Objective: The aim of the study was to use the Haddon matrix to analyse crash and injury mechanisms in a severe coach crash, to investigate if a safety belt would have reduced injuries, and highlight the triage problem in a mass casualty situation during severe circumstances. Methods: A specific coach crash was chosen as the subject for the case study. All 34 occupants on board were interviewed about the crash, their injuries, and how they sustained their injuries. Medical records concerning ambulance and hospital treatment have been examined. Police reports and other documents concerning the vehicle, weather conditions and the road have been examined. The materials were structured in different cells according to Haddon's matrix. Results: The coach went off a road via a guard-rail and landed on the right side, in a 90° position right across a small river. The main reason for the coach to deviate from the road was strong and gusty side winds imposing lateral forces on the coach, making steering impossible. The impact from the crash was greatest in the front part of the coach, as this part fell 3 metres from the bridge guard-rail down to the river bank. The most frequent injury mechanism was that occupants were hit by other falling occupants. Most occupants would have benefited from having worn seat belts. Ten ambulances and one helicopter from different locations were called upon and the first ambulance arrived 30 minutes after the alarm (a 67-km drive). The helicopter, with an anaesthetist on board, arrived after 1 hour and 20 minutes (a 120-km flight). Nine occupants with moderate injuries and 10 seriously or severely injured occupants were transported by ambulance or helicopter to the hospital. Fifteen occupants, triaged as priority 3, were transported by a chartered coach to hospital where they arrived after about 3 hours. Conclusion: If 100% of the occupants had used a two-point belt, about two-thirds of the injured occupants with MAIS 2+ injuries would have sustained an injury reduction. A further injury reduction by roughly 20% could have been achieved by shifting from two-point belts to three-point belts. Triage of injured occupants could be different from normal practice because of the limited space inside a coach, and the use of ordinary equipment is not always possible inside a crashed vehicle. The fact that most of the side windows remained in position after the crash probably prevented many occupants from serious and fatal injuries caused by ejection or partial ejection.
The crash took place on Friday, 24 January 2003. Due to technical problems, a train was cancelled in Ludvika, a village in central Sweden. A replacement coach was to transport the passengers 115 km to Vsters, via the same route. In darkness, at 4.23 pm, i.e. during working hours, the coach went off the road on a left-hand curve. The driver reduced the speed to 49 km/h before the curve, but lost control of the coach, which skidded off the road, down a high road bank and landed on its right side. The coach's structural damage was mainly located on the right side. Of the 49 occupants, 11 were partially or totally ejected, and 6 were fatally injured. Forty occupants had injuries classified as ISS 1-15, three as ISS 16-30 and six as ISS 41-75. All those in the last group sustained fatal injuries.
Objectives: The aim of this study was to examine, during field conditions, what impact additional insulation on a spine board would have on thermoregulation.
Method: The study was conducted outdoors, under field conditions in February in the north of Sweden. The subjects, all wearing standardised clothing, were immobilised on uninsulated (n=10) or insulated spine boards (n=9). Tympanic temperature as well as the subjects’ estimated sensation of cold and their estimated level of shivering were measured at five minute intervals during the trial. Statistical analysis of the data gathered for the first 55 minutes was performed.
Results: There were no differences between the two groups regarding reduction in body core temperature or cold discomfort. There was, however, a statistically significant increase in estimated shivering for the subjects placed on uninsulated spine boards.
Conclusion: Additional insulation on a spine board by the means of an insulation mat rendered a significantly reduced need for shivering in a cold environment. This is an effect that could be of great importance during protracted evacuations of injured, ill or otherwise compromised patients. In the light of these results we conclude that spine boards, as well as other materials used for prehospital transportation of patients in cold environments, should be well insulated. This is a measure that could be accomplished by such simple means as using an additional insulation mat.