Police

Author Question: Treatment of Teen Suicide Victim (1/2)

/ Jordyn Redwood / Leave a comment

Pink Asks:

Hi there! I’m so glad I’ve found your site and thanks for taking the time to read this. Ok, here goes.

I’m writing about a fifteen-year-old boy who is being abused physically and sexually by his father. One day at school, he tries to commit suicide by slitting his wrists. He becomes scared by the amount of blood, so he leaves the restroom to try to find help. He is found by his teacher and passes out. Now, I know with any kind of suicide attempt, the police are always contacted, and given the all clear for the paramedics.

Jordyn: I think it would depend on the city, county, school district (and whether or not there was a school resource officer) as to the level of police involvement if he just really needs medical attention. I would advise that if this is written about a real place you ensure they have co police response because a paramedic team would be able to handle this call.

Pink: What will the ED staff do to stabilize a patient who has slit their wrists? Is surgery necessary if the wound is pretty deep?

Jordyn: We always look at airway, breathing, and circulation first. If the patient is talking to us then we can quickly check off the first two as at least functional for the time being. As far as circulation the priority is to stop all active bleeding first by direct pressure. Also, does the patient exhibit any vital sign measurements that show he’s suffering from blood loss—which in this case could be increased heart rate, low blood pressure, and also low oxygen levels.

After that, the medical priority for this patient is to further control the bleeding and determine how much blood he’s already lost. Direct pressure is the method used to control the bleeding. Blood work would be done to look at his blood counts to see if he needs any blood replacement. Next would be to look at if he damaged any arteries, tendons, ligaments or nerves during the attempt. Generally, an exam of the function of the fingers can reveal if there is a concern there. For instance, do his fingers have full range of motion? Do any fingers have areas of numbness? Arterial bleeding is very distinct so it’s usually obvious if an artery has been severed. If he has damaged anything that would limit the function of his hand then he would need follow-up evaluation by a hand surgeon for surgery. If there is no damage to the structures as listed, there is a possibility the wound could be closed in the ER as a simple laceration repair.

Pink: Upon discharge, what will the patient be given to take home for treatment of their wound (the slit wrist)?

Jordyn: If the patient gets a simple laceration repair (merely closing the skin even if it takes a lot of stitches) then pain could be managed at home with over-the-counter pain relievers like Tylenol or ibuprofen. If the patient requires surgery, a short course of a narcotic may be given for pain control,    but we also have to look at other factors to determine if this would be wise for the patient (are they a current drug addict or is there continued concern for suicide attempt). If the patient has surgery, then it is up to the surgeon to determine the patient’s home pain relief.

Pink: If a nurse or doctor notices any bruises on the patient’s body, can they examine an unconscious patient?

Jordyn: Yes, an unconscious patient’s skin can be externally examined. In fact, it is often protocol to do so because we are looking for clues as to why the person is unconscious.

Well continue this discussion next post.

Medical Review of Fox’s 9-1-1

/ Jordyn Redwood / 4 Comments

I’m so happy to be back blogging! I hope everyone had a fantastic holiday season and is ready for a new year. Today is officially my 20th wedding anniversary! Can you believe that? I know I can’t. It’s crazy to think how much time has gone by.

Considering the occasion, I thought it would be best to write a positive (well, mostly positive) review of a new TV show— Fox’s series 9-1-1. I know . . . you can pop your eyeballs back in. This is truly a rare event considering much of this blog’s time is spent skewering medical inaccuracies in print, movies, and the small screen.

9-1-1 is a series devoted to dispatch, police, and fire calls. I’ve watched the first two episodes and was pleasantly surprised at how much I liked it. Now, it does have some problems. Writing completely to stereotype would be the biggest.

Let’s look at what they did well.

