TRANSPORTATION INJURIES
MUDr. Kateřina Stoklásková
pedestrians
bicycles
motorcycles
cars
light vans under 1.5 tons
trucks
buses
trains
airplanes
…
frontal (60-80 %)
rear
lateral
roll-overs
…

•transportation injuries are the most common cause of death below the age of 50 years in developed
countries
•
•tissue injuries are caused by a change of rate of movement – acceleration or deceleration
(measured in ‘G forces’)
•

Injuries to pedestrians
•injuries are caused by acceleration (as opposed to injuries to vehicle occupants, which are caused
by deceleration)
•
•primary injuries are caused by the first impact of the vehicle on the victim- usually legs and
hips
•secondary injuries are caused by subsequent contact with the ground

Injuries to pedestrians
•depending on the profile of the front of the car, the struck pedestrian is either thrown forwards
in the direction of travel if the bonnet-front is high and blunt, or scooped up onto the bonnet
top, as with many slope-fronted modern vehicles
–if thrown forward, secondary injuries will be suffered as a result of striking the ground, the
body can be run over by the vehicle
–if the impact is on the front corner of the car, the pedestrian may be knocked diagonally out of
the path of the car and can be run over by a different vehicle overtaking in another lane or coming
in the opposite direction
–if scooped up, the victim will land on either the bonnet or against the windscreen or
corner-supporting pillar (the A-frame)
–scooping-up can occur at speeds as low as 23 km/hour, pedestrian may then fall off sideways or
when the speed is higher may be thrown over the roof, if the driver applies the brakes violently
the body may slide off in front of the car
–in a high-speed impact (over 50 km/hour) the body can be flung high in the air
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•

Injuries to pedestrians
•child victims
–the primary contact is higher up their body, so they tend to be hit forwards rather than rotated
upwards
–they tend to be projected further by impact and may be hurled in the air at lower speeds compared
to adults
–they are more prone to be run over by reversing vehicles
–
•larger vehicles (van, truck, bus)
–the initial point of impact is higher
–because of the flat profile there is no scooping-up effect and the victim is usually projected
forwards
•

Injuries to pedal cyclists
•less severe counterpart of motorcycle lesions, as the pedal cycle has the same instability but far
lower speeds
•
•injuries from primary impact
•secondary injuries from passive falls- head injuries,…
•

Injuries to motorcyclists
•because the rider inevitably falls to the ground, head injuries cause majority of deaths
•crash helmets are mandatory in the Czech Republic, but the severity of impact often defeats the
protective effect of the helmet
•typical skull fractures:
–temporal-parietal
–hinge fracture, motorcyclist´s fracture- transverse crack across the floor of the skull, crossing
the petrous base or behind the greater wing of the sphenoid bones through the pituitary fossa to
the opposite side
–ring fracture around the foramen magnum in the posterior fossa caused by an impact on the crown of
the head
–
•‘tail-gating’ accident- rider drives into the back of a truck so that the machine passes
underneath, but the head of the motorcyclist impacts upon the tail-board
•

Injuries to vehicle occupants- unrestrained driver
•the body is moving forward and upwards
•
•head strikes the upper windscreen rim or the side pillar
•flexion of the cervical and thoracic spine
•chest and abdomen colide with the steering whell
•legs strike the parcel-shelf area
•
•any protruding parts of the interior can cause injuries
•the body can be ejected through the broken windscreen
•
•
•
in a rear impact the head is moving forward and than backwards – whiplash injury
(hyperflexion-hyperextension sequence)

Injuries to vehicle occupants- front-seat passenger
•no steering wheel- nothing to brace against to reduce the the collision with the windscreen
•does not pay as much attention to the road as the driver
•
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•Injuries to vehicle occupants- rear-seat occupants
•unrestrained occupants are projected forward towards the soft back surface of the front seats, may
cause an injury to other occupants or be ejected from the vehicle
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Seatbelts
•reduce deaths and serious injuries by 20-25 %
•in the Czech Republic compulsory for all vehicle occupants
•usually „three point attachement“- lap-strap and shoulder
•with the area of 500 cm2 they decrease the force applied per unit area during deceleration
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•References: Knight´s Forensic Pathology, 2004