Careers: EMT/Emergency Medical Technicians/emergency room treatment of head wounds
QUESTION: Hi, Jim. I'm another novelist, writing about a young man who's had a motorcycle trailer tip over on him. He has severe head injuries and is on life support while they see about harvesting his organs. He's been taken by ambulance to an ER in the next town. My question is: How would they have treated superficial cuts and scrapes and generally cleaned him up before his family sees him? He has a badly fractures skull and brain matter has come out. He was a mess when his wife last saw him. Would he be completely bandaged with none of the cuts and bruises showing or wouldn't they bather? For the story, it would be good if he looked awful, but is that realistic? Thanks for your help. I want to get this right.
ANSWER: Hi Judith,
If it is realism you are seeking you will have to clean him up a bit. Here's why...
Basically before they could declare that he is actually suffering from fatal injuries he would be taken to the OR. In prep for the surgery they would clean him up as much as possible. In case he might somehow survive to prevent infection. And, in the case they intend on harvesting his organs, to prevent his organs from becoming contaminated.
They have cleaned him up a bit and have actually covered any grossly open wounds and, in the interest of providing his family with some comfort, will allow them to see him prior to "pulling the plug".
A 19-year-old decided to kill himself and suffered a horrible gunshot wound to the side of his head. When we arrived he was still alive (well, still breathing and had a pulse anyway) but his wound was obviously fatal. Half of the side of his head was quite literally gone. We transported him into the ER where they cleaned him up a bit, confirmed the extent of the damages, and then basically wrapped his head in what amounted to a turban to cover the wound. His family was then allowed to come in and say their good-byes. His face was swollen and he was on a ventilator. He did not look anything like he looked prior to the incident. But the point was to give the family some closure with at least some slight measure of humanity. I cannot imagine his mom seeing the open wound he suffered. But at the same time I cannot imagine not letting her say she loved him one more time while he was still "alive".
The family got to see him one final time. A blanket was pulled up as if to keep him warm but in reality it covered much of the medical equipment still keeping him alive. His head was wrapped in a cloak of deceit that obscured a view of the horrible wound that had been suffered. The gaping hole was still there - it was simply covered with a thick layer of dressings. And they got to hug him and say goodbye.
I hope this helps. Take care and Happy 2013!
---------- FOLLOW-UP ----------
QUESTION: Thank you. Your answer was fabulous, just what I needed. But now I need to know if a person in an ambulance stops breathing, is the ambulance equipped to intubate? Are there a vntilator on board? Are EMTs trained and permitted to use it?Is it possible to say that the person was "on life support when he was brought in to the ER?" The reason to keep him alive is to harvest his organs. Can this be done? (Or do I have to have him stop breathing in the ER?)
Glad my answer helped. As for intubation, here in Florida EMT-Paramedics do indeed perform invasive airway maneuvers. This actually includes even surgical airways if necessary.
In the event we are trying to buy a patient time, whether to salvage them or just their organs for harvesting, we will secure an airway. In one recent case we actually administered RSI medications to allow us to get the intubation done.
We aren't 100% sure that the patient won't make it by the way - we treat the patient as much to attempt to give the patient as much of a chance as anything else.