Fall Call: Dianna Benson, EMT


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I love these posts from author and EMS expert Dianna Benson where she weaves medical detail into a fictional piece. 
Welcome back, Dianna!
I shake my head to full awake from my cat-nap, and gear up for the trauma call less than a minute drive away. Once my partner and I roll on scene, I note the three cop cars arriving.
Additional information regarding the call flashes across our ambulance laptop screen.
Proceed with caution. Law enforcement dispatched.
“What’s the deal?” my partner yells out the driver window at a cop rushing toward the building.
“Another worker pushed the guy.”
“Ah,” I say with a nod. “Attempted homicide.”
“Or homicide, but if the guy’s not already dead, he’s gonna need us.” My partner jumps out of our ambulance.
We grab a C-collar (cervical collar) and a backboard, and toss it onto our stretcher already loaded with EMS equipment and supplies.
“Remember caution?” I remind my partner.
“Yeah, yeah. Guy was pushed not shot or stabbed. Let’s go.”
I really didn’t want to hang back either. Our patient’s life may be over if we wait.
Inside the building, we push through a crowd of gawkers. I notice three cops drawing their guns at a man choke-holding some young woman, her wide eyes glossed-over.
“Let her go,” the cop at the left yells out. “Now.”
I’m hoping the guy follows the demand or we’ll have more than one patient. As I rest my hand on my radio in case I need to request additional EMS crews, I scan the area for an injured man on the ground. I spot our patient on the other side lying supine and lifeless in a pool of blood on the cement, his attacker in the middle and blocking us from our patient. I glance up and see the catwalk and assume our patient was pushed off of the suspended walkway about twenty feet above.  
The guy fell twenty feet? I think to myself.  If he’s alive over there, he’s in critical condition.
“Clear out,” the cop to the right shouts. “Everyone. Out of this room. Now.”
The crowd scampers away. My partner and I hold our position behind the cops. The perpetrator doesn’t have a weapon, so there’s no danger to us.
After a few drawn-out minutes of the cops warning the perp to let the woman go, and our patient remaining lifeless and out of my reach on the ground in the near distance, I somehow dig up my most gentle tone and interject, “Sir, I don’t think you want to hurt her. Do you?”
The perp jerks his head in my direction. Ten seconds tick by with him just staring at me as if pleading me to help him out of this. “Ah…no. No, not really.”
“I didn’t think so. How about letting her go and we’ll talk?” Stop blocking me from my patient. If he’s not already dead, he needs me now. Needed me minutes ago.
 “Talk? Yeah, yeah,” he nods, “I just need to talk.” Chest panting, arms shaking, the perpetrator shoves the woman aside and drops on the ground. All three cops pounce on him and drag his arms behind his back.
I roll the front of the stretcher around the chaos on the ground; my partner pushes from the back. As I pass the perp, I ignore his insistent yells to talk with me since my focus is on my patient.
“Sir?” I say to the lifeless man as we approach him.
No answer. No movement of any kind.
I slide my fingers to his neck and find a thready carotid pulse. His chest is rising and falling in steady rhythm bi-laterally.
My partner holds his head in an in-line spinal stabilization position as I strap the C-collar around his neck. I slip a towel underneath his head for hemorrhage control and feel for trauma. I find an open skull wound, crepitus bone, and flesh.
Two firefighters appear at our side and assist me with log rolling the unconscious patient onto a spine board and strapping his body down. I secure the man’s c-collared head to the backboard with head blocks, straps and tape, allowing my partner to finally release the manual c-spine stabilization.  
“What do you need from me?” some guy asks. “I’m his supervisor.”
“How old is he?”
The manger answers that pertinent question as well as all my others, as I connect my patient to our cardiac monitor. Less than a minute later, I’ve assessed all vital signs and the heart rhythm, as my partner performs a rapid trauma examination. Our patient remains unconscious. I’m thinking internal bleeding is the main cause and he’s headed to hypovolemic shock, and if that’s the case, surgical interventions are vital. No more time to waste on scene.
“Femur fracture,” my partner says.
“Among other things,” I say. “Let’s go.”
All of us lift the backboarded man onto the stretcher, and roll it out to my ambulance.
As one of the firefighters drive, my partner and I attend to our trauma patient in the back with the assistance of another firefighter. Our patient remains unconscious. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  
“Take over bagging,” I say to the firefighter, and he grabs the bag valve mask from my hands.  
I spike an IV bag as my partner slides in an eighteen-gauge IV needle into our patients left arm. Since the patient is unconscious, there’s no point to administer pain meds.
I grab the radio mic. “Wake Med ED, this is EMS 16.”
“Go ahead EMS 16.”
“We are en route with a thirty-three year old male. Trauma patient. Twenty-foot plus fall onto concrete. Unconscious. Intubated. Open head trauma posterior. Fractured femur.  Normal sinus cardiac rhythm. BP 95/52 and falling. 182 heart rate. ETA 5 minutes.
Even if this man’s body survives, his brain will probably never be the same. I swallow the sadness clogging my throat, hoping he doesn’t have any children, and I re-focus on finishing my job on this trauma call.
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Dianna T. Benson is 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. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

