is simple, Auriemma said. Just tuck the coat around your child outside the cinched seat belts. You may also keep a blanket in the car for this reason. Or better yet, bring a warm one in from the house! You can also have the child already in thin, heat-containing layers before that big coat goes on.
Of course, it’s easier to type those words than take a warm coat off your child just as you put her in a car that hasn’t warmed up yet on a cold January morning. Just consider the brief discomfort an investment in the safety of your child should you meet with an accident on the road.
Most car seats are not put in right
Speaking of car seats, that puffy coat isn’t the only barrier to them functioning right. Sadly, as many as three out of four car seats are installed improperly, according to federal statistics. Many public service agencies like your fire department offer a free service of showing you how to put a car seat in correctly. Just stop by your local station house and ask. If they don’t have such a program, the firefighters will know where to point you.
Although lap belts are not recommended for pregnant women, they are safe and suitable for other adult passengers. Three-point seat belts are safer, but wearing a lap belt is far better than wearing no seat belt at all, because the greatest risk of injury to car occupants in an accident comes from being thrown about inside the vehicle or being ejected from it.
The lap belt should go over the pelvis (not the soft stomach area) and fit as tightly as possible. Most car manufacturers now fit at least some of their range with a three-point seat belt in the centre of the rear seat.
Seat Belt Adjustment
Several devices exist which are designed to attach to the seat belts in order to pull them into a different position or change the way in which they rest on an occupant. P bar Y Safety Consultants do not recommend the use of these devices, as no standards currently exist ensuring a basic crashworthiness.