Ejection Trauma: What First Responders Need to Know About High-Impact MVCs
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When a person is ejected from a vehicle during a crash, the outcome is almost always severe. Ejection trauma represents one of the most catastrophic mechanisms of injury emergency responders will encounter. Whether partial or complete, being thrown from a vehicle amplifies the forces acting on the body—turning an already violent impact into a multi-system trauma event.
What Is Ejection Trauma?
Ejection trauma occurs when a vehicle occupant is completely or partially thrown out of the vehicle during a collision. This typically happens when seat belts are not worn or fail, or when the force of impact breaches the vehicle’s structure.
There are two main types:
Partial ejection – The patient is partially expelled, often trapped by the seat belt or vehicle frame, resulting in crushing or shearing injuries.
Complete ejection – The patient is fully thrown clear of the vehicle, often resulting in secondary impacts with the ground or other objects.
Mechanism of Injury (MOI)
Ejection trauma is classified as a high-mechanism MOI, and responders should immediately suspect:
Severe blunt trauma
Multiple fractures
Spinal, head, and internal injuries
Airway compromise or shock
The energy transfer doesn’t stop at the first impact—the patient often experiences multiple points of contact:
The initial crash inside the vehicle
Contact with the vehicle structure on exit
Impact with the ground or another surface
Potential secondary impact with objects (trees, poles, other vehicles)
Each of these contributes to a complex and unpredictable injury pattern.
Common Injuries Associated with Ejection
Responders should anticipate multi-system trauma, including:
Head and neck injuries: Concussions, skull fractures, traumatic brain injuries (TBI)
Spinal trauma: High risk of spinal fractures or cord damage due to rotational forces
Thoracic injuries: Flail chest, pneumothorax, hemothorax, cardiac contusions
Abdominal trauma: Liver or spleen lacerations, internal bleeding
Orthopedic injuries: Long bone fractures, pelvic fractures, amputations
Soft tissue injuries: Severe abrasions, degloving injuries, lacerations
Scene Assessment
When responding to an MVC with possible ejection, scene safety and situational awareness come first.
Scan the entire area—patients may be thrown significant distances or hidden in brush, ditches, or behind obstacles.
Note patient position relative to the vehicle; it offers key clues about trajectory and energy transfer.
Look for additional hazards: leaking fuel, oncoming traffic, downed power lines.
Patient Management in the Field
Ejected patients require rapid, systematic assessment and early activation of advanced care.
1. Scene Safety & Triage
Request additional units and air transport early.
Perform a global scan for multiple patients.
2. Primary Survey (Check, Call, Care)
Airway: Suspect spinal injury—manually stabilize head and neck, use jaw-thrust if needed.
Breathing: Expose the chest, check for symmetry and adequate air movement.
Circulation: Control major bleeding immediately. Prioritize rapid identification of life-threatening hemorrhage.
3. Secondary Survey
Head-to-toe assessment, noting deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAP-BTLS).
Monitor vitals frequently—changes can indicate internal bleeding or decompensating shock.
Maintain spinal motion restriction (SMR) if indicated.
4. Shock Management
Treat for hypovolemia: position appropriately, keep warm, and prepare for rapid transport.
Oxygen administration and airway management should be prioritized.
The Role of Prehospital Responders
As a first responder, your calm and methodical approach can make all the difference. Recognizing the severity of ejection trauma early allows for:
Prioritizing rapid extrication and transport
Effective communication with dispatch and incoming EMS
Early notification of trauma centers
Ejection = Severe Trauma Until Proven Otherwise.
Never underestimate the forces involved—patients may appear stable initially but can deteriorate quickly.
Key Takeaways
Ejection trauma is one of the deadliest outcomes of an MVC.
Always assume multi-system trauma and spinal involvement.
Focus on airway, breathing, and circulation while minimizing movement.
Rapid transport and early hospital notification are essential.
Scene safety, teamwork, and clear communication are critical under pressure.
Final Thoughts
Every ejection call reminds responders why scene assessment and mechanism recognition matter so much. Behind every statistic is a human life—one that depends on the calm, structured, and skilled actions of those first on scene. Whether you’re an Advanced First Aider, EMR, or paramedic student, understanding ejection trauma prepares you to manage chaos with confidence and compassion.
