Search

A lateral radiograph of the cervical spine was obtained for 174 of the 207 persons killed in road crashes in Adelaide, South Australia, during the 12-month period of June 1, 1987 to May 31, 1988. Of the total of 57 cases of cervical injury, routine postmortem examination identified 30 cases (52.6%), and the radiographic examinations identified 51 cases (89.5%). In the cases where it was performed, radiography identified 96.2% of injuries. One-half of injuries of level C3 and above were not reported at postmortem examination, compared with 22% of those occurring below this level. This finding correlates with the physical difficulties of examining the upper part of the cervical spine. This study has shown that lateral cervical radiography is a simple and effective method of more accurately identifying significant cervical spinal injuries, thus improving greatly the value of postmortem examinations in determining the patterns and mechanisms of these injuries.

A survey of tow truck services operating in a defined area of the south-east suburbs of Melbourne was undertaken to determine their potential for delivering emergency medical care at the scene of crashes. Most towing firms have an association with a panel-beating shop, and operate within a limited area of one to three miles radius. The rapid response of tow trucks to crash scenes is due to their well-developed intelligence network of "spotters" and the short distances the trucks travel. Very little first aid is provided by the drivers, although one-fifth had some first aid training at some time. In about one-half of the calls to crashes a damaged vehicle is still at the scene, in about 20% an ambulance is called, and in about 5% a hospital admission occurs. Direct observation of 22 crashes suggests that on average, tow trucks arrive at a crash scene five minutes before the ambulance, and fifteen minutes before the police. There is a good case for making first aid training a preerequisite for issue of a tow truck operator's license.

This study has demonstrated that activity sampling is a practical and sensitive method of analysing the general practitioner's task. The data so gathered can be used in planning and devising innovations in practice management, in planning and evaluating the use of allied health professionals for non- diagnostic tasks, for assisting in the definition of objectives for medical education more clearly, and finally, when the appropriate indices have been developed, for evaluating the quality of care provided.

The records of all cases of injury to the cervical spine sustained in road crashes for the 6 year period (1 January 1981 to 31 December 1986) which were admitted to the Spinal Injuries Unit of the Royal Adelaide Hospital, to the Adelaide Children's Hospital, or were identified at post-mortem examination were examined, and the relevant data extracted. There were 291 cases in the non-fatal group, and 161 in the fatal group. These represent a complete enumeration of all such patients in the state of South Australia over the 6 year period, given that up to 50% of cervical injuries in fatal cases can be missed. Comparison of the two groups showed that the fatal group had a much higher proportion of pedestrians, and persons over 50 years of age. About one-half of the fatal group had injuries at the level of C1 or the atlanto-occipital articulation. The most frequent level of injury in the non-fatal group was C2 (29.2%). About 30% of the non-fatal cases had some spinal cord damage. Case fatality rates were calculated, and ranged from 100% for injury at the atlanto-occipital articulation to 8% at C2. The fatality rate of pedestrians was about 4 times higher than that of vehicle occupants. About three-quarters of all cervical spine injuries occurred in vehicle occupants. There was an increase in the number of cases occurring in each year of the period studied. This rise was noted in non-fatal cases, in males, in vehicle occupants, and in crashes in the country.