Trauma Call/Domestic Violence: Dianna T. Benson, EMT

I am pleased to welcome back award-winning novelist Dianna T. Benson. I love how she writes these scenes fictionally but conveys a host of medical details along with it. 

Welcome back, Dianna!
EMS 6, Stabbing, TAC Channel 12”
     Responding to a domestic disturbance call, my partner and I park our ambulance in front of an upscale home over a million dollars. Not atypical – EMS is too often called out to the rich on domestic violence.
     “Did you know the power company turns off this zip code for lack of pay more than any other in the state?” I ask my new partner.
     “Yep. Idiots living beyond their means. No wonder they’re so stressed out and hurt each other.”
     At the front door, we join a fire crew, as three cops enter the house, all three with weapons drawn.
     “Scene isn’t safe?” I ask.
     “Not sure,” the last cop answers then trails his two buddies.
     The fire crew of four hangs back with me and my partner.  
     “Was the door unlocked?”
     “Yup,” one of the firefighters answers me.
     After five long and boring minutes of standing around on the lawn in the dark of night, I radio in to dispatch. “EMS 6. Standing by outside residence. Any updates from PD on scene?”
     “Yes. Scene is secure. PD is with victim.”
     “Copy that.” I roll the front of our loaded stretcher into the house.
     In the family room, I find one officer bent over a body, the other two talking with an agitated man.
     I kneel at the woman’s other side. She’s supine on the carpet, her lapped hands pressed to her lower abdomen and covered in blood.
     “Ma’am?” I touch her shoulder in comfort.
     My patient blinks at me then flutters her eyes closed.
     “Can you tell me your name?”
     “Judy,” she whispered in a pained voice.
     I brush my hand over hers. “Judy, are you hurt anywhere other than here?”
     “Don’t know,” she mumbles.
     “Judy?” I stare into her eyes, mascara smudged underneath them. “Can you move your arms down at your sides?”
     She does.
     My partner hands me trauma scissors, a stack of 5X9 sterile gauze pads, and an occlusive dressing. As I rip open the gauze packages, my partner hooks up the patient to our cardiac monitor and focuses on assessing and monitoring vital signs.  
     “How can I help?” one of the firefighters asks me.
     “Perform a rapid trauma assessment.”
     “You got it.” He starts at the head.
     With the trauma scissors, I cut Judy’s shirt, exposing the wound. Noting no debris other than blood, I cover the gushing horizontal wound—thin but long—with one sterile gauze pad after another, and apply direct pressure with my palms. “Did a knife do this, Judy?”
     “He did.”
     “With a knife?”
     “Steak knife.”
     “I see nothing else,” the firefighter informs me at the patient’s feet.
     I nod. “Thanks.”
     I glance at the monitor screen for Judy’s vital signs. Her heart rhythm is normal, but her blood pressure is too low, pulse too high, indicating she’s headed to shock due to blood loss. My guess is she’s bleeding internally, the knife blade sliced an organ or two, maybe the abdominal aorta. Regardless of what’s injury, she needs a surgical team.
     I look at my partner. “We gotta go. Now.” 
       
     “Give me the switchblade,” one of the cops says, alarm in his tone. “Sir, you’re just making things worse for yourself.”  
     “Past time to go,” I whisper to my partner, a rush of panic clogging my throat.
     “No kidding,” he whispers back, wide-eyed.
     “Get out of here,” one of the cops says to us.
     “What’d you say to them?” the agitated man shouts.
     “You don’t want a murder charge, do you? The EMS crew needs to get her to the hospital.”

     The cops deal with the perpetrator, as my partner readies the stretcher. I blanket the dozen or so bloody gauze pads with a towel.
     Inside the moving ambulance, I raise the foot of the stretcher to treat for shock. I cover Judy’s mouth and nose with a non-rebreather oxygen mask and turn on the O2 to 15 lpm. Since none of her organs eviscerated, I do not apply an occlusive dressing. Instead, I add additional 5X9s and a fresh towel and instruct the one firefighter who joined us en route to press his hands over it for direct pressure. I insert an IV saline bolus and consider administering morphine or fentanyl for pain.
  
     “More cops dispatched to scene,” my partner yells back from the driver’s seat. “Guy stabbed one of the cops and fled the scene on foot.”
     I look down at my patient. She doesn’t indicate she heard those disturbing words.
  
