Author Question: Pedestrian vs. Truck 1/2

Luna Asks:

I hope you can help me with my writing. I need some details for my character.

She is a 24 year old girl that was hit by a 4×4 pickup truck while crossing the road. She was thrown and her head hit the road divider. She was bleeding moderately (not too heavy) from her head injury. She was conscious when her friend sent her to the hospital where later the doctor said she had brain hemorrhage as a result from that accident.

Can I have the details for:

  1. Will she have shock and shortness of breath on her way to the hospital?
  2. What will the doctor check or say when she first arrives at the emergency department?
  3. Is surgery needed?
  4. Does she require blood transfusion for the surgery?
  5. What type of machines would be used to keep her alive?
  6. How long will she be in the hospital? I am writing for two days.

Jordyn Says:

Hi Luna! Thanks so much for sending me your question.

First off, this is a VERY significant trauma to this young woman. There are some specifics missing from your scenario that would be helpful in answering your questions such as how fast the truck was going when it hit your character. The fact that you mention that the victim was thrown indicates a higher rate of speed. Being thrown coupled with the fact that her head hits a very hard surface (the concrete divider) doesn’t bode well for your character.

From your questions, it sounds like you want this to be a more minor injury. If you want this to be a survivable injury (which could be doubtful) you would need to change the nature of this accident and make it less lethal. For instance, the character isn’t thrown a distance. The truck isn’t traveling at a high rate of speed. Or, your character is in a vehicle of her own.

I will answer these questions based on your scenario as is, but keep in mind, this is a very serious accident and if the character survived, she would likely have an extensive hospitalization.

Will she have shock and shortness of breath on her way to the hospital?

You don’t specify in your question whether or not 911 was called and the patient was transported via EMS to the hospital. I would recommend that you do this. You also outline in your scenario that her head wound isn’t bleeding a lot. This is another part of your question that will need some revision. Head wounds do bleed extensively and heavily. If you’ve ever seen a minor laceration to the head you’d be impressed. The scalp is very vascular (meaning lots of blood vessels supply the area and therefore a much higher rate of bleeding).

Yes, this character could be in shock likely related to the blood loss from her head wound, or her head injury, or psychologically from the fact that she’s just been hit by a truck. Keep in mind, the head injury may not be her only injury. Anyone hit by a vehicle and then thrown will likely have other injuries such as broken bones, possible internal injuries, other cuts, lacerations, and abrasions.

If the patient was transported by EMS, they would first provide for C-spine stabilization (placement of a C-collar and backboard) while simultaneously assessing her breathing. Whether or not she’s breathing would be up to you. I could see it either way in this scenario. If she’s not breathing, then they would assist with her breathing. In addition, they would control any visible bleeding by applying pressure and dressings. She would be placed on a monitor to track her vital signs. An IV would be placed and IV fluids would be started.

Since this is a lengthy question, we’ll conclude tomorrow.

Someone Please Rescue 911: Teach Them to do CPR Correctly

I’ve been teaching CPR for almost thirty years. Can you believe that? I hardly can.

I’m pretty passionate about CPR because time after time studies have shown that this is the patient’s best path for survival— high quality CPR given as soon as the patient needs it. It’s not rocket science and it’s pretty easy to research. Here’s a Google link to a bunch of images that show the algorithm for CPR.

What you want to be sure of is that you’re using the most recent guidelines. For the American Heart Association (AHA), their most recent set came out in 2015. The AHA reevaluates their CPR guidelines based on research every five years. Next update will probably happen next year, but the educational materials likely wouldn’t be released until 2020.

In episode nine of this season’s 911, Hen and Howie rescue a boy from a submerged vehicle. He is unresponsive and pulseless once he reaches the shore. They begin CPR (just compressions) and after every set of compressions they do a pulse check. After about a minute, they revive the patient.

Did you know that even healthcare providers are not that great at determining whether or not there is a pulse? It’s true. On top of that, imagine trying to do a pulse check with cold hands, in the dark, in the rain. Not easy to be sure.

The reason the pulse shouldn’t be checked that much is that it ultimately delays compressions and we don’t want to do that. Every time compressions are stopped, the blood perfusion to the heart also stops and it takes several compressions to reperfuse the heart. Some fire departments have gone to doing two hundred uninterrupted compressions for this very reason.

In lieu of this issue, I did like this episode quite a bit. It’s Hen’s origin story and I do think it highlighted some of the issues minorities face in the fire service.

911— let’s just stop messing up the little things.

911: Let’s Provide Some Medical Care

In the Season Two/Episode Eight airing of the FOX television show 911— there was a great scene on how to really provide no medical care.

The setup: A gay couple is getting ready to go on a bike ride. Much time is spent in a musical montage showing their lives together. It’s clear they have had a loving relationship and remain deeply in love. One gentlemen goes to load a bike onto a SUV when, in a series of unfortunate events, he gets pinned by the SUV to the entrance gate— akin to Anton Yelchin’s accident (though they do show in the episode the SUV was placed in neutral).