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. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.

Motor Vehicle Collision: Dianna Benson, EMT

I love this post by Dianna Benson, EMT written in first person about the treatment of a patient involved in a MVC. A lot of information presented in such an interesting way.

Dianna’s debut novel, The Hidden Son, released in March.

Welcome back, Dianna!

EMS #16 and #22 MVC at Park Avenue and Green Street.

I toss the rest of my sandwich into a trashcan, and rush out of the fast food joint toward my ambulance, my partner behind me.

Less than five minutes later, we roll up on scene behind an arriving ladder fire truck. I slip mybright orange reflector EMS vest over my head and lurch toward two cars mangled together in a huge intersection, their hoods now one. The EMS #22 crew heads to the one patient in one car, so my partner and I bolt for the two patients in the other.

civilian is leaning inside the driver’s door.
“Sir?” I say, approaching.
He looks at us, eyes wide, face pale. “Glad you’re here. I’m a doctor, an urologist, but I see patients in my office. I don’t deal with emergency—”
“It’s okay. We got it.”
Blowing out a sigh, he backs away.    
Unconscious, the driver’s face is buried in the deployed air bag, arms dangled around it in a laxhug.
“Sir?” I feel his pulse. It’s thready and rapid. Blueness surrounds his mouth and colors his lips, his chest not rising and falling. Respiratory arrest,” I say to my partner who’s assessing the unconscious passenger, the lifeless patient’s head caught in the shattered door window.
Frowning, my partner shakes his head. “Cardiac arrest over here. Facial skin ripped away. Neck twisted 180 degrees and split open. Bled out.”
Code for: We can’t do a thing for her.
My partner rushes our equipmentloaded stretcher around the trunk to the driver door, as I wave a firefighter over to climb into the backseat. With both hands, the firefighter stabilizes the patient’s head straight against the headrest as I assess the minor facial wounds caused by flying glass. Another firefighter grabs the airbag, punctures it and rips it out of my way.  
I insert an oropharyngeal down my patient’s throat to protect his airway. I cover his mouth and nose with a BVM—bag valve mask—connected to oxygen tubing and a D-tank running at 15 liters per minute. As I squeeze the footballsize bulb every five seconds to oxygenate his system,I assess his legs. Right femur appears fractured, left is covered with bleeding abrasions and lacerations, but no hemorrhage threat.
I strap a C-collar around his neck. Keeping his spine in-line, my partner and two firefighters place his body on a backboard on top of the stretcher, as I continue to bag him. I check his pulse again. Still present. I check for spontaneous breathing. Still nothing, although cyanosis no longer blankets his lips. I brace his entire right leg in a traction split to assist with hemorrhage control.
Inside the ambulance, my partner hooks our patient up to the cardiac monitor via a 12-lead, a firefighter bags the patient, and perform a rapid trauma assessment, head to toeAfter I find no other significant trauma or issues, I spike a bag. Less than a minute later we have an IV bolus in place, running high fluids.      
Spiked and dipped lines display on the monitor screen. “Normal sinus rhythm,” I speak out loud. “But hypotension and tachycardic.” Meaning low BP and high pulse rate. I’m thinking it’s possible this patient is headed to hypoperfusion (shock) due to internal blood loss.
   
“Ready?” another firefighter asks from the ambulance’s driver’s seat.
“Yep, take off.” I listen to our patient’s chest. Heart beating rapidly but strong. Lungs sounds absent on the left side. Diminished on the right.
I eye my partner. I’m thinking left pneumothroax. Right may be heading in that direction.” I read the monitor screen. “Severe hypotensive now. How about administering Dopamine?”
Already on it,” my partner says, filling the IV catheter with the med. “He needs chest decompression. Let’s—
“I’m having trouble bagging,” the firefighter says. “You wanna intubate him?”
   
