What is the initial assessment and management approach for a 17-year-old car accident victim?

Initial Assessment of a 17-Year-Old Car Accident Victim

Immediately ensure scene safety, activate EMS if not already done, and perform a systematic primary survey focusing on life-threatening injuries while maintaining spinal immobilization, as adolescent motor vehicle crash victims have high rates of serious injury requiring specialized trauma care. 1

Immediate Scene Management

Safety and Help Activation

• Do not move the victim unless the area is unsafe for you or the victim 1
• If the scene is unsafe, move the victim to a safe location only if it is safe to do so 1
• Activate the EMS system immediately if not already done—do not delay emergency medical assistance 1
• Recognize that motor vehicle crashes are the leading cause of death for 16-20 year-olds, accounting for approximately 5,500 occupant fatalities annually 1

Spinal Protection

• Maintain manual spinal immobilization with stabilization of the head to minimize motion of the head, neck, and spine 2
• Assume spinal injury until proven otherwise, particularly given the mechanism of injury 1
• If the victim is face down and unresponsive, turn them face up while maintaining spinal precautions 1
• Be aware that cervical spine injuries can produce profound hypotension from loss of cardiovascular sympathetic innervation 2

Primary Survey: Life-Threatening Injuries

Airway and Breathing Assessment

• Assess for airway patency and adequate breathing 1
• If the victim has difficulty breathing due to copious secretions or vomiting, or if you must leave to get help, place in modified HAINES recovery position: extend one arm above the head, roll to side so head rests on extended arm, bend both legs to stabilize 1
• Note that chest injuries occur in about one-quarter of older adult motor vehicle crash victims and can cause respiratory failure 1

Circulation and Shock

• Assess for signs of shock and optimize hemodynamic parameters to prevent secondary injury 2
• If shock is evident without trauma contraindications, have the victim lie supine and raise feet 6-12 inches (30-45 degrees) unless this causes pain 1
• Recognize that cervical injuries may cause profound hypotension requiring immediate intervention 2

Neurological Status

• Assess level of consciousness and neurological function 2
• Look specifically for disproportionately greater motor weakness in upper extremities compared to lower extremities, which suggests Central Cord Syndrome from hyperextension injury 2
• Check for bladder dysfunction or urinary retention, common in spinal cord injuries 2

High-Risk Injury Patterns in Adolescent Crashes

Mechanism-Specific Considerations

• Recognize that 17-year-olds have crash rates approximately 5 times higher than the general driving population (20 crashes per million miles vs. 4 per million miles) 1
• Unrestrained occupants ejected from vehicles sustain injuries in reproducible patterns affecting the central nervous system, thoracic and abdominal viscera 3
• Driver vs. passenger positions produce distinct injury patterns that should guide radiographic evaluation 3

Associated Risk Factors in This Age Group

• Consider alcohol involvement: 9.9% of 9th-12th graders report driving after drinking 1
• Consider marijuana use: detected in 17% of injured drivers in some studies 1
• Males aged 15-20 have higher rates of speeding-related crashes (38% vs. 25% for females) 1

Critical Time-Sensitive Actions

Immediate Priorities

• Arrange urgent MRI if spinal cord injury is suspected, as it is the gold standard for diagnosing spinal cord contusions and compression 2
• Transfer to a specialized acute spinal cord injury center within the critical therapeutic time window if incomplete spinal cord syndrome is suspected 2
• Early surgical decompression within 24 hours is strongly recommended for incomplete spinal cord syndromes to improve neurological outcomes 2

Ongoing Monitoring

• Continue spinal immobilization during all movements and transport 2
• Monitor for deterioration in neurological status, respiratory function, or hemodynamic stability 2
• Document mechanism of injury, position in vehicle (driver vs. passenger), and use of restraints to guide evaluation 3

Common Pitfalls to Avoid

• Do not overlook serious injuries to extremities, neck, or internal organs while focusing on obvious injuries—knowledge of mechanism should prompt systematic evaluation of all at-risk areas 3
• Do not assume the victim is stable based on initial presentation—adolescents may deteriorate rapidly 2
• Do not delay transfer to specialized trauma care if serious injuries are suspected—management in specialized units reduces morbidity and mortality 2
• Do not move the victim unnecessarily, as this may worsen spinal cord injury 1, 2