Monday, February 9, 2009

Trauma is Easy

People like to say that compared to complex medical calls, trauma is easy. Just backboard, Oxygen, and bang in an IV, they say. Still, it has been these trauma calls that have been tripping me up lately.

Its about scene control. These patients aren't supine in their nursing home beds with a neatly-printed medical history and medication lists at the ready. There are no nurses with the story, no recent diagnosis to help with the case. Instead we find these patients twisted up in their cars, drunken on the sidewalk or combative on the ground. Taking care of these people isn't simply about their medical problems, but also (sometimes even more so), about resolving the issue at hand. A combative, drunken man dressed in four snowcoats who needs to be exposed and backboarded provides a unique challenge, and I've found myself more than a few times at a loss what to do next.

A man drove through an intersection and T-boned another car at a high rate of speed. When we get there we notice immediately that both cars have significant damage, but only the occupants of the second car are on scene. They tell us that the man who hit them ran down the street, taking with him a small child who was also in the car. A few minutes later the police find the man, and call us over to evaluate him. He is about 30 years old, not making any sense, and gripping a two year old girl tightly to his chest. His left leg is severely deformed with an open tib-fib fracture. How he made it two blocks away from the accident on that leg, we may never know. We can't communicate with the guy. He is either altered, drunk, or doesn't speak english. ...Likely some combination of all three. He won't let go of the little girl, who is now screaming in terror and burying her face in the man's chest. This man's car is destroyed, with intrusion damage into the passenger compartment and windshield starring. We need him backboarded and to the trauma room, but he doesn't seem to understand and he won't let go of that child.

How long do we work with him? How hard do we try to coax the child away from his arms? Do we just pull the two apart and hold the man down as he struggles to get his child back? What is the best for both patients?

I wasn't sure.