Tuesday, January 18, 2011

T is for Trauma

Before we moved to the midwest, I worked at a Level 1 trauma center, and for the year I worked in the ER there, I got truly excellent training and experience with trauma patients. There's always plenty more to learn, though, and you've never seen it all.

In the south, trauma season is summer. Well, summer is the height of it, anyway. Everybody gets out their motorcycles, ATVs, boats, jet skis, and what have you, and they get a little crazy. Here, winter is trauma season, because despite its annual recurrence, nobody seems to remember how to drive in snow and ice from year to year.

My current ER doesn't meet all the requirements to be a Level 1, so we're a Level 2. Basically, we don't have all the capabilities and resources of a Level 1. That also means you get fewer trauma patients, and your nurses have less training and experience.

So last week when the charge nurse pulled me out of triage and said, "We're getting two really bad traumas. I'm giving you the baby," it was a little disconcerting. Me? Are you sure?

Yep, they were sure. Fortunately, I also had a lot of help from the on-site EMS training staff and the trauma coordinator. We didn't get much of the story beyond that it was a car vs. dumpster at about 35 mph, and nobody was wearing seat belts. Two of the patients went to our neighboring hospital, and two came to us. They did it a little backwards, though - sent us the toddler and the pregnant patient, and sent the fifty-year-olds down the road. Why backwards? We don't have a pediatric unit or a mother/baby unit. Oops.

My patient was an 18-month-old girl who, instead of being in a car seat, was in her mother's lap.


Huge laceration on her forehead, another just below her nose, bit through her tongue, and a tooth missing. And that was just what we could see. She was crying inconsolably and really acting like she had more of a head injury than what we could see.

The ER doctor took one look at the laceration and had the secretary start making phone calls for a transfer to a facility with a pediatric ICU.

The little girl had been c-collared and creatively restrained in the big orange EMS car seat so that she was sitting upright instead of laying flat. Probably a good idea, considering the cut below her nose. We did the trauma thing, took off her clothes, put her on the monitor, drew blood, started an IV. I had her in the CT scanner 20 minutes later, and she had only been there for an hour and eight minutes when the helicopter landed to transport her elsewhere.

Now, she was the first trauma patient I've had to send elsewhere by air, but that has to be some kind of record. I'm just glad the doctor acted as quickly as she did, otherwise my patient might have lingered with us much longer.

She was one lucky little girl, though - no skull fractures, no bleeding in the brain, no other injuries. Just some nasty lacerations.

Looking back at it, though, the whole situation was pretty ridiculous. I mean, come on. First of all, who in their right mind takes the risk of not putting their child in a car seat? I understand they can be expensive, but isn't your child's life worth shelling out for the cheapest one you can find? And if you can't afford a car seat for your one child, why on earth are you having another?

I know, I know. They didn't think about it that much. Or plan. Or whatever.

I think that if I have to deal with the results of your poor decision-making, I earn the privilege of criticizing it.

Now, I realize that it wasn't all that long ago that it was common practice to put your baby on your lap, or your toddler on the bench seat next to you. Things change so quickly, though. Cars today go much faster, and we let a lot more people drive. Who, evidently, shouldn't.

I really hate it for that little girl, that she'll have that scar front-and-center. I guess the good thing is that right now, for the worst of the healing process, she's too young to care. And every time her parents look at her, they will, hopefully, be reminded of the importance of buckling up.

So in case you weren't sure about it, learn from their mistake. Buckle up.

1 comment:

  1. Bo has a scar from his eye brow across his forehead and back across the top part of his skull from an accident where he was not in a car seat. Not to mention majority of health dept give car seats away for free or a minimal price. There is no excuse for not buckling you child up!