Case report

In the early hours of the morning a small car was involved in a high-speed head-on collision with a lorry. The driver was unrestrained and, following the collision, was positioned in the front passenger footwell with his back resting against the inside of the passenger door, legs drawn up and feet in the driver’s side footwell. The ambient temperature was −2.5°C.

The patient’s level of consciousness fluctuated between alert and responsive to pain. The airway was clear with spontaneous breathing and bilateral air entry. The blood pressure was normal with a pulse rate of 68 bpm and the pupils were normal and reactive to light. The abdomen was soft to palpation. The upper limbs appeared intact, with multiple scarring and superficial …