Gun Shot Wound

Posted by on Feb 11, 2013 in Blog, Medical/EMS | 0 comments

EMS expert and author Dianna Benson blogs today writing a first person account of caring for a gunshot wound victim. I love how she’s written this post with such detailed information that portrays the medical info so accurately. EMS 4. Gun Shot Wound. 123 Main Street, Apartment G.  I flip my book closed—Jordyn Redwood’s newest suspense—and zip it inside my backpack. I rush from my station’s crew quarters to the ambulance bay. My partner slips behind the steering wheel; I signal us en route to the call via our laptop nailed to the dashboard. “Twenty-nine year old male, GSW in abdomen, conscious and breathing,” I relate the facts as I read them on the laptop screen. “Raleigh PD already on scene.” I wait for further information to display; my nerves rev up. GSW calls often place EMS in deadly situations. Even if the scene is safe at first, bystanders, the shooter, even the patient can turn violent. Prepared for anything at any given moment is the hallmark philosophy to staying alive. “RPD in process of securing scene,” I read the new information out loud. “Stage near the manager’s office.” “Manager’s office?” my partner turns our ambulance left at an intersection. “That can’t be far enough.” I hear the fear in his voice. Only six months ago, he suffered a knife wound from a patient’s husband who didn’t want us to resuscitate his wife. “I know these apartments,” I say. “Building G is in the back. Furthest away from the office.” More information came across the screen. “Patient took off on foot. Stumbled away from the shooter. He’s down. Gas station on corner of Hill Street and Brown Avenue.” Once we arrive at the gas station and notice RPD has the scene in their control, I duck under the yellow tape blocking the public from our GSW patient lying supine in one of the parking spaces like a car. Five firefighters surround the patient, each one pressing towels to his abdomen, as countless cops hold the perimeter they’ve established. The firefighters step away, allowing us to take over medical care.  “Sir, can you tell me your name?” I yell over the chaos surrounding me. “Ronald,” he...

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Author Question: Car Accident Injuries 1/2

Posted by on Oct 3, 2012 in Blog, Medical/EMS, Uncategorized | 0 comments

Author questions are some of my most favorite posts to do. How do you really write an accurate medical scene? Which injuries are plausible and which are not? Amy is visiting and Dianna Benson (EMS expert) and myself (ER nurse extraordinaire) are going to tackle her question. Dianna will be today and I’ll be Friday. Amy asks: I am putting one of my characters in a pretty major car accident — a rollover in which she lands on a broken window and ends up with a lacerated back full of broken glass, in addition to a broken leg, fractured ribs, etc. I need a scene to take place in the hospital where she is recovering. With those kinds of injuries, what treatments would she be under? More importantly, how exactly would she be laying in the bed? Obviously not on her back. But would she be on her side or stomach? Perhaps that depends on the other injuries she sustains… but the lacerated back is the biggest one I want her to have. Dianna Says: The story and the characters are first priority, so I’ll make the medical aspects fit into what you’ve explained. Since it sounds like you don’t have an EMS scene at all (no scene where rescue crews—EMS and fire—are present), it keeps it simple from my end, but I’ll give you pertinent background on what I’d do if I were the EMS crew on your scene. Also, based on the MOI (mechanism of injury) you described, I’ll explain what type of injures are possible. Every patient is different, every MVC (motor vehicle collision) is different, and every rollover is different, so that definitely gives you leeway. First of all: I like the scenario: Your character runs a red light causing another car to slam into hers, which causes it to spin then roll over while her back is dragged on the asphalt over the broken window. I also like the adding of a boyfriend; yes, he’d definitely worsen her injures by landing on her, so have him either land elsewhere inside the car or just have him belted in (unless you want her seriously injured to the point she’s in-hospital...