He is discovered by his partner who then calls 911. Upon arrival, there isn’t much done for his lover. He is essentially declared dead on arrival.

Then, the gentleman who discovered his partner, goes unconscious while a firefighter has his back turned. Literally only a few seconds have expired when the firefighter discovers he’s passed out. They provide one and a half cycles of CPR and kind of shrug their shoulders declaring that he’s died, too.

This is unacceptable management of this patient. It’s essentially a witnessed arrest so they were correct to start CPR immediately, but at the very least, he should have been connected to an AED for rhythm analysis and probable defibrillation. A very common reason for sudden collapse are arrhythmias that will respond to electricity. There’s no reason why this gentleman’s treatment  should have been so sparse. It would have increased the drama and the tension of the episode to have this patient get a full resuscitation.

9-1-1 S2/E1: What Can be Diagnosed in the Field?

Fox’s 9-1-1 series is beginning Season 2. The series is enjoyable, but there is some definite leeway the series takes when making certain field diagnosis.

In the first episode of the season, a man gets hit with an old artillery shell in his leg. As noted on the picture on the right, by simply shining a flashlight into the wound, the paramedic declares that his femoral artery has been severed. This could be more believable if there was even some mild pulsatile bleeding, even with a tourniquet in place, at the site which is characteristic for arterial bleeding.

Later in the episode, a picture of the wound is shown with a “live” shell in the anterior thigh. The fact that it is a live shell is made by a firefighter who is former military based on the color. I can’t comment on whether or not that’s true— I’m not military— but the team does make a decent choice (since the patient is stable) to not take him inside the hospital.

When the bomb squad gets there, they are able to take this sweet x-ray in the field. It is a plain, diagnostic x-ray. There is no way for an EMS crew to take an x-ray like this. Can the bomb squad? Yes. So the show is doing it’s due diligence by having the bomb squad perform this task. However, the bomb squad would not need the military to diffuse this— my law enforcement brother who used to work with the bomb squad verified this.

What other things have you seen shows diagnose in the field that they wouldn’t be able to do?

Disaster Status: Part 3/3

Dianna Benson returns to conclude her fascinating three part series on hazardous materials. You can find Part 1 and Part 2 by following the links.

I was on-shift the night an industrial hazardous waste plant burst into flames. I have all the inside information, but it won’t be released to the public, so I’m sorry to say I can’t share most of it with you. What I can say— inside the facility was stored toxic material that ignited.

The fire quickly grew to a plume of smoke then the entire facility erupted into a fireball with several rapid fire explosions. This swift and extreme domino of events occurred simply because the burning toxic chemicals were stored right next to oxygen cylinders— and oxygen feeds fire. You guessed it, properly stored oxygen is essential.

The reverse 911 system was activated. Recorded messages called all nearby residents and warned them to evacuate. View the photos included here— it was an intense explosion and the burning toxic chemicals created a massive haz-mat situation.

The chemicals involved in that explosion react negatively when mixed with water, so we were forced to allow the fire to burn itself out. Two days post the onset of the incident, a foam application extinguished the remaining flames.

Even though this makes for boring fiction, emergency agencies that night proved pre-planning and inter-agency training and execution results in excellent emergency incident response outcome. My crew along with many other emergency crews, successfully worked the potentially deadly incident— no loss of life and only minor exposure issues occurred. But think of the endless possible dramas that could have happened.

All photos are courtesy of Apex Fire Department.

Disaster Status: Part 3/3. Write realistic hazardous materials scenes. 
Click to Tweet.

*Oringinally posted January, 2011.*

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Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden SonFinal Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.

 

Disaster Status: Part 2/3

Returning today is award winning author, Dianna Benson, for Part 2 on her series involving hazardous materials. You can find Part 1 here.


A Real-life Haz-Mat Incident

In Graniteville, South Carolina On January 6, 2005 in Aiken County, a railroad engineer left his train for the night to sleep at a hotel in town. Before leaving his train, he failed to properly reline the railroad switch for mainline operations. Meaning, he simply forgot to change the rails on the track. Changing the rails would’ve closed off the track where his train was parked, successfully forcing an incoming train to veer-off onto another track and pass the parked train.

In the middle of the night, an incoming train, planning to pass the town, collided with that parked train, which contained chlorine gas, sodium hydroxide, and cresol. The collision derailed both locomotives and many freight cars. The parked train’s tank car, containing ninety tons of chlorine, ruptured and then released sixty tons of the gas, creating a haz-mat spill and also polluting a nearby creek.

A true haz-mat team— trained, experienced, and equipped for such a catastrophic event— is not located in small-town Graniteville. Only a few of Graniteville’s emergency crews are trained in haz-mat. Their training, expertise, and equipment is insufficient for an incident of this magnitude.

Inside the Avondale Mills plant near the crash site, a man in respiratory distress called 911. From a dispatcher’s viewpoint, this situation is heart-wrenching. Even if rescue crews could’ve safely entered the area to extricate the man, it would’ve been pointless due to his immediate exposure to chlorine.

