Careers: EMT/Emergency Medical Technicians/Serious Head Injury

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QUESTION: I am doing research for something I am writing, and during my research I came across a new story about a local woman who was hit by a car and sustained a "serious head injury".

http://www.kirklandreporter.com/news/34230414.html

But the story goes on to say that she was released from hospital a few days after the incident and is expected to make a full recovery.

I was wondering if you could tell me what kind of head injury would be considered "serious" in a situation like this? Is it likely this woman could have needed surgery and yet still been released from hospital so soon after?

I realize it's difficult to answer without knowing all the details of the incident, but any information you could give me would be very helpful. Thanks in advance!

ANSWER: Hi Alison,

Hopefully I might be able to shed some light on this.

First and foremost ALL head injuries are considered serious until proven otherwise. They are proven by either exam results and a neurologist and/or time. I have personally seen people who showed little or no outward indication of trauma who died of an internal head bleed. On the other side of the coin I once responded to a gunshot wound victim - shot directly in the center of his forehead. And the bullet failed to hit anything vital - he ended up surviving the incident with no ill effects afterwards.

In the case of the response you cited in all liklihood the media asked the responders about the call. Our answers are often generic and rehearsed; "We responded to a motorcycle accident and one victim was transferred to the trauma center for potential head injuries."

The hospital PIO then is called and answers, again generically, "We are currently evaluating one victim for potential serious head injuries."

Now, remember, only time and test results will truly prove whether or not there is brain injury in many cases. (permanent injury that is) So, in the end the patient is left with no residual injury and yet initially the injury was identified as "Serious".

Great question by the way. Amazing how the information we allow out is actually at times not as accurate as we would hope.

I sincerely hope that this helps you out. If not feel free to follow-up.

Take care,
Jim Wilson

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for the fast and thorough response, Jim, it definitely answered the question.

The reason I was doing research, as morbid as it probably seems, is for a storyline I'm writing. Unfortunately, since I'm not in the medical field, I have no way of knowing what kind of injuries could realistically be inflicted if someone were to be hit while crossing the street. For the storyline, I needed it to be something that could appear potentially life-threatening at the time, and be serious enough to require surgery, but that ultimately wasn't serious enough to result in a lengthy hospital stay.

I've asked around on reference forums and sites like allexperts, but no one has been able to give me any real answers or ideas. So I turned researching real life incidents that matched the situation in my storyline to see if I could figure anything out that way. But, as you said, the information is generic and not always entirely accurate. So that's been no help either. Too bad I'm such a stickler for accuracy, because I think I'm going to drive myself crazy trying to get this one right.

In case there's ANY chance that you could help, here are the basics of the situation:

30 year old male, in good health, is hit by an SUV while crossing a city street (30 MPH speed limit). The driver is distracted and doesn't see him, so doesn't have chance to slow down much (if at all). I don't know enough about physics to know if he's more likely to be knocked forward onto the street or up onto the hood, or which would cause more/worse injuries.

Like I said, it's been nearly impossible to get a clear answer that I can use to help me with this. The details of the situation aren't set in stone, so if I need to alter things to achieve the outcome I described above, I can try. I just don't even know what would need to be altered.

Sorry if this was a confusing mess.

Thank you again for your answer. :)

Answer
Hi Alison,

Ironically we just responded to the aid of a 12-year-old who was hit by an SUV that was traveling about 35 mph. She died of her injuries the most profound of which were head.

Many factors determine the patient outcome. (under or over the vehicle and such) If the person sees it coming they are likely to attempt to jump out of the way - they are already airborne and therefore they end up flying up and over the hood. It is also dependent on the angle of the hood. A jeep for example has a flat front and will push the person forward and down. A Toyota is more rounded and it more likely to cause them to fly on impact. In my experience most people see it coming and they fly. I have seen dozens of people take flight but can count on one hand the number of people who have been crushed.

So...

Your guy, even at 30 or so MPH, is very likely to fly back towards the windshield and the "A" post. (the first post that sort of connects the windshield to the door and body) Depending on how he hits this solid post it will cause a lot of damage. I have personally seen someone hit at around 25 who slammed into the A post and ended up with an open skull fracture as a result. In addition there would be lacerations from the windshield and other injuries including rib fractures and abrasions from where they finally slide off and land on the pavement.

It is unpleasant to say the least.

And...

The driver can also be injured. One unfortunate young man hit a pedestrian only to have the victim come flying up and through the windshield. The young man was struck by this 175 pound flying victim so hard that he broke his neck. Both were dead on the scene. (impact speed estimated at 45)

I hope this gives you an idea. Yes there is some science involved but there are lots of variables and thus I would also wager that most people would agree that there is also luck involved. I have seen people hit by a car going 45 and they walked away from it because it hit them, the flew up and over, landed relatively softly, and didn't hit anything vital.

Hope this helps!
Time for my dinner!!!!

Jim Wilson

Careers: EMT/Emergency Medical Technicians

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Jim Wilson

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I can answer questions regarding training, education, and experiences as well as providing some incite into the world of Emergency Medical Services.

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I have over 25 years of experience in EMS, Fire, and Air Transport.

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BS, AS, EMT-P, ACLS (and instructor), BLS (and instructor), PALS (and instructor), PPC (and instructor), BTLS (and instructor), PHTLS, and NALS. Have instructed EMT and Paramedic in Florida since 1986.

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