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A Scoliosis Journey

Posted by on Jul 20, 2012 in Blog, Medical/EMS | 0 comments

If you want your character to struggle with a disease starting in childhood and worsening in adulthood, scoliosis may be the right one to choose to create long-term drama and conflict. At age nine my daughter was diagnosed with scoliosis with a twenty degree double curvature; meaning, her spine was S-shaped due to a thoracic curve and a lumbar curve jutted in opposite directions. For a year she only had x-rays every few months to monitor the curvature as she grew.   At age ten it increased to twenty-eight degrees, so she was placed in a full body (torso) bending brace twelve hours a day. The bending brace overcorrected her spine to allow only twelve hours per day wear versus twenty-four. She wore the brace for five years and had x-rays regularly to monitor the curvature. At age fifteen, an x-ray of her hip showed the growth plate closed, indicating she was nearly done growing. Scoliosis protocol at that point indicates the brace is no longer necessary.   Every patient is different, and for her the curvature worsened out of the brace, the first year to thirty-three degrees. An increase isn’t uncommon as the body adjusts to life without a brace, but unfortunately her increase continued and was rapid and severe. When she was seventeen, her curve worsened to thirty-seven degrees. Less than a year later to forty-four degrees, which led to her five-hour surgery May 2012 performed by the top scoliosis surgeon in America who operates on professional and college athletes. Her freshman year in college (fall 2011), she started to suffer with acute back pain. A full scholarship college swimmer, she pushed through the pain during the swim season, even at ACC Championships in February and NCAA Championships in March. From fall to spring, she endured three in-hospital spinal injections, plus took pain meds and an anti-inflammatory regularly. Due to the year of intense pain she suffered, her Virginia Tech coach was stunned by her performance at ACCs—she broke records, swam the fastest 100 backstroke time of the meet, and her performance qualified her for NCAA Championships, which is tougher to qualify for than US Olympic Trials. At NCAAs, her right leg numbed due to nerve involvement and her back muscles froze to protect her spine, forcing the need for the VT trainers to drag her out of the pool after...

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Author Question: The Pesky Reporter and the Wildfire

Posted by on Jun 27, 2012 in Blog, Medical/EMS | 0 comments

Charise’s question is very pertinent particularly with so many wildfires burning in my home state of Colorado right now. How does EMS handle it all? Charise asks: I’ve got a forest fire happening and a news photographer out trying to get the best shots. She’s walking around recently scorched areas. Her car is parked on black top.  It’s still pretty hot and smoky but she is there without an air tank so it can’t be too crazy. I need her car to be inoperable but nothing too crazy like exploding. Is it possible that parked on asphalt, the tires would blister or begin to melt (but a person could still be okay walking around on the dirt)? It seems the way heat is conducted in the earth vs. pavement makes this plausible? Also, I know animals flee a fire but do they get caught sometimes? Is it possible she’d come across a dead deer? After she leaves the area, it’s normal she’d have some smoke inhalation problems? Coughing, hacking, etc? Does that require medical treatment or would she be left alone since she’s lucid and otherwise healthy? Dianna says: My first thought is that rescue personnel (fire, EMS, law enforcement, haz-mat, etc.) form a perimeter (boundary circle) of three areas: the hot zone, the warm zone and the cold zone. Hot zone is where the actual emergency event is occurring (in your story case, the forest fire). Warm zone is the surrounding area next to the hot zone; it’s for rescue personnel to enter and exit the hot zone and for decontamination. Cold zone is the area beyond the warm zone and is the only area okay for civilians, including the media. That said, your character wouldn’t be allowed in an area that her car would experience the damage you stated. Now, of course, sometimes the media and other civilians enter a restricted area like the warm zone (they wouldn’t enter the hot zone unless they’re willing to die). So, you could certainly add that into your story, but she would have charges brought on her, so your story needs to reflect that. It sounds like you have your reporter character staying with rescue crews, and that’s not accurate. We ”deal with” the media this way — we tell...