“Do you have full resistance or only some?” I ask.
“Full.”
Blood quirts out of the patient’s mouth.
I gain my partner’s eye contact. “Cricoid intubation?”
“Yep. Chest decompression can wait.”
I locate the cricothyroid membrane, and prep the area with betadine. My partner punctures the skin with a needle while aspirating for air with a syringe, then slides a cannula along needle and syringe. I secure the cannula with a neck strap, and osculate for breathing with my stethoscope.
I hear solid breath sounds. “We’re good, I say then eye the firefighter. “Continue bagging.
snag the radio and switch the channel to the number one trauma hospital.
“Wake Med? This is EMS #16. We’re en route with an MVC patient. Unconscious. Absent left lung sounds. Diminished in right. Surgical trach in place. O2 saturation 90% with BVM at 15lpmBolus IV in placeDopamine dose administeredBP 90/50, pulse 162.  ETA 15 minutes.”
“Chest decompression,” my partner says as he arranges equipment.
To prep the site, rub iodine to the patient’s second intercostalin the mid-clavicular line. My partner inserts a 14-guage catheter into the skin over the third rib. He advances the catheter through the parietal pleura.
“Pop,” he says indicating he felt a pop, which is the goalHe advances the catheter to the chest wall, then removes the needle, leaving the catheter in place.
I secure the catheter to chest wall with dressings and tape.
Six days later, I see the patient exiting the hospital in a wheelchair, his right leg casted. Two hospital employees assist him into an awaiting car. I smile huge and thank God.

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Dianna T. Benson is 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. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 
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. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.

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Author Question: Treatment of Car Accident Victims



Taylor asks the following regarding treatment of multiple victims of a car accident. 
SCENARIO: Serious MVC involving two cars and multiple victims. All passengers were wearing seatbelts, and airbags deployed, but the crash was serious enough that victims are still severely injured.
Jordyn: When writing about the car crash—I’d have it be pretty visual that the car is near ruin. Particularly if someone has died on scene. Having the car rollover several times would accomplish this.

Taylor: Three girls (friends) were in one car together, on the way to a Christian concert. Drunk driver character had an argument with his wife about his drinking, denying that he has a drinking problem, then got angry, left the house and went out for drinks (doing the very thing they just argued about, partly to spite her and partly “to calm down”). He causes a crash with the girls.
CAR ONE: This vehicle contains only the driver.
DRIVER:The driver is a male in his early thirties. He is slumped forward in his seat, initially unresponsive, but rouses when medics address him. There is a strong smell of alcohol on his breath, and although he is responsive, he is displaying obvious signs that he is intoxicated. Upon seeing the crash scene in front of him, he becomes upset, crying and saying things like, “I didn’t mean to”, “My wife is going to kill me”, and “What have I done?” He has a bleeding laceration on his forehead and minor scrapes and bruises on his face (from the impact of the crash and airbags), and bruising from his seatbelt. Aside from these, he is uninjured. Vital signs are elevated, but within normal limits.
Jordyn: This patient would be placed in C-spine precautions. An IV/fluids started. Usually, when EMS starts an IV—they’ll grab several tubes of blood that the hospital can send to the lab. They’ll dress the laceration on his forehead and not likely worry about the minor cuts and scrapes. Whenever there is seatbelt bruising, we always worry about what would be injured underneath.
In the ER: Since he’s intoxicated, he’s not a reliable informant about his pain. So, he’ll get automatic C-spine films to rule out neck/back fracture. They might even consider a CT of his chest and abdomen (they’ll take vital signs into consideration). Law enforcement will be involved and they’ll want blood alcohol levels and if your book is in a specific/real location—I would figure out what the procedure is in that town/city. After major stuff is ruled out—his cuts will be cleaned. The laceration to his forehead would be irrigated and stitched. Tetanus shot if none in the last five years. Once he’s medically cleared, I’m guessing he would be off to jail.
CAR TWO:This vehicle contains a driver and two passengers.
DRIVER:The driver is a female, age 18. She has no detectable pulse or respirations. Apparent DOA, killed on impact in the crash.
Jordyn: She may be declared dead at the scene. That would probably be the easiest way to manage this patient.
PASSENGER ONE:Female, age 17. Managed to free herself from the car after the crash, and is sitting in the grass a short distance away. She is displaying signs of shock. Respirations are slightly shallow and rapid, skin is pale and clammy, and pulse and heart rate are elevated but still within normal limits. She is mostly responsive, but groggy/drowsy and complaining of severe headache, nausea, and dizziness. Chest and neck are bruised from her seatbelt, and she has several other bruises and superficial bleeding cuts on her body. Her right arm is bruised, swollen, and oddly angled, and she is cradling it against her chest and complaining of pain.
Jordyn: Since she is shocky, she’ll get an IV/fluids and tubes drawn for labs at the ER. Considering the mechanism of injury (the fact that one of the occupants of the crash has died) she’ll be placed in C-spine precautions as well. All surviving patients (including the drunk) will also be give oxygen (as it is treatment for shock as well). Her arm will be splinted in a position of comfort. It’s hard to know if they would give her pain medication or not—her c/o of headache, nausea and dizziness could signify head injury and giving a narcotic could complicate that assessment. So, she may just have to tough it out until she’s in the ED.
ER: Vital signs. X-rays of neck, back and deformed arm. Possible CT of the head, chest and abdomen. Often times, deformed extremities need to be reduced either in the OR or can be done under conscious sedation while in the ED. Depends on how you want to go. This patient may be able to go home if her arm can be set in the ED and no other significant injuries are noted.

