Author Question: Law Enforcement Shooting with Vest in Place

Carol Asks:

I have a cop who is involved in a shooting. She’s wearing a vest and is hit outside the vest’s protective area. I need her hospitalized long enough that the shooter (who she killed— they shot simultaneously, more or less) to have been claimed post autopsy. I can’t have her debilitated for months— just a week or two. Where would I shoot her? Hip? Leg seems hard to hit and shoulder does too. I don’t want her disabled, nor do I want a months long rehab.

Jordyn Says:

What I would recommend is a shot coming through the side, under the armpit, causing the lung to collapse. I would pick the right side over the left— there’s just a lot more vasculature on the left that could prove deadly/problematic. If her right arm was raised and she was say . . . turning into the shot . . .  it could leave her vulnerable.

She would have difficulty breathing. How difficult would depend on how quickly the pneumothorax (air moving into the chest and deflating the lung) expanded. She would be transported to the ER via ambulance and receive an IV, oxygen, and vital sign monitoring.

A chest tube would be placed, likely after a quick chest film, unless she is in significant distress to re-expand the lung. If in significant respiratory distress or cardiovascular compromise then she would get a rapid needle decompression to buy some time or some facilities will go straight to chest tube placement. For a “simple” pneumothorax she would be admitted into the hospital (regular floor— not ICU) and observed.

Generally, depending on the size of the pneumothroax, it’s a few days to get the lung to re-expand, a day or two with the tube to “water seal” to make sure it stays up without suction, and then the tube would be removed. Maybe one or two more days after that to make sure all was well.

If she’s young and healthy she should recuperate pretty quickly, but would still be winded, perhaps easily fatigued for another week or two.

Hope this fits your time frame.

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.*
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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.

Reverie: Not so Medically Dreamy

NBC has launched a new summer show titled Reverie.  In it, Mara (ex traumatized cop, maybe psychologist) is recruited by a company specializing in making-your-dreams-come-true via a hyper advanced virtual reality program. The participants receive an implant that allows them to interact virtually with a program partly of their design.

Problem becomes, some of the clients don’t want to leave. Hence, our heroine, Mara, is recruited to go in after them and pull them back to reality.

In the first episode, it’s noted that the client has been in his dream world for two weeks and it’s commented by the staff that he’s essentially comatose. The man is lying on a bed connected to an ECG monitor and some oxygen via nasal cannula as pictured below. They give the man two days left to live providing a time pressure for the heroine.

However, medically, this man would have already been dead because they are not providing for either hydration or nutrition. This could be solved simply medically by inserting a feeding tube via his nose and providing free water interspersed with bolus liquid feeds. After all, thousands of people live in comatose states for years if their basic medical needs are met such as oxygen (if needed) and nutrition.

The heroine, Mara, is psychologically damaged. She’s had a significant personal trauma she hasn’t quite worked through. There is also a concern expressed by the designers of the program that something might not be quite right with it. When Mara enters the virtual reality program for the first time to retrieve a voluntarily trapped client they run an EEG on her which measures brain waves.

After she successfully retrieves the client, there is a conversation between the designer and lead dream architect that something is wrong with Mara’s EEG— something that indicates she could have a mental illness.

An EEG cannot diagnose a mental health disorder. Its use might be to determine if a patient has a medical cause that may be masked by some psychiatric like complaints such as a seizure disorder or sleep disturbance.

In episode 2, the producers must have gotten some feedback that they needed some actual medical equipment if they were concerned about these clients suffering medical complications. This time, a woman’s heart is going into erratic rhythms, specifically V-tach, because of the stress she’s under in her dream scape. But the medical equipment must make sense. What’s pictured in the photo to the right is what we call a rapid fluid infuser. It delivers IV fluids very quickly. Typically, it would be used in a trauma patient or one who is suffering from overwhelming sepsis where rapid delivery of IV fluids can be lifesaving. It is not appropriate for this patient who is suffering from a heart arrhythmia— much better to park a defibrillator at her bedside.

Have you watched Reverie? What do you think of the show’s premise?

Author Question: Transplanting an Infant with a Congenital Heart Defect

Erin Asks:

I stumbled across your blog earlier this week and you have no idea how incredibly excited I was to have made the discovery. I’ve been devouring your recent blog posts and I am so impressed with the details of your answers. You are amazing!

I recently finished the first draft of a novel, tentatively titled The Blood Farm. It is a story about what happens to society when we begin to view one another as commodities.

I have tried to do my due-diligence in researching medical practices, specifically organ transplants, but I’m not confident in all the details.

Here is my question:

In the scene, an unborn baby is diagnosed with multiple genetic defects (including hypoplastic left heart syndrome) that have caused her organs not to form correctly. She is scheduled to undergo a heart and double-lung transplant following birth. The mother goes into pre-term labor and the baby’s outlook is dire.

What would the procedure be for prepping this baby for transplant surgery?

Jordyn Says:

Hi Erin! Thanks for all the compliments regarding my blog. I’m so glad you have found it to be a useful resource.

First of all, for the blog readers, a simple explanation of hypoplastic left heart syndrome (HLHS) is that the baby is born with an underdeveloped left ventricle. The left ventricle is the primary part of the heart that propels blood out to the body and is larger in size than the right ventricle. If the heart’s strongest chamber is weak, it’s easy to see how this can be problematic for life. Also, this is generally not the only thing wrong with the heart when there is this congenital heart defect.

There are two approaches to the management of Hypoplastic Left Heart Syndrome. One is a three-staged operation over the child’s first few years of life and the other is transplant, but the first surgery will still be required to save the baby’s life even if going for transplant.

