Injuries and fatal outcome after automobile collision is one of the most common cause of ER visit. Auto accident can cause injuries to any part of the body. Severity of injury depends on driver’s awareness of surrounding, severity of impact and physical conditions of occupants in the vehicle. Most fatal injury is head injury. Head injury may by concussion, contusion of brain or laceration of brain. Laceration of brain is most detrimental injury and may result in death or permanent brain damage. Head injury may be associated with bleeding within (cerebral bleeding) or outside brain (epidural or subdural bleeding). One of the common injuries after car accident is neck injury. Neck injury can be muscle sprain, disk bulge, disk herniation, facet joint injury or subluxation of vertebrae. Neck should be stabilized before patient is transferred from site of accident to hospital.
Auto accident may result in minor or major injuries to driver and passenger. Severity of injuries in many cases are not interconnected to obvious damage of the car. Minor automobile damage may cause severe injuries and vice-versa severe automobile damage may cause minor injuries. Minor injuries may not need any referral to ER or primary care physician. In few cases of automobile collision, injured driver and passenger may be trapped in the car for several hours. Seriously injured driver will be taken to emergency room (ER) by an ambulance as soon as possible. Patients who can ambulate and respond to questions are interviewed after initial evaluation. After initial report, driver is given a choice to drive or be driven by ambulance to primary care physician’s office or ER for further examination. Initial accident report is done by police officer. Injuries such as profuse external bleeding, abdominal trauma, internal bleeding, head injury, neck injury and compound fracture are considered serious injuries. These patients are transferred to hospital ER immediately by ambulance after initial resuscitation and airway management. Initial clinical assessment is often done by pre-med accompanying ambulance and fire truck. Patient is examined by physician in the ER and may be advised to undergo multiple investigations. ER physician will consult specialist depending on outcome of clinical examination and findings of investigation. Transfer to emergency room (ER) is always at the closest hospital.
Injured driver and passenger following accident often experience emotional and physical shock. On many occasions following accident injured driver is unable to get in touch with family members and unable to make necessary arrangement to pick their children from school or nurseries. Most of the drivers suffer with post-traumatic worries, concern, anxiety and strains. These symptoms are predominantly secondary to thoughts of future loss of income, unable to fulfill family responsibilities, possible broken automobile and additional financial burden because of loss of wages and out of pocket medical expenses. In ER further investigation are advised and 23 hours stay in observation room is considered necessary. Injured driver often fails to get in touch with spouse, family members, neighbors, friends or close relatives following accident. In many cases injured patient ignores pain and suffering and may try to go home against medical advise. If driver decides to go home with pain and sufferings to take care of family problems, insurance provider may in future try to establish that victim never had serious injury. ER documents of discharge against medical advise suggest treatment was not provided to patient and many a times future legal opinion might confirm that treatment was not indicated. Thus injury will not be considered serious as patient never had any test or treatment.
Documentation is important to established injury and necessity of treatment. Decision to go home against medical advice is also used to establish that driver went home with no impairment. Initial medical report from ER physician within few hours of accident establishes the cause of subjective pain. Also initial investigation establishes the cause of pain and injury. Few injured drivers may be treated like malingerer or drug seeking individual by adjuster of insurance companies and physicians in ER during initial interview.
There are few necessary steps that need to be taken to avoid future un-cooperation by insurance companies. Following accident it is important to establish a police report because the police report will explain the cause of accident and vehicle damage. Driver and passenger are always advised to go to emergency room for medical check up. At times, driver or passenger is transferred to ER by ambulance. Initial reaction after accident is that of anger and frustration. Injured victim should establish his pain and make sure all test are performed as advised by physician. Physician’s report should be comprehensive and complete.