     “We’re ten minutes out,” my partner yells back at me.
     I pick up the radio. “Wake Med ED, this is EMS 6.”
     “Go ahead EMS 6.”
     “We are enroute with a thirty-eight year old female. Left lower quadrant adnominal stab wound. No evisceration. BP 82 over 56. Heart rate 173. Non-rebreather at 15 liters per minute. Legs elevated for shock treatment. Place OR on stand by. ETA 10 minutes.”
     “See you in 10. Wake Med out.”
     “EMS 6 out.”  
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Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.
 
   
          

Dianna T. Benson: A Son’s Tale of Traumatic Brain Injury


The term concussion is well known. The medical field refers to a concussion as a TBI – Traumatic Brain Injury. Contact sports are one of the top causes of a TBI, another are MVCs – Motor Vehicle Collisions.
My teenaged son has endured four concussions. The first two as a goalie for the Junior Hurricanes and the third in a MVC. The first one took him out of school for a month and hockey for three months. The second, a year later, was more mild, which is unusual. Typically, a patient suffers a more severe TBI the second time. In the MVC, a classmate was driving them to school when another car struck them. This third TBI ended my son’s hockey career, preventing him from attending the Junior Hockey draft in Canada Spring of 2013.
The problem wasn’t simply that this was his third concussion, although that in itself is a strong reason to end a contact sport career. With this third TBI, a neurologist evaluated him versus just the concussion clinic MDs who’d treated him with the first two. Not only was it his third TBI, but his symptoms were extremely severe, which didn’t make sense to me – the details of the MVC didn’t suggest such injuries for my son: 1) None of the others involved in the crash suffered any injuries 2) No air bags deployed 3) Vehicle damage was minor. As an EMT for nearly a decade, I wondered about underlining health conditions in my son. I also considered he had not fully recovered from the first two concussions and was in denial about his symptoms in order to play hockey.
Sure enough, the neurologist diagnosed my son with hyper-mobile joints (something I already knew but wasn’t aware of the danger with contact sports.) The MD also diagnosed him with mild CP (cerebral palsy), a diagnosis that made sense to me since my son was born in respiratory arrest and was non-verbal and had spasticity until over age two. Both diagnosis are a recipe for injury, especially in contact sports. The MD gently told my son he was done playing goalie forever – it was devastating and crushed him. Understanding his hockey career was over, he admitted he’d ignored symptoms because he had a shot to play Junior Hockey, college hockey, and possibly professional hockey. A life-long athletic competitor myself, I completely understood the denial that led him to ignore his body.
Hyper-mobile joints, while creating an incredibly athletic body, are highly susceptible to any musculoskeletal injury in that individual. For my son, after two TBIs in a contact sport, his hyper-mobile neck was easily and severely whip-lashed in the MVC, jostling his brain fiercely, causing all his concussion symptoms to return and more heightened than ever.
Ten months after the car accident, the fourth TBI occurred December 2013 just days after the neurologist cleared my son to return to his life minus contact sports. The neurologist gave my son the green light to snowboard. That December day on the mountain, my son didn’t even hit his head and he sustained no head trauma – simply snowboarding jostled his brain enough to cause another TBI.   
Even though he’s extremely athletic, my son’s body shouldn’t do what it can to do. The risk of permanent brain damage and partial or full paralysis is too high for him– something he now understands. I described it to him as this: When Cam Ward (the goalie for the NHL team Carolina Hurricanes) is playing goalie, his body is naturally like a SUV of protection in a MVC. Whereas, for my son, his body is like a motorcycle in a MVC – no protection.
Until Spring 2015, my son is restricted from doing anything with speed, wheels, height or repetition (basically everything fun.) This next year his brain will heal, then little by little he can attempt things (no contact sports ever, though) to see how his body responds. At 6’7” in height and extremely athletic, he appears a medically sound seventeen-year-old, but inside his body tells a different story. 

    

God works in amazing ways and this is my son’s blessing. Since cerebral palsy only affects motor function, and none of the four TBIs caused him any loss of cognitive abilities, he’s still as annoyingly brilliant as ever and is anxious to head off to college this fall. For now, his goal is to graduate medical school with a degree in neurology and become a neurosurgeon since he feels (understandably so) he can relate to patients’ symptoms with head trauma. 
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 Dianna Torscher Benson is a 2014 Selah Award Finalist (winners not yet announced), a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release.
After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need.
Dianna lives in North Carolina with her husband and their three children. 
Her releases are available wherever books are sold. Below are the links to Final Trimester at the three largest booksellers: