Author Question: Motor Vehicle Collision 2/2

Today, we’re focusing on Susan’s questions surround two victims of a car accident. You can find the first post here.

Let’s turn our attention to the second patient.

Patient #2: The passenger (the above’s twenty-six- year-old sister) flies from the convertible.
1. If she was found unconscious about 20 feet from the vehicle without any injuries, how would EMT’s treat her?

2. Would she still be in her own clothing while unconscious at the hospital?

3.What sort of treatments would they give her, if any, at the ER? IV’s, examinations, etc?

We find out later that the passenger actually was near death and healed by a supernatural character. She actually hit her head (skull fracture?) and is close to death when he finds her

4. Is this scenario even possible or would she have immediately died from the injury?
5. If her survival was impossible, what can I make her injuries so she can be healed by the other character?
6. How would she appear? Eyes open, eyes closed, or would it matter? Vomit? Skin coloring?
Jordyn Says:
1.  One, they’ll assume she could be gravely injured considering her mechanism of injury. They’ll first check to see if she’s breathing and has a heartbeat. At the same time, they’ll be stabilizing her spine by putting on a C-collar and placing her on a backboard. If she’s breathing on her own at an adequate rate, they’ll give her some oxygen via a mask. If she’s not breathing or doesn’t have a pulse then they’ll begin resuscitation by giving her breaths and doing CPR. After those major things are taken care of, they’ll start an IV to give her some fluid. Then begin to look for secondary injuries. An unconscious patient thrown from a vehicle will have presumed traumatic brain injury or TBI.
2. If the EMS team can provide her adequate care without cutting off her clothes, then they’ll leave her that way until she gets to the hospital.

3. In the ER, we start where the EMS team left off. We’ll start our assessment much in the same way the EMS team does. We continue any care they’ve provided. If they were unable to get IV access—we’ll start to work on “getting a line”. We’ll do a detailed secondary survey looking for other injuries which means entirely undressing the patient, log-rolling them to their side and checking for injuries to their back as well. A catheter would be inserted into her bladder and the urine tested for blood and she’d also likely get a pregnancy test.

Additional tests in the ER for this unconscious patient would be: x-rays of her spine, CT of her brain and likely chest and abdomen. Some baseline labs: blood counts, electrolytes, labs that look to see if organs have been injured and bleeding time studies. They’d likely “type and cross” her for blood products. Any other injuries would be x-rayed as well—for instance if her arm were misshapen or significantly bruised.

The unconscious patient is challenging because they can’t tell you what hurts.

 4. Skull fractures can run the gamut and there are several different types of skull fractures. A patient could have a traumatic brain injury that eventually causes death but just have a simple linear skull fracture. Or, a patient can have a depressed skull fracture and be awake and talking to you. As an author, you have a lot of leeway here.

5. I guess it depends on what you mean my “healing”. Do you want her to have evidence of injury but be fine?

6. I’ll go with the assumption that she presents to the ER unconscious. An unconscious patient can look relatively well to nearly dead—again, you have a lot of leeway here. They can “appear to be sleeping” except they’re completely dead weight. There are specific vital signs a patient will demonstrate when their brain is swelling but I’m not sure you want to go that route.

Hope this helps and good luck with your novel!

Head Injuries: Jason Joyner

There was that time when the editor saved the medical professional.

As a physician assistant, I enjoy having medical aspects in my story. But even medical folks can slip up and have errors in our fiction.

I have a scene where my heroine gets head trauma and wakes up later in the clutches of the villain. The freelance editor, Ben Wolf, wondered about that. He had read that if there was significant time of loss of consciousness (LOC), then it suggested a serious injury that would be hard for the victim to bounce right back from to be active.

One of my pet peeves is when characters are injured and recover too fast, so I had to look into this again.

Basically, my heroine suffered a concussion, also known as a Traumatic Brain Injury (TBI). Symptoms of a concussion can include headache, confusion, dizziness, visual changes, a blunted affect, and may or may not include LOC. (People always flash lights in pupils to check for concussion. If the pupils are affected, it is a serious sign and they won’t be up and active soon.)

LOC usually is only for a few minutes, and as my editor noted, will mean a much more severe injury if it lasts for hours.

Blast. Foiled by the editor.

Except, you can use the amnesia angle.

A concussion with LOC may have retrograde (before the incident) or antegrade (after the incident) amnesia. According to one research article, the antegrade amnesia can last for a few hours after the incident. I can attest – I had a concussion in 5th grade and couldn’t remember a couple hours afterwards.

So if you need your protagonist to be out of it for a while, keep the actual LOC on the short side and use the amnesia angle to get you where you need to be. The victim may be incoherent, unsteady, with a blank expression during this time. Use these symptoms to add drama to the situation.

When your protagonist comes to, it is actually the end of antegrade amnesia. I remember with my concussion it was like I “woke up” after lunch during our quiet reading time at school. I was confused, unsure of what happened. I could remember part of the morning, but about two hours was blank. I even found a goose egg on my head later, but I didn’t know how it got there.

So that was my work around. My heroine didn’t have LOC the whole time. But there was enough injury to cause confusion and amnesia, keeping her from attempting escape. There you go Ben. A few minor tweaks, and all is well. Except for my heroine, who’s tied up and threatened. But that’s another story.


Jason loves good stories and wants to use words to make a difference. When he’s not writing, playing soccer, or losing in fantasy football, he works as a physician assistant in southeast Idaho. He also tries to keep up with his awesome wife, three high-energy boys, and his little princess. He writes suspense and YA supernatural, and likes to use his medical experience to punch up the stories. You can find him on Twitter @JasonCJoyner or his blog at