Road traffic injuries: pedestrians, drivers and riders
- Topic
Road traffic injuries follow patterns set by the person's role: pedestrian, driver, passenger or motorcyclist, and help reconstruct the event.
What it is
Road crashes kill about 1.16 million people a year worldwide and are the leading cause of death between ages 5 and 29, according to WHO; more than half of those killed are pedestrians, cyclists and motorcyclists. For the doctor, injuries follow patterns set by the person's role. In a pedestrian struck by a car there are primary impact injuries (bumper, at leg height), secondary impact injuries (bonnet and windscreen, often the head) and secondary injuries (from the ground); the person may also be run over. In occupants, the steering wheel, dashboard and seat belt matter; in motorcyclists, the helmet and the head.
Key facts
- Primary impact injuries in pedestrians cluster in the lower limbs; secondary impact injuries in the head and neck.
- A small external injury may hide serious internal injury: there are no "minor" injuries after a crash.
- Seat belts can reduce the risk of death for vehicle occupants by up to half (WHO).
- Alcohol and other substances are tested in drivers and pedestrians when the law or the case requires.
- A fall from height and a pedestrian impact can give similar injuries: the scene and the pattern help tell them apart.
Step by step
- Treat and rule out internal injury; observe the patient even if they seem stable.
- Ask and record the role (pedestrian, driver, passenger, motorcyclist), helmet or seat-belt use and the type of vehicle.
- Describe each injury with its location; on the legs, measure the height from the heel.
- Look for patterned injuries: tyre tread, seat belt, steering wheel, vehicle grille.
- Keep clothing and debris (glass, paint) with chain of custody.
- Take samples for alcohol and other substances when requested, with chain of custody.
Next step: what to do and document
- Do not discharge early after a crash in which someone in the same vehicle was badly hurt or killed: observe and rule out internal injury.
- Record the person's role in the crash, helmet or seat-belt use and the time of care.
- Describe and photograph patterned injuries and measure the height of leg injuries from the heel.
- Keep clothing, paint or glass debris and biological samples with chain of custody when the authority requests them.
- Write the record and reports with precise descriptions: they are often used in criminal and insurance proceedings.
Test yourself
Think of the answer, then tap the question to see it.
Where are primary impact injuries found in a pedestrian struck by a car?
In the lower limbs, from the bumper; secondary impact injuries (bonnet, windscreen) often involve the head.
Why is the height of leg injuries measured from the heel?
To compare it with the height of the vehicle's bumper and help reconstruct the impact.
What pattern does a wheel passing over the body leave?
Abrasions reproducing the tyre tread, often with flaying of the skin and crush injuries.
By how much does a seat belt reduce the risk of death for occupants, according to WHO?
By up to about half.
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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Road traffic injuries (fact sheet) (World Health Organization, 2026); Pattern and distribution of pedestrian injuries in fatal road traffic accidental cases in Dharan, Nepal (Journal of Natural Science, Biology and Medicine (PMC), 2014); Distinguishing injury patterns in fatal falls from heights versus pedestrian impacts: an autopsy study (Forensic Science, Medicine and Pathology (PMC), 2025); Trauma Forensics in Blunt and Sharp Force Injuries (Journal of the West African College of Surgeons (PMC), 2022).
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