PASSENGER TWO:Female, age 17. Pinned in her seat inside the car, unable to free herself. Conscious and responsive, but clearly very frightened, and displaying signs of shock. She is complaining of some pain in her neck, numbness and lack of sensation below the waist, and inability to feel or move her legs. Chest and neck are bruised from her seatbelt, and she also has several bruises and cuts on her face, arms, and legs. There is a large, deep bleeding laceration on her right lower leg.
Jordyn: Same: C-spine/back board. IV, fluids, oxygen. Get blood for labs. Laceration of right lower leg will be bandaged to control bleeding. 

ED: Largest concern for this patient is her sign of C-spine injury. So, not only would she get C-spine films. She’ll likely get CT of her neck, spine, chest and abdomen. Probably would x-ray the leg with the laceration to look for foreign bodies before closing it up. Stuff like the leg laceration can wait until a medical game plan is decided upon after they figure out what her neck injury is.

Gun Shot Wound: Dianna Benson, EMT

EMS expert and author Dianna Benson blogs today writing a first person account of caring for a gunshot wound victim. I love how she’s written this post with such detailed information that portrays the medical info so accurately.
EMS 4. Gun Shot Wound. 123 Main Street, Apartment G. 
I flip my book closed—Jordyn Redwood’s newest suspense—and zip it inside my backpack. I rush from my station’s crew quarters to the ambulance bay.
My partner slips behind the steering wheel; I signal us en route to the call via our laptop nailed to the dashboard.
“Twenty-nine year old male, GSW in abdomen, conscious and breathing,” I relate the facts as I read them on the laptop screen. “Raleigh PD already on scene.”
I wait for further information to display; my nerves rev up. GSW calls often place EMS in deadly situations. Even if the scene is safe at first, bystanders, the shooter, even the patient can turn violent. Prepared for anything at any given moment is the hallmark philosophy to staying alive.
“RPD in process of securing scene,” I read the new information out loud. “Stage near the manager’s office.”
“Manager’s office?” my partner turns our ambulance left at an intersection. “That can’t be far enough.”
I hear the fear in his voice. Only six months ago, he suffered a knife wound from a patient’s husband who didn’t want us to resuscitate his wife. 
“I know these apartments,” I say. “Building G is in the back. Furthest away from the office.”
More information came across the screen.
“Patient took off on foot. Stumbled away from the shooter. He’s down. Gas station on corner of Hill Street and Brown Avenue.”
Once we arrive at the gas station and notice RPD has the scene in their control, I duck under the yellow tape blocking the public from our GSW patient lying supine in one of the parking spaces like a car. Five firefighters surround the patient, each one pressing towels to his abdomen, as countless cops hold the perimeter they’ve established.
The firefighters step away, allowing us to take over medical care.
    