1. The characters face consequences for their actions. I’ve said all along that it’s okay for medical people to do bad things in fiction, but there must also be consequences for their actions. The point of this are many. It increases the conflict in the story AND reflects real life. Too many times in fiction medical people are shown doing bad things without consequence. One firefighter is shown facing some serious repercussions for his poor (saying that lightly) choices.

2. There is respect for HIPAA and also how hard that is for medical people. HIPAA is the patient privacy law. Because of HIPAA, most of us who work on the front lines (EMS and emergency departments) rarely ever hear how our patients do after they leave our care. This is, flat out, not easy for any of us and it makes closure difficult.

3. Shows the problem of poor coping mechanisms. It is true that healthcare people do not always have the best coping mechanisms. Hello, to all the nursing units with the mandatory chocolate drawer. Some develop addictions  and can have bad co-dependent relationships. It was nice to see highlighted that the stress of this work does take an emotional toll.

4. Highlights the difficulty of work/life balance. Of course, all professionals face work/life balance issues, but I also feel like the nature of our work makes it hard to feel like you’re getting a break. If you’re taking care of a medically/terminally ill loved one at home, and then go to work doing the same thing— there can be little room to breathe.

5. Medical information was not distracting. The medical information was kept pretty light in the first two episodes and not too distracting. There were a few minor medical errors I’ll keep close to the vest for now.

Have you watched the new Fox show 9-1-1. What did you think?

Author Question: Small Town Care for Complex Medical Patient

/ Jordyn Redwood / 2 Comments

Holly Asks:

In the very first chapter of the story I’m working on, the main character gets sent to hospital. The character in question is a sixteen-year-old female who has been missing for eleven years. She is found in the woods surrounding the town it’s set in and presents naked, severely malnourished, heavily pregnant, and with a gunshot wound to her leg. There are other superficial injuries that one might get when attempting to flee nude through dense woodland. The town and hospital are relatively small. The hospital has seventy-five doctors and forty-five nurses on staff and it’s in a fairly isolated location.

I’ve got a few questions:

1 – Would the hospital I’ve  described be able to treat a patient in this condition? What would be the basics of this treatment?

2 – Is there a procedure hospitals have in place for patients who act violent? My character hasn’t been around people for eleven years. She’s borderline feral and she attacks a doctor when she wakes up. Since she’s pregnant, I wasn’t sure if they’d be able to sedate her.

3 – Can doctors share information about patients with police officers? Since she’s a missing person and a minor, the police are going to be involved but I’m not sure how much doctors can share.

Jordyn Says:

Hi, Holly! Thanks so much for sending me your questions. These are complex ones for sure.

Question #1: Could a small town rural hospital be able to care for this patient? Maybe. One thing I want to clear up is your ratio of doctors to nurses. Usually, there are many more nurses in a given area than physicians so maybe adjust your numbers if you’re making a point about this in your novel.

When I first read your question, I thought the medical care aspects might be cared for by a rural hospital, but it was going to be a tough undertaking. This victimized teen is going to need, at a minimum, five services to be in place to stay in a rural hospital— a good general practitioner (to manage her overall care), a nutritionist (for the malnutrition), a surgeon (surgical evaluation of the gunshot wound), an OB/GYN (for the pregnancy), and a psychiatrist and/or psychologist (just because she’s been held hostage for eleven years.) Already that list is going to be tough and likely insurmountable for the area you mention.

What tilts the balance for me in saying she would have to go to a large, urban center are the psychiatric issues you mention in your second question.

Question #2: Yes, hospitals have procedures in place for violent patients, but the staff and mental health care specialists who will be required to manage her care are likely to be found at an urban center.

Violent patients are generally managed in a step-wise fashion. Can talking to them de-escalate their behavior? Is there something they’re requesting that we can give them to get them to calm down? Does she have some sort of object (like a stuffed toy) that giving her would help if it was safe for her to have?

If it’s more a fight response because of what she’s been through and she’s a danger to herself and others then she’d have to be restrained and placed under one on one observation. This type of patient can tax staffing resources which is another reason why transfer might be best.

