#mvas

Welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends. 

Today we’ll be talking about Car Crashes and the trajectories the occupants can go: Up and Over and Down and Under. 

For the rest of the Mangled Mondays series, [click here].

Car Crash: Up-And-Over

Lethality Index

5

What Is It?

This is less a specific injury than it is an injury pattern.

In a frontal car crash, an unrestrained character has two directions they can go: up and over the dashboard, or down and under it.

An up-and-over pathway means that the character is launched, facefirst, toward the windshield.

  The resulting chain of impacts is dangerous and very often lethal. The characters can expect significant trauma to the head, the face, the neck, the back, the shoulders, and the arms; it’s possible that they’ll suffer trauma to the pelvis as well.

The head injury tends to produce some form of traumatic brain injury, and may cause enough trauma to be instantly lethal.

In addition to deforming and crushing, the head tends to twist a little in response to the impact with the windshield, and a large part of the force is also transmitted backward into the neck. The resulting turn and compression forces can cause compression fractures of the neck anywhere between the base of the skull and the top thoracic vertebra (T1). If the fracture is high and transects the spinal cord, this is a lethal injury; if the fracture is low enough, the character may be paralyzed below midchest.

Modern automotive glass…

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I’m gonna say “not so helpful.” 

The thing about airbags is that they’re anchored in place. The mylar balloon is going to move around when your character hits it, rather than simply stay where it is and get smooshed. Also, I really, really want to not be in that car if that balloon pops. 

However, just because it doesn’t actually prevent an injury, doesn’t mean it isn’t comical as hell. Use it for the visual and go from there :) Seat belts still save lives, so make sure the character is buckled up! 

xoxo, Aunt Scripty

Hey there nonny! Thanks for the ask. By the language “road accident” I’m assuming you’re from the UK, or someplace outside the US; this is based on a US medic’s training and experience, but it should be very similar. 

The first thing the paramedic thinks of isn’t actually the patient. A paramedic’s first thought working a road accident – we call them MVAs in my area, Motor Vehicle Accidents – is, Am I safe? Busy highways don’t stop, lonely night roads are prone to coming around turns at high speeds and plowing into emergency vehicles, and drunk drivers actually veer towards flashing lights. Paramedics die at MVA scenes. This is partially mitigated by where and how the characters park the ambulance, but in a lot of areas it’s a fly car that arrives first, not an ambulance. 

Next is, how many patients? Most crashes involve two cars, which implies at least two patients; even a single car can now have 6 or 7 people inside. Is anyone dead? Who’s injured the worst? 

So the first patient-oriented step is to count the number of cars and the number of people and try and get a picture of how the accident happened. Was it a T-bone? A solo crash into a tree? Did they go off an embankment? What additional resources do I need to do the job? Can I get all of these people out of this car, or do I need resources to extricate one or more of them? Does the car have airbags? 

Let’s focus on an individual patient-character for a moment. We’ll call him…. Billy. Billy Badbones. 

Where was Billy in the car when it crashed? Where is he now? (Unrestrained passengers from the back seat have been known to wind up under the front seat, or to go over the front seat and kill the belted driver and passenger with their bodies.) Is Billy awake? Can Billy get out of the car on his own? 

MVAs are all about speed – kinetic energy = mass x (velocity ^2) – so it’s really important to get a solid understanding of the speeds of the vehicles involved. Head-on collisions are the worst, because the speed of both vehicles becomes the total; if each car is going at 50mph, then the head-to-head is a 100mph collision.  

Now, back to Billy. Paramedics have three main concerns: airway, breathing, and circulation. (More recent course-takers will remember this with circulation first, but I am An Old™ and I remember it “the old way.”) 

Is Billy awake? If not, does he wake up to painful stimuli? Can he follow commands? Either “no” is a bad sign. 

Is Billy’s airway clear? If not, suction it out and pull out the teeth sitting in there. 

Is he breathing properly? Is his chest wall intact? Is there anything to seal or stabilize, like a flair chest or a sucking chest wound? Does he need artificial ventilation – do I need to breathe for him? 

Is he bleeding from anywhere? Is he circulating enough blood to have strong pulses? Keep him warm and elevate his feet if he’s shocky. 

That whole assessment should take under 5 minutes. Once he’s been packaged and put in the ambulance, then you can get a better assessment of him. 

Of course, if Billy isn’t severely injured, we may still keep these in our mind, but the approach will be much more casual. “Hello, sir. Can you step out of the car and come over to the ambulance with me?” 

Once all that has been established, Billy will get a thorough checking-over: palpation of the head, checking for blood from the ears, seeing if his trachea is midline, palpation of the bones of the chest wall, a neurological assesment of all four extremities, ….. 

One last word of thought. A paramedic’s ultimate priority is, what will kill my patient first? If Billy’s got two broken lower legs and a penetrating chest wound, I honestly don’t care about his legs – not until I’ve stabilized  his chest. Once each thing that can kill Billy has been mitigated, then I can worry about his legs. Does that makes sense? 

I hope this was helpful to you! 

xoxo, Aunt Scripty

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Hey there nonny! Yeah, I’d buy this in a story. A seatbelt injury over the liver or spleen could definitely cause this kind of delayed collapse. She might feel dizzy or just crappy, and might get pretty pale before she collapses, but this is certainly a plausible scenario!

Best of luck! 

xoxo, Aunt Scripty

(2) MC's father's funeral will kind of depend on her recovery time.  I understand that due to the severity and possible complications of her injuries, MC will likely be in the hospital for a good while.  So this ask is actually a few questions.  One: how long will MC's total in-patient hospital time likely be?  Two: Do you think (if she was doing well, circumstances considered) her doctors would allow her to leave hospital and go to her dad's funeral for a couple hours?  If so, would they (3) probably send a health professional with her for the time that she is out of hospital?  Funerals are sometimes delayed for 2-3 weeks, so that would probably be the time range on her recovery.   Thank you so much!  I'm sorry for the long ask.

Hey there flippy!  I am going to break your heart. No, your character is probably not going to this funeral, even if it’s delayed.

Look, first of all, if she’s in a coma -- especially if she’s in a “medically induced” coma (sedated) -- she’s in pretty bad shape. With the injuries you describe all complicating each other, and the other things you didn’t mention that are likely to result (things like severe blood loss and anemia, and the potential complications of the ICU stay she’ll have), I would expect her to spend at least 1-2 weeks in the ICU, much less the months of rehabilitation she’ll likely have (in the hospital and likely in a nursing or rehab facility).

The neurological components alone are drastic and life-altering. Also, hospitals do not, as a general rule, send people out with patients to attend funerals, though I’ve heard of them getting an ambulance and having the crew take her there and then take her back.

The only way to get her to this funeral is to reduce the drastic nature of her injuries. The easiest way to do this is to have her and her father be in two totally different situations with regards to the crash: she’s seatbelted, he’s not. He could die from being ejected from the vehicle, but her injuries could be drastically less because she was wearing her seat belt.

I can see only two outcomes for this story you’re writing: If you want the injuries, lose the funeral. If you want the funeral, reduce the injuries.

Sorry to burst your bubble, flippy. Forgiveness?

xoxo, Aunt Scripty

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