 “Sir, can you tell me your name?” I yell over the chaos surrounding me.
“Ronald,” he uttered with a flutter of his eyes.
I peek under the wad of bloody towels to examine the wound in his upper abdomen. Since bullets often act like a plug, gun shot wounds often don’t produce heavy external bleeding. This one the exception.
“Package and go,” I say to my partner. “Ronald, what medications do you take?”
“Nothin’.”
Gunfire whizzes near my ear, busts the car window next to us. My heart is pounding as cops tackle some guy behind me. The scene is safe again.  
With the help of the firefighters, my partner and I log roll the patient onto a spine board, place the backboarded patient onto our stretcher, and wheel it toward our ambulance.
I lean my face near Ronald’s ear. “What about street drugs, Ronald? I’m not a cop, so it’s best for your health if you tell me the truth. I don’t want to inject any med—”
“Nothin’.”
“Okay.”
We load the stretcher inside the ambulance.
“Any health issues? Allergic to anything?” I continue to ask Ronald questions.
“No, no,” he says, squirming. “The pain. It’s bad. Real bad.”
“I’m sure. Hang in there with me, okay?”
One of the firefighters slip behind the steering wheel as two others hop into the back with me and my partner.
I place a bunch of bandages over the bullet wound, crisscrossing and stacking them. I spike an IV bag, as my partner inserts an eighteen gauge needle into our patient’s arm. As I connect Ronald to our cardiac monitor via a 12-lead, one firefighter maintains direct pressure to fresh towels over the bandages, the other wraps a BP cuff on the patient’s right arm then clips a pulse ox to his left index finger for a blood oxygen saturation reading.
I glance at the readings on the monitor. “Hypotensive and tachycardic,” I shout over the sirens wailing and engine roaring. “82 over 54. Pulse 160.” I feel his left radial artery. It’s thready. “Trendelenburg,” I say, instructing the firefighter on my right to lift the foot of the stretcher, a treatment of hypoperfusion (shock), this case hypovolemic shock due to blood loss.  
I’m thinking the bullet pierced the vena cava. If so, this patient is bleeding internally and surgery is vital.
As my partner shoots morphine in the IV catheter, I notice our patient’s eyes are closed and he’s still and silent. Blood oozes from his mouth. His oxygenation reading drops to 91%
“Ronald?”
He’s unresponsive. I press my fingers to his carotid artery. Pulse still present.    
I suction blood from his mouth. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  
I read the newest vital signs on the monitor, “74 over 46. HR 168.”
My partner grabs the radio, switches it to the closest trauma hospital.
“Wake Med ED? This is EMS 4.”
“Wake Med. Go ahead EMS 4.”
“We’re en route with a twenty-nine year old male. Abdominal GSW. Tachycardic at 168. BP falling, last reading 74 over 46. Trendelenburg position. Administered morphine. Endotrachael in place. ETA five minutes.”
I glance at the cardiac monitor screen. “Astyole,” I shout out. “Take over bagging,” I tell one of the firefighters.
I begin chest compressions, as my partner injects epinephrine and vasopressin into the IV line. Nine compressions later, Ronald’s eyes flash wide.
I smile down at him. “You still hanging in there with me?”
He nods as we pull into the emergency department.   

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Dianna Torscher Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book releases March 2013.

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. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. You can connect with Dianna via her website at www.diannatbenson.com

Author Question: Car Accident Injuries 1/2

Author questions are some of my most favorite posts to do. How do you really write an accurate medical scene? Which injuries are plausible and which are not?

Amy is visiting and Dianna Benson (EMS expert) and myself (ER nurse extraordinaire) are going to tackle her question. Dianna will be today and I’ll be Friday.

 

Amy asks: I am putting one of my characters in a pretty major car accident — a rollover in which she lands on a broken window and ends up with a lacerated back full of broken glass, in addition to a broken leg, fractured ribs, etc. I need a scene to take place in the hospital where she is recovering. With those kinds of injuries, what treatments would she be under? More importantly, how exactly would she be laying in the bed? Obviously not on her back. But would she be on her side or stomach? Perhaps that depends on the other injuries she sustains… but the lacerated back is the biggest one I want her to have.

Dianna Says: The story and the characters are first priority, so I’ll make the medical aspects fit into what you’ve explained. Since it sounds like you don’t have an EMS scene at all (no scene where rescue crews—EMS and fire—are present), it keeps it simple from my end, but I’ll give you pertinent background on what I’d do if I were the EMS crew on your scene. Also, based on the MOI (mechanism of injury) you described, I’ll explain what type of injures are possible. Every patient is different, every MVC (motor vehicle collision) is different, and every rollover is different, so that definitely gives you leeway.

