On the 24^th of May 2021, a light-rail commuter carrying a total of 213 passengers had collided with another empty train on the tracks, causing severe injuries to 47 commuters and the remaining 166 with light injuries.

Through this incident, some facts that we can learn about the incident are such as:

• The train was travelling at high velocities (avg 40km/h)
• The structure of the train sustained heavy damages with shattered glass and bent frames and metals.
• Passengers in the train were flung off from their seats.

Sources from THE EDGE & Malay Mail

picture source: social media

Given with the conditions that were present, some of the probable common injuries that can be sustained are such as:

Open wounds

Given that the glass windows had broke and its shards were everywhere, the likely hood of open wounds and bleeding is great. Both high and low-risk wounds could present during this situation. Low-risk wounds involve normal cuts while high-risk wounds could consist of deep punctures of a foreign object into the tissue, critical systems involved, contaminated or foreign chemicals, or open fractures in this case.  

Acute Stress Reaction (ASR)

The likelihood of a fight or flight situation on board is tremendously high and this can cause an ASR attack. Typically, whenever our body detects or is in danger, it automatically releases adrenaline into the body system to protect yourself. Some of the signs and symptoms are such as increased pulse rate, breathing rate, dilated pupils and the ability to temporarily mask pain.

Spinal Injury

Given that many passengers were flung off their seats during the time of the collision, a probable spinal injury could present itself with the trauma impact that was delivered to the body. Typically, a patient is assumed with spinal injury whenever they experience trauma from high velocities, a fall greater than their height and sustained injuries to the neck or head. A spinal injury does not need to be treated fast but required to be treated with care and proper techniques to evacuate the victim. A mistake could leave the victim with more damages to their spine or spinal cord which will result in a neurologic deficit.

How can we provide first aid in this situation?

Rescue personnel tending to the injured passengers at KLCC station, after a collision between two LRT trains on the Kelana Jaya line, May 24, 2021. — Picture by Firdaus Latif

Despite the situation and your eagerness to help ease the on-going problem, it is always important that you first protect yourself before you assist another person. The rule of thumb is to always check for:

Mechanism of Injury (MOI)

Ask yourself if there are any other known or unknown factors that could cause harm in your way? Check your surroundings and ensure that the environment is safe to enter. Do not proceed if you think that the environment is deemed unsafe. For example, is there another incoming train from the back? Are there any fires and spilled toxic chemicals around the area?

Safety

Be sure to always protect yourself against any transmission of diseases by wearing gloves, masks and glasses if possible. Remove all possible risk of getting direct contact with others bodily fluids such as blood, spit, vomit and much more.

Number

Identify the resources that you have with you and your capabilities of aiding someone. With this information, you would be able to identify your number of patients and rescuers. Therefore, organizing a better and well-planned first aid.

What’s the next step? First Aiding  

After determining the situation and resources that you have to help others. How can you now proceed to the next step to provide first aid in this situation?

Open wounds

The key to treat bleeding open wounds is to always provide well-aimed direct pressure on the wound to stop the bleeding. Typically, by doing so solves the problem most of the time. However, if the situation involves heavy bleeding, only well-aimed direct pressure might not be enough. Hence, elevate the limb or area of the wound above the patient’s heart and continue applying well-aimed direct pressure. Generally, heavy bleeding is an emergency that needs to be solved quickly because an average of 30-40 percent of blood lost could result in a volume shock.

Acute Stress Reaction (ASR)

Generally, victims with acute shock response will recover naturally as time passes. As a first aider, you could use this time to provide assurance and care to the patient by practicing (PROP- Position & protection, reassurance, oxygen, and positive pressure ventilation). Get your patient to sit up to allow gravity to assist the diaphragm and to help keep fluids out of the upper and lower airway. Reassure them by encouraging the patient to take slow and deep breaths. Provide any supplemental oxygen from a tank if available and be ready to provide positive pressure ventilation (PPV) by helping the patient to breathe.

Spinal Injury

If your victim is assumed positive spinal injury, be sure to take your time, reduce any movements and always protect your patient from their surroundings. First, slowly reposition the patient’s body into an anatomic position where then you can use to check for other ongoing injuries such as bleeding or open wounds. While repositioning the patient’s body, be sure to move their limbs and joints slowly, stabilize their hips and shoulders to reduce any spinal movements. Ensure that the victim does not move their head by firmly gripping onto their head or placing objects that can restrict their movements. Typically, in the wilderness, there are certain ways that you could use to clear a spine injury by performing a couple of tests such as checking their CSM – Circulatory, Sensory and Motor abilities. However, in this urban situation where help is not far away, the best thing a first aider could potentially provide is to stabilize the patient and reduce their movements.

Conclusion

Regardless of your environment and situation, as a first aider remember to always protect yourself, examine the situation and prepare a game plan that will help save yourself or others before professional help arrives. 

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References

Bernama. “213 Injured, 47 Seriously, In LRT Train Collision”. The Edge Markets, 2021, https://www.theedgemarkets.com/article/prasarana-reports-incident-involving-lrt-train-kelana-jaya-line-tonight.

CHIN, EMMANUEL SANTA MARIA. “Transport Minister: 166 Wounded Including 47 Seriously Hurt In LRT Train Crash Near KLCC | Malay Mail”. Malaymail.Com, 2021, https://www.malaymail.com/news/malaysia/2021/05/24/bernama-at-least-166-hurt-in-lrt-crash-near-klcc/1976729.

Isaac, Jeff, and David E Johnson. Wilderness And Rescue Medicine. Wilderness Medical Associates International, 2013.