He was suffering from bronchial chlorine burns and he died a painful death while on the phone with the 911-dispatcher. For haz-mat training purposes, I listened to that chilling 911 recording. Overwhelmed in every way, that dispatcher could only listen as this man gasped his last breaths. Understandably, she had no words of comfort to offer him. That gave me a passion to become a 911 dispatcher once I’m too old to run the streets.

When that man plead with the dispatcher, “Please, don’t hang up. I don’t want to be alone.” I would’ve spoken with him about his family and his passions in life in order to get him as calm as possible. I would’ve talked about God and offered to pray with him. Often when people suspect their death is imminent, they suddenly forget all about being atheist, agnostic, stumbling in their faith, or whatever else, and reach for God.

Due to this haz-mat incident, nine people died, two-hundred and fifty were treated for chlorine exposure, and five thousand-four-hundred residents within a mile radius of the crash site were forced to evacuate for nearly two weeks while haz-mat teams and clean-up crews decontaminated the area.

Think of the fictional characterization possibilities within this tragedy:

1) Plagued by guilt, the train engineer is pushed over the edge by predisposition to mental illness, and becomes a murderous psychotic (an example of a villain in one of my books). What similar characters could you develop? To be honest, though, my heart goes out to that train engineer. My greatest fear in life is making an unintentional mistake as an EMT, resulting in a patient’s death.

2) The 911 dispatcher: For fictional purposes, let’s suppose it was this dispatcher’s first day alone (no longer training) on the job that horrible night in early 2005, and she resigns, making her first day also her last. Think about the baggage she would carry for years to come. In addition, what if she was already in a severe financial bind and now being jobless she’s in dire straits? She’d make a likable and fascinating main character.

3) Me, a future 911-dispatcher— what if a character had aspirations to be an amazing dispatcher but fails miserably? What if he/she is unable to handle the stress of the work and is then lost in life on where to head career-wise? Another idea for a terrific main character.

Disaster Status: Part 2/3. Write realistic hazardous materials scenes. Click to Tweet.

*Originally posted January, 2011.*

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Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden SonFinal Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.

Disaster Status: Part 1/3

Nothing can complicate a story more than a disaster hitting the town in your novel. What would a realistic response look like from the EMS community? There’s no one better to talk about disasters than an EMS professional. Dianna Benson is here for a three part series on EMS and hazardous materials.

Worst Possible Haz-Mat Situations

In a hazardous-material situation, a small town can easily and rapidly become overwhelmed and thus unable to efficiently handle the crisis at hand due to their limited resources. Below is a list of some additional factors beyond “the town is small” that would heighten the chaos, and for writers, would create solid fictional conflict.

Scenario: Traveling at high speeds, two tanker trucks collide; both roll-over. One truck is an atmospheric pressure tank; the other is a cryogenic liquid tank.

Additional possible factors….

The accident occurs:
1)      Near a school during school hours
2)      Near a stadium filled with spectators and athletes/performers
3)      Near a power plant
4)      Near a hazardous waste facility
5)      Near the town’s landfill (landfills contain countless haz-mats)
6)      Near the town’s water treatment plant
7)      Near the town’s only EMS station
8)      Near the town’s only hospital
9)      Near the town’s only fire department
10)  Near the town’s only police department
11)  During rush hour traffic
12)  During a storm
13)  At 3am
14)  The closest haz-mat team is four hours away

In all of the ten “near” cases above, assume those buildings/areas are contaminated by hazardous material spills from both trucks. Haz-mats are often airborne (so air vapors), which are the most deadly simply because air vapors are invisible— they travel quickly, through most any material (including ventilation systems), and without warning. Plus, they’re next to impossible to contain. Sometimes an unusual cloud or smell is detected, but obviously that warning comes concurrent of the smell and/or cloud discovery, so those individuals in or near the hot zone are already exposed. Keeping safe distance from the hot zone is the only way to eliminate exposure.

Minimum safe distances depend on the chemicals of the hazardous materials present, but an example of an initial minimum safe distance is: 1,000 feet downwind, 500 feet upwind, 330 feet complete radius. Avoid downwind areas entirely and stay upwind. Clearly, continuous monitoring of wind changes is vital.

What additional scenarios and additional factors can you think of?

Disaster Status: Part 1/3. Write realistic hazardous materials scenes. Click to Tweet.

*Originally posted January, 2011.*
*********************************************************************************************

Dianna Torscher Benson is an Award-Winning and International Bestselling Author of suspense. She’s the 2014 Selah Award Winner for Best Debut Novel, the 2011 Mystery/Suspense/Thriller Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne du Maurier Finalist, and a 2007 Golden Palm Finalist. She’s the author of The Hidden SonFinal Trimester  and Persephone’s Fugitive. The 2nd edition of The Hidden Son released in 2016.

An EMT in Wake County EMS since 2005, and a victim advocate practitioner since 2016, Dianna authentically implements her medical, rescue, and crime victim advocacy experience and knowledge into her suspense novels. She loves helping people in need, often in their darkest time in life. Dianna and her husband live in North Carolina with their three children.