Initial Assessment and Management of Adolescent Car Accident Victims

Immediate Scene Management and Primary Survey

The American Heart Association recommends ensuring scene safety, activating EMS, and performing 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
The American Academy of Pediatrics notes that motor vehicle crashes are the leading cause of death for 16-20 year-olds, accounting for approximately 5,500 occupant fatalities annually 2, 3
The American College of Surgeons advises to maintain manual spinal immobilization with stabilization of the head to minimize motion of the head, neck, and spine 4
Assume spinal injury until proven otherwise, particularly given the mechanism of injury, as recommended by the American Heart Association 1

The American Academy of Pediatrics recognizes 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) 2, 3
Consider alcohol involvement: 9.9% of 9th-12th graders report driving after drinking, according to the American Academy of Pediatrics 6
Consider marijuana use: detected in 17% of injured drivers in some studies, as noted by the American Academy of Pediatrics 6
Males aged 15-20 have higher rates of speeding-related crashes (38% vs. 25% for females), as reported by the American Academy of Pediatrics 6, 7

Arrange urgent MRI if spinal cord injury is suspected, as it is the gold standard for diagnosing spinal cord contusions and compression, as recommended by the American Association of Neurological Surgeons 4
Transfer to a specialized acute spinal cord injury center within the critical therapeutic time window if incomplete spinal cord syndrome is suspected, as advised by the American Association of Neurological Surgeons 4
Early surgical decompression within 24 hours is strongly recommended for incomplete spinal cord syndromes to improve neurological outcomes, according to the American Association of Neurological Surgeons 4
Continue spinal immobilization during all movements and transport, as recommended by the American College of Surgeons 4
Monitor for deterioration in neurological status, respiratory function, or hemodynamic stability, as advised by the American College of Surgeons 4

Do not assume the victim is stable based on initial presentation—adolescents may deteriorate rapidly, as noted by the American College of Surgeons 4
Do not delay transfer to specialized trauma care if serious injuries are suspected—management in specialized units reduces morbidity and mortality, according to the American College of Surgeons 4
Do not move the victim unnecessarily, as this may worsen spinal cord injury, as recommended by the American Heart Association and the American College of Surgeons 1, 4