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Decompresion Illness

Posted by on Apr 27, 2012 in Blog, Medical/EMS | 0 comments

If you ever write a scuba diver character, a deep sea diver, a search/rescue/recovery diver, a Navy submariner, etc., you’ll need to understand Decompression Illness (DCI), a serious illness caused by trapped nitrogen. There are two mechanisms of DCI:   1)      Decompression Sickness   2)      Arterial Gas Embolism   SCUBA (Self-Contained-Underwater-Breathing-Apparatus) divers breathe a purified air mixture of 79% nitrogen and 21% oxygen. The longer a diver is breathing this mixture and the deeper he/she descends, the more nitrogen will be absorbed by the body. A slow ascent and a safety stop at about thirty feet for three minutes, allows the diver to efficiently exhale the nitrogen. Dive tables set limits for dive times and depths. Decompression Illness is caused by tiny nitrogen bubbles forming (instead of being exhaled) and becoming trapped in the blood and tissues. There are two types of Decompression Illness:   1)      Type I   2)      Type II   Type I:   1)      Skin capillaries fill with the nitrogen bubbles, resulting in a red rash.   2)      Musculosketal: Joint and limb pain   Type II:   1)      Neurological decompression sickness: Tingling, numbness, respiratory problems and unconsciousness.   2)      Pulmonary: Bubbles interrupt blood flow to the lungs, causing respiratory distress or arrest.   3)      Cerebral: Bubbles travel to arterial blood stream and enter the brain, causing arterial gas embolism and symptoms of blurred vision, headache, confusion, unconsciousness.   General Decompression sickness symptoms: Extreme fatigue, joint and limb pain, tingling, numbness, red rash, respiratory and cardiac issues, dizziness, blurred vision, headache, pain with swallowing, confusion, loss of consciousness, ringing in ears, vertigo, nausea, AMS (altered mental status), pain squeeze, SOB (shortness of breath), chest pain, hoarseness, neck fullness, cough.   Factors that increase the risk of getting decompression illness: Dehydration prior to dive, stressful dive or rapid movements during dive, alcohol intake prior to diving, flying too soon prior or post diving, not following dive tables. As every patient is different, every diver will have their unique combination of symptoms and reaction to both the illness itself and the treatment. Decompression illness is treated by hyperbaric recompression chamber therapy. Only certain hospitals in the word have a hyperbaric chamber. The severity of the patient’s condition and his/her symptoms will decide the...

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Unbelievable Real Life, Believable Fiction

Posted by on Mar 12, 2012 in Blog, Medical/EMS | 0 comments

When I hear a reader say: “That’s not realistic; all of that couldn’t happen to one character.” I think, “That reader has skirted through life with little trial.”Spring 2009, a cop barreled into our car, injuring my oldest daughter, my son and myself. My husband and our youngest daughter escaped uninjured. The two kids healed; I suffered a shoulder and cervical injury. Actually, those injuries initially occurred when I was in a bicycle accident (a driver ran a stop sign); the car accident worsened those injuries. A few months following the car accident, my husband’s biopsy on an enlarged lymph node was negative, but a few months later he was diagnosed with head and neck cancer (the biopsy results were wrong). In 2009 and 2010 he endured two surgeries and cancer treatments. During this same time, our son battled a mysterious illness I suspected was Lyme disease since he had fourteen Lyme’s symptoms, but Curtis didn’t test positive so no physician would listen—see Brandilyn Collins’ posts May 2011 titled: The Lyme Wars. Most Lyme’s patients don’t test positive. For the love of hockey, Curtis fought the pain and continued to play; unfortunately, he suffered a shoulder separation during a game. In a sling for that injury, he had a MRI on a large cyst behind his knee; it tested benign. Hoping I was wrong about Lyme, I agreed to allergy injections to treat Curtis’ allergy-like symptoms. Days after the injections started, he developed a systemic rash. The allergist responded, “There’s an underlining cause.” So, I told an infectious disease MD, “Don’t think of me as a mom; as an EMT I’m telling you this patient has Lyme disease. Please help him.” After several months of Lyme’s antibiotics, Curtis improved but still battled bilateral knee and ankle arthritis. My orthopedic surgeon (explanation later in this paragraph) diagnosed Curtis with Lyme arthritis saying, “Bring on the CDC; this kid has Lyme disease and I’m treating him as so.” During the several months of Curtis enduring tons of doctor appointments (pediatrician, allergist, dermatologist, infectious disease, rheumatologist and orthopedist) plus countless tests, my shoulder worsened to the point I needed surgery to repair a labral tear. To date, Curtis...

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