First thing to know about HLHS is that it is a ductal dependent lesion which means that the way the baby’s heart formed in utero is required post birth. When a baby is born— two holes in the heart close— one (the PDA) pretty early. We need to keep the PDA open for these infants so a drug called Prostaglandin E is given as a continuous IV infusion to keep this hole from closing.

Most often, babies with this condition are known prior to birth so once they are born they could be intubated depending on their work of breathing and oxygen levels. These infants have lower than normal oxygen levels and don’t have normal oxygen levels until after their third surgery, but they are always started on Prostaglandin.

The plot you propose regarding a heart transplant for a newborn infant is very tricky. It will take months to find a heart for this baby. The earliest a doctor friend of mine had heard about transplanting infant’s like this was at three months of age. As I mentioned, there is a three-stage operation that can also be done with survival rates at about 70%. From what I can tell from this article this matches the transplantation survival rate. However, the ethical argument, due to the limited availability of donated infant hearts, is that the three staged operation should be used in these infants to save those limited infant hearts for children with other conditions for which there is no other treatment.

Babies born with HLHS will not leave the hospital until their first surgery is done.

So, all this to say, I’m not sure HLHS would be the best condition to give this baby.

You might want to consider some of the hypertrophic cardiomyopathies. This pamphlet would be a good place to start.

Author Question: Transplanting an Infant with a Congenital Heart Defect  Click to Tweet.

Plants: Poisons, Palliatives and Panaceas Part 2/2

Author Kathleen Rouser returns to discuss the historical use of plants for medicinal and not so medicinal purposes. You can find Part I here.

Plants: Poisons, Palliatives and Panaceas
Part II

 

Foxglove/Anne Burgess

From the Middle Ages onward, medicinal plants grown by wives and mothers for their families were referred to as “simples”. One of them, foxglove, had been used to treat many maladies, even tuberculosis. By itself, ingesting a single leaf of foxglove can cause immediate heart failure. But housewives learned how to use digitalis, the drug derived from foxglove, as a stimulant for the heart. By the late 18th century, an English doctor recorded that digitalis would strengthen an ailing heart. Today, digitalis is often prescribed to treat heart failure, regulating the heartbeat and strengthening the cardiac muscle.

 

Deadly Nightshade/David Hawgood

 

Another poisonous plant, deadly nightshade, grows berries that can be fatal if eaten. Larger pupils were considered more attractive during the Middle Ages, so drops of juice from this fruit were once used to dilate the pupils of young women. It was called “belladonna”, meaning “beautiful woman” in Italian. Today, atropine is produced from deadly nightshade, to dilate patients’ pupils, so eye care practitioners can further examine their eyes.

American frontier families carried dried simples, some of them familiar to us as food seasoning, such as marjoram or thyme. They believed tasty sassafras would purify or thin the blood.

A popular tonic once used by mothers and prescribed by doctors in the nineteenth and early twentieth centuries was derived from the castor bean. A powerful laxative, castor oil cleansed the bowel, a treatment often used to cure whatever ailed you.
In ancient times Hippocrates warned against the use of opium, a painkiller made from the milky juice of poppies, because of its powerful addictive properties. This didn’t stop mankind from using it, whether to develop dangerous drugs such as heroin or pain relieving narcotics. In the 1660s, the English physician Thomas Sydenham produced laudanum from mixing opium with wine and saffron. This painkilling drug was used into the twentieth century. During the earlier 1800s, both the powerful narcotic morphine and the less potent codeine, were first made from opium extracts.

 

Willow Tree

As chemists learned how to extract and isolate chemicals in plants, they found just which components actually worked. German chemists were eventually able to analyze the bark of the willow tree. From ancient times extracts of willow bark had been used to reduce fever and relieve achiness, but not until 1899 was it known that the active ingredient was salicylic acid. Yet, decades passed before they figured out how this active ingredient, we know as aspirin, worked!

The shelves of our local health food stores are filled with herbs and ingredients made from many different plants. Some of these are based on folk remedies, proven successful throughout history, while others are yet unproven. Who doesn’t enjoy the soothing calm brought to one’s nerves through a cup of chamomile tea on a cold winter’s eve? Or settled an upset tummy with ginger ale or peppermint tea?  God knew what He was doing when He provided us with curative and nourishing plants—plants that we even derive many helpful and healing pharmaceuticals from today.

Thanks so much, Kathleen, and be sure to check out her forthcoming multi-author novel, The Great Lakes Lighthouse Brides Collection, releasing November, 2018

Plants: Poisons, Palliatives and Panaceas Part 2/2: Click to Tweet.

*Originally posted May, 2011.*

Resources:

Court, William E. “Pharmacy from the Ancient World to 1100 A.D.

Making Medicines: A Brief History of Pharmacy and Pharmaceuticals. Ed. Stuart Anderson. London, UK: Pharmaceutical Press, 2005. 21-36. Print.

 

Facklam, Howard and Margery. Healing Drugs: The History of Pharmacy. New York: Facts on File, Inc., 1992. Print.

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Kathleen lives in Michigan with her hero and husband of over 30 years. First, a wife and mother, she is “retired” after 20 years of home educating their three sons, who are all grown and have moved away.  Kathleen has been published in Home School Digest and An Encouraging Word magazines. She writes regularly for the local women’s ministry “Sisters” newsletter. She also contributes articles and author interviews to Novel PASTimes, a blog devoted mostly to historical fiction. You can connect with Kathleen via her website.