First of all: I like the scenario: Your character runs a red light causing another car to slam into hers, which causes it to spin then roll over while her back is dragged on the asphalt over the broken window. I also like the adding of a boyfriend; yes, he’d definitely worsen her injures by landing on her, so have him either land elsewhere inside the car or just have him belted in (unless you want her seriously injured to the point she’s in-hospital for a long while and possibly suffering with lasting effects). Just so you know: The reason for the seatbelt law is not just to protect the person wearing the seatbelt; it’s to protect others from being struck by that person propelling in the air (inside and outside of vehicles) like a weapon. Just a thought — if she landed on the driver window and it’s a rollover, then the car is on its side (driver side) upside down, right? Make sure you’re clear about that.  

Any rollover is a high index of suspicion of injury; meaning, severe injuries and death likely. You have two separate impacts in this story: 1) Smash from the other car 2) Rollover. Therefore, you have two separate MOI’s and both cause different injuries.

Since fiction is about the story and the characters, make the speed of the car fit; meaning, if you want your character(s) to be seriously and extremely injured, keep the speed high. For a character who is injured and needing in-hospital care (not just on-scene EMS treatment and ED treatment) yet doesn’t sustain any life lasting effects or long term damage, then keep the speed down low.  

Possible injuries for both the side impact and the rollover: Again, every patient and incident is different, and I’ve seen it all—some accidents where based on the MOI patients surprisingly die and some where patients surprisingly live.   

1)      Whiplash: back and neck
2)      Air bag deployment: facial injures (soft tissue), labral tear (shoulder), etc.
3)    Seat belt injures (chest injuries, labral tear, etc.)
4)      Head injures
5)      Anything flying around inside the vehicle and hitting her and boyfriend
6)      Other possibles: knee ramming into door and shattering patella, elbow ramming into steering wheel, shoulder striking window., etc. etc. 
7)      Fractured femur or fractured tib/fib or just one of them (tibia or fibula) from twisting or hitting, etc. 
8)    Fractured hips
9)      Fractured ribs
10)      Etc. Etc. Etc.

A fracture is the medical term for broken bone.

Assuming the patent is unconscious when I arrive on scene, I’d verify she has a pulse and is breathing efficiently. If so, then I’d control all bleeding via wound care—sterilization and bandaging. I’d strap a C-collar (cervical collar) around her neck then extricate her from the vehicle onto a back board with padded blocks holding her head in place and strapped to the board. I’d splint any dislocations or suspected fractured (I don’t have x-ray vision) if not properly splinted via backboard. We do a ton of medical treatments and monitoring, but I won’t blah, blah, blah it all, especially since you don’t have an EMS crew on your scene.

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Dianna Torscher Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book releases March 2013.

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMSdegree. 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. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. You can connect with Dianna via her website at www.diannatbenson.com.  

Decompression Illness: Dianna T. Benson, EMT

If you ever write a scuba diver character, a deep sea diver, a search/rescue/recovery diver, a Navy submariner, etc., you’ll need to understand Decompression Illness (DCI), a serious illness caused by trapped nitrogen.

There are two mechanisms of DCI:

1)      Decompression Sickness

2)      Arterial Gas Embolism

SCUBA (Self-Contained-Underwater-Breathing-Apparatus) divers breathe a purified air mixture of 79% nitrogen and 21% oxygen. The longer a diver is breathing this mixture and the deeper he/she descends, the more nitrogen will be absorbed by the body. A slow ascent and a safety stop at about thirty feet for three minutes, allows the diver to efficiently exhale the nitrogen. Dive tables set limits for dive times and depths. Decompression Illness is caused by tiny nitrogen bubbles forming (instead of being exhaled) and becoming trapped in the blood and tissues.

There are two types of Decompression Illness:

1)      Type I

2)      Type II

Type I:

1)      Skin capillaries fill with the nitrogen bubbles, resulting in a red rash.

2)      Musculosketal: Joint and limb pain

Type II:

1)      Neurological decompression sickness: Tingling, numbness, respiratory problems and unconsciousness.

2)      Pulmonary: Bubbles interrupt blood flow to the lungs, causing respiratory distress or arrest.

3)      Cerebral: Bubbles travel to arterial blood stream and enter the brain, causing arterial gas embolism and symptoms of blurred vision, headache, confusion, unconsciousness.

