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Monday, 27 December, 1999, 13:35 GMT
Surviving the crash
Car crashes are the most significant cause of serious injury
When a car collides with something solid, its contents stop in their tracks in a fraction of a second.

Accident and Emergency
In that fraction, the passengers and driver are dependent on which bits of the the interior come into contact with which parts of the body.

The advent of seatbelt legislation in the UK, combined with improved car construction, has dramatically reduced the number of seriously injured crash victims.

But the skills of trauma surgeons are still far too frequently tested to the limit.

Before they can go to work fixing smashed bones and damaged tissue, however, the paramedics and A&E doctors must ensure the short term survival of the patient.

Modern cars can withstand greater impacts
This means making sure their airways are clear and that air is being pushed in and out of their lungs, and that blood is circulating around the body.

In a road accident victim, some of the most frequent major problems are broken bones in the pelvis.

These often damage blood vessels or internal organs, leading to internal bleeding.

And often, because the broken bones are still free to move around, the blood vessels do not get the chance to clot, leading to more bleeding.

An orthopaedic surgeon is sometimes required to "stabilise the pelvis", to stop the bones moving around.

This is done with a mechano-like collection of plates and screws to hold the bones in place.

Mr Richard Rawlins, a consultant orthopaedic surgeon at Bedford Hospital, said: "We have set standards which say that this surgery should take place within six hours.

Standards not met

"We're concerned that very many hospitals can't provide that access to surgery.

"If there has been a serious road accident, you may have three or four people who need surgery."

Most of the improvements over recent years, he said, have been refinements to existing techniques, although strides forward in plastic surgery have meant far less serious scarring for patients.

However, in the future, he is hopeful that scientists currently probing the genetic structure of humans will be able to reproduce the 'glue' that allows bones to grow together naturally - which will significantly cut recovery times.

See also:

11 Oct 99 | Health
Crash victims offered counselling
02 Jun 99 | Health
Car crash medicines examined
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