Each drug is given a category related to its potential to harm a developing baby that is easily searchable via the internet. The categories go from Category A to Category D. Category A is deemed safest to D which has proven adverse reactions in humans. Just because a drug is listed as Category C or D doesn’t mean it might not be used. Several things would be taken into account— what we call risks versus benefits.

For instance, if she was late in her pregnancy, the doctors could risk it because the baby is fully developed. This is tough, though. Many physicians will err on the side of what’s safest for the pregnancy. However, you can’t leave a patient restrained forever and some form of psychiatric medication could be warranted here.

Question #3: Can doctors share information with police officers? Yes, they can. There is actually a special provision listed in HIPAA (the law that rules over patient privacy) that allows for this. Police officers mostly need to document what “serious bodily injury” the patient has suffered so they can determine what criminal charges to bring against a perpetrator.

The other thing to consider is the size of the local police department. Small towns may not even have their own police department but rely on the county sheriff’s office and/or state police to handle the investigation of this crime.

I actually think the best place for this teen would be the closest children’s hospital. Children’s hospitals have specialized teams in place to manage issues particularly around crimes against children. The caveat would be her pregnancy— for which she would likely deliver at an adult center.

Hope this helps and good luck with your story!

Author Question: Family Notification of Death

/ Jordyn Redwood / 4 Comments

Themelina Asks:

I have read some of your posts and I am wondering if I could please have some help regarding a book I am writing. I have three scenes in my book that are in a hospital. The background story is that a girl gets notified that her mom and sister have been in a car crash. Her mom has died and her sister is currently in surgery. Is it right that a police officer comes to her house and lets her know or does something else happen?

After she finds out she faints, and hits her head. I don’t want to make this part sound too serious. However, I still want her to go to the hospital. So what floor would she go to? How long would she stay?

Lastly, the third scene is where the sisters see each other after surgery for the first time. She is paralyzed. How could she communicate with her?

Jordyn Says:

Thanks, Themelina, for sending me your questions.

Question #1: Who would notify the family of the death? I could see this happening a couple of ways. If the mother was declared dead at the scene of the car accident then the police would notify the family. If the mother is transported to the hospital and the hospital team declares her dead then it probably falls on the hospital team to notify the family.

We don’t generally like to give death notifications over the phone. I’m not saying it’s not ever done, but not preferred. We would likely call the family and ask them to proceed quickly, but safely, to the hospital. This might also be preferred because the sister is requiring surgery and except in the most extreme cases surgeons generally like consent before they operate. If there is not a parent to give consent (you don’t mention a father in your scenario) it could fall to the sister, if she is eighteen or over, to give consent for her sister’s surgery.

Question #2: People who pass out and hit their heads are rarely admitted to the hospital. I’m assuming you want this sister to suffer some form of concussion. She gets the awful news about her family, passes out, hitting her head in the process. If she wakes up rather quickly (a few minutes or less), is oriented to person, time and place, and doesn’t show neurological signs of a brain injury that might require surgery then she would get a physician evaluation, a few hours of monitoring to be sure her symptoms are improving, and then she would be discharged home. There would also be no need to wake her up through the night. This is a myth.

Question #3: You don’t specify in your question the level of the sister’s paralysis. Her ability to talk will depend on the level of paralysis. Patients paralyzed from the neck down are, at least for a while, on a ventilator. When a person has a trach, there are special adapters for the trach that allows people to talk. However, a trach is not placed at the beginning and it takes time for a person to learn to talk with the special valve. If she is on a breathing machine and can’t write (because her arms are paralyzed), but is awake and can understand questions then we use a system of eye blinking for responses. One blink for “yes”. Two blinks for “no”. And obviously more simply phrased questions.

Hope this helps and good luck with your story!