General Decompression sickness symptoms:

Extreme fatigue, joint and limb pain, tingling, numbness, red rash, respiratory and cardiac issues, dizziness, blurred vision, headache, pain with swallowing, confusion, loss of consciousness, ringing in ears, vertigo, nausea, AMS (altered mental status), pain squeeze, SOB (shortness of breath), chest pain, hoarseness, neck fullness, cough. 

Factors that increase the risk of getting decompression illness: Dehydration prior to dive, stressful dive or rapid movements during dive, alcohol intake prior to diving, flying too soon prior or post diving, not following dive tables.

As every patient is different, every diver will have their unique combination of symptoms and reaction to both the illness itself and the treatment.

Decompression illness is treated by hyperbaric recompression chamber therapy. Only certain hospitals in the word have a hyperbaric chamber. The severity of the patient’s condition and his/her symptoms will decide the length of time the patient is treated inside the chamber. 

Nitrogen narcosis is also caused by trapped nitrogen, but this is a simple fix and isn’t serious if resolved. The diver simply ascends to a shallower depth until his/her symptoms clear. Symptoms include: An altered state of awareness and gives the diver an intoxicated state of feeling, incoherent reasoning and confusion.

As always, thank you for reading and for your interest. Please do not hesitate to ask if you have any questions.

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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. An EMT and Haz-Mat Operative in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com

 

Micheal Rivers: Altered Mental Status

I’m pleased to host guest blogger Michael Rivers today as he discusses the EMS perspective on altered mental status.

Welcome, Micheal!

EMS handles thousands of calls every year especially in the larger cities like Chicago. There is one kind of emergency call that can take the life of a Paramedic or EMT very quickly, or leave him or her with serious injuries. These calls are either for domestic or institutionalized people with altered mental status.

These calls are handled differently from other calls even involving shooting because the medical personnel have no idea what they can be walking into. Although he is there to help, the sight of the uniform alone can cause a very violent reaction from the patient. The ambulance personnel must not only be wary and insure the safety of the scene, but he has to be inventive when handling his patient.
Depending on the scene you never want the patient to hear your siren or see the flashing lights of the ambulance. It frightens them and they automatically become defensive. If you are running code 3(emergency) stop the siren and the lights a block or more before you arrive on the scene. If at all possible gather all the information on your patient and turn this to your advantage. These are some very good examples that work. This knowledge was gained through experience.
The patient was a 320 pound female confined to a psych facility for homicide. She was known to go through fits of rage even when under the influence of her medication. Arriving on the scene she was found in the nurse’s station sitting in a chair brooding. An armed security guard from the Sheriff’s department stood close by her. Due to the experience of the EMT’s, one stayed at the entrance while the attending EMT walked by the patient basically ignoring her while visually accessing her as he passed by. This assessment tells a great deal about who he is dealing with.
With a better knowledge of the problem and a few personal facts you begin to communicate with your patient. They want to be heard. Listen to them and find a way to get them on the stretcher without a fight. You may have to become an accomplished actor, but you have to convince them you are genuinely concerned and you are their friend, their guardian. In this case the attending EMT was able to get the vitals and convince her to get on the stretcher on her own when in the beginning she refused to be touched. If they had tried to force her, there would have been someone taking a lot of body damage. She was strapped x4 thinking it was for her safety.
Knowing the patient was not diabetic and was allowed sweets was a plus. With a simple cookie and the promise she would not be harmed, (history of physical abuse) she co-operated fully. She was even able to display sympathy for the EMT when he said he would get in trouble if she did not let him take her to the hospital. The call went smoothly and the patient was able to receive treatment without causing further harm to her.
These EMTs were very experienced. Experience cannot always let you see the unexpected coming. They specialized in the Altered Mental Status calls and knew exactly what to look for. Yet, Ambulance 04 was retired one year later after nearly being destroyed as the driver was attacked by a street person from inside the ambulance with altered mental status. This was an incident where the driver’s window was down to answer a man’s question. The street person dove through the window attempting to kill the EMT. At the time they had another patient inside the ambulance also with altered mental status.
This is a perfect example of the symptoms of altered mental status not being displayed by a person you are speaking with. If you are an EMT or Paramedic you already know the question; “Is the scene safe?”
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Micheal, born in 1953, is an American author. He served his country as a United States Marine during Vietnam. Born in North Carolina, he lived in the Chicago area in the past and furthered his education there and served the community as an Emergency Medical Technician. Micheal returned to the mountains of North Carolina where he resides with his wife and his Boxer he fondly calls Dee Dee. You can learn more about Micheal at http://michealrivers.com/.