Author Question: Police Notification of Violent Injuries by the ER

/ Jordyn Redwood / Leave a comment

Dale Asks:

I see in TV shows and movies people who are shot or stabbed go to get medical treatment and yet they never deal with the police. Or they refuse to go because they are afraid that it will get reported.  If a person is taken to the ER with a knife wound or gunshot wound, would the medical staff have to report it to the police?

Jordyn Says:

Police car lights close up. A group of policemen on the background.

Police car lights close up. A group of policemen on the background.

Yes, we have to notify the police if a person is shot or stabbed with nefarious intent. Knives can cause lots of wounds that aren’t criminally motivated. Think about the person slicing vegetables and cuts their finger. Knife wound . . . not criminally motivated. We wouldn’t call the police.

The most important aspect is whether or not the person is being truthful regarding their injury. It’s obvious if someone comes in with a gunshot wound that something criminal has likely happened.

If a person comes in with a knife stuck in their chest, we’re likely getting the police involved even if they say it was an “accident”. However, say a woman comes in with a defensive knife wound to the palm of her hand as she tried to keep her boyfriend from stabbing her, but she tells us that she cut it grabbing a knife from the bottom of a sink full of soapy water. If the woman doesn’t have any other suspicious injuries, we probably wouldn’t question her story.

In all honesty, we can only help patients as much as they are willing to help themselves. If they are truthful about the violence involved in whatever type of injury they have (particularly beatings from domestic abuse) then there is help we can offer them.

Ever wonder why you’re asked when presenting for medical care whether or not you feel safe? This is inherently because we know, as healthcare providers, that it is hard for victims to speak up. That question is your open door. If you feel you can’t answer honestly at the time, then look for a way to speak to your nurse or physician privately. Sometimes we try and facilitate a conversation like this by asking other visitors to step out of the room. If we do this, it should signal to you that we are suspicious that your injury did not happen the way you stated and we’re trying to find a way to help you.

It is true a patient might not seek medical treatment for fear of police involvement. The same can be true for child abuse injuries. A parent may not seek treatment or delay treatment for fear of being reported to child protective services and/or the police.

See how the different variables can vary to increase conflict in your story?

ED Issues: Cop versus Nurse

/ Jordyn Redwood / Leave a comment

My brother works in the next county over as a deputy sheriff. I always say a writer is blessed if they have a law enforcement officer and a medical person in the family. That helps cover a lot of manuscript issues. My brother does patrol so, at times, he’ll bring a person in custody to the ER for drug testing. After a frustrating interaction with the ED staff, I’ll get an irate call from him, “Why did the ER do that!” Most often, it has to do with making him wait.

Personally, I have a great respect for the police and know their time is valuable as they would rather be on the road than stuck in the ER. Most areas of conflict come up when we don’t understand the other’s work. ER nurses get upset with the floors when they don’t take an admission quickly because we can’t stop what walks into the department even if we close to ambulances. The floors think the ED didn’t do enough of an evaluation and left too much for them to do. Nearly every agency that receives and hands-off people to someone else has sources of conflict– this is guaranteed.

When my brother called to complain about how long he’d had to wait for his prisoner to get his lab work, I immediately wanted to defend the ER workers.

These are the first things I thought.

1. The prisoner is a low priority. We’re going to take care of sick patients first. The higher the acuity in the ER, the longer the wait time is likely to be. We have to save lives first.

2. Confusion on what needs to be done. I remember this from my adult ER days. We’re not drawing blood or doing drug testing on prisoners every day. Since it’s not something done often, there are likely questions on the proper procedure. We’re going to want to make sure it’s done correctly, particularly if it goes to court. The delay could be the staff actually researching how to handle the situation (what tubes to put the blood in and what paperwork to fill out).

3. The prisoner has a babysitter. I know that’s a horrible term for a police officer. Generally, a police officer cannot leave someone who is in his custody. So, as the ER staff, we know there’s an extra set of eyes on that person and we will worry less about something happening to them.

What other sources of conflict do you see? Have you written a scene with a mix of ER and law enforcement?