Injuries from Motor Vehicle Accidents: What is a Trauma Center? Why Should I Care?

Emergency Room, Chealion, FlickrWhere should I go?

When I had my motorcycle crash and received a severely broken leg, I had no idea that the hospital I had chosen to be taken to for treatment was a level IV trauma center. Nor was I aware that Washington State uses a 5 level rating system for the various hospitals/trauma centers associated with these hospitals.  The trauma nurse and doctor at Northwest Hospital looked at my x-rays and discovered that they were going to stabilize me for transport and that would be about it. I was going to need much more surgical specialty personnel than was immediately available for them to muster. Oh, joy.  Another ambulance ride.

The pain from being moved around for a dozen x-rays was getting to the point where medications alone weren't effective and it was time again for distractions and daydreaming - taking my brain away from the pain, like with the Shoreline paramedic talking with me about my once- beautiful bike (Grrrrr!). Yup, that worked and now that I know it will only work for a couple of minutes, I started thinking about trips my wife and I have taken - standing on the observation platform atop the Eiffel Tower in Paris, gaping at the Crown Jewels in the Tower of London, watching humpbacked whales in the Strait of Juan de Fuca ; the vivid, Technicolor type memories that are forever etched in your mind. Those memories are the ones that seem to work best to push pain down and away. I still felt it, but the pain was much more tolerable and allowed the medications to work better.

Trauma Center Ratings

Level V (5) is the lowest rating for a Washington trauma center and level I (1) is the highest. If you live in Washington, Idaho, Montana or Alaska and need a level I trauma center, you will be going where I wound up - Harborview Medical Center, Seattle, The State of Oregon has two level I trauma centers in Portland to help cover that state and SW Washington.

The trauma center with a level I rating is going to have 24/7 staffing and on-call availability of every specialty doctor, nurse, anesthesiologist, and technician that severely injured people might need, including burn and plastic surgeons.There will also be on-site most diagnostic and imaging devices these specialists will need to help fix you up.  In my case, it was for the orthopedic surgeons. (Yay, HMC Green Team!) The centers with levels II, III, IV and V will triage patients, and if they can be stabilized, they will send them off to a higher level facility that will have necessary staff waiting or on the way when the transferred patient arrives by ambulance or helicopter. There are many rules of triage and transfer these trauma centers follow and these guidelines vary from state to state. Look up specifics for your state or states you're likely to travel through as part of a pre-trip planning guide. It could help steer you towards a better choice and eliminate unnecessary transferring. And unnecessary pain.

Triage at the Trauma Center - Three Days Without Food

One thing to keep in mind about trauma centers is that they are very busy places, indeed. The Friday I crashed was the day before the Seattle Seafair festivities began and man, was that hospital busy. Remember I mentioned triage?

If your condition is relatively stable or can wait for treatment, you will probably wait. Here's where the letting your mind wander technique can help, especially if you're bored with watching tv or there's no tube where you've been stashed. Once a code blue is called on your floor, you will have to wait for more pain meds until the emergency is over and your nurse is freed up. You may have to deal with the pain one on one, using the power to reduce pain your mind has built into it - you against the pain beast. Kick the beast where it hurts, but remember to stay calm, relaxed,centered, sitting on the beach or wherever it is you choose to go.

The nurses called it "getting bumped" or as I found out, no food for three days.

Each time I was scheduled for the first surgery to install an external fixator (lovely piece of equipment - Google it to see examples), someone more seriously injured would come to have their life saved. Usually. Not everyone who made in in survived. I didn't have anyone die next to me, but a temporary roomie did.

Once, I made it as far as having the surgeon initial my leg and have the sleepy-time guy go to get the good knockout drops when Nurse Killjoy came in again to bump me. No ill will towards those bumping me, but three days without food made me a little cranky. Seafair weekend in Seattle gets a lot of torn-up people into the hospital, and depending upon what is going on at the time you're ever admitted to a trauma center, be prepared to wait.

Distraction Pain Control

Practice a little distraction pain control at home before you really need it.

Practice controlling your breathing and breathe like an opera singer - slowly, from the diaphragm, up and down, not in and out. I got pretty good at it and found that I could slow my heart rate quite a bit and lower my blood pressure (being hooked up to monitors made it easy to quantify). You can learn how to do it, too, Use it to work on relaxing pain away a little at a time, one spot at a time.

Dave

Shoreline, WA

Pain & Perseverance

Perseverance and a positive mental attitude are critical in managing pain and overcoming pain. 

Given David's series on pain management after a motor vehicle accident (in his case, a motorcycle accident), I thought the below article was very relevant. 

Sydney was able to overcome the pain and injury from a motorcycle accident to dance at the Kennedy Center when most said that she would be lucky to walk again.

Read Sydney's story on managing pain and overcoming pain to dance. 

Dancer by Smabs Sputzer, Flickr

What To Do After Your Motor Vehicle Accident

Ambulance Returing to Hospital, Chris Wong, FlickrYou Crashed Your Motorcycle. Now What?

All of the people you need to process the scene of your incident have arrived, you're in a lot of pain, and they all want to ask you questions and be given answers at once.

If you are lucky to have an adrenaline surge (as I did), that will help control the pain level for a few minutes at best. Start using breathing control - regular, slightly slower than normal breaths to help keep it together. Yeah, it still hurts, but there are important decisions that can't wait for answers to be dealt with right now and this will help you get through it.

Where do you want to be taken?

If you are conscious, tell the emergency personnel your wishes. Ask for their advice if you aren't familiar with the area or are not sure about the severity of your injuries. Now what about cases where you are NOT conscious or coherent?

Your wallet should have your I.D. in it, and the police and paramedics need information. Secure an old business card in your wallet where it can be easily found that has ICE wriiten on it in big letters (In Case of Emergency).  Put your emergency contact person's phone number on it and your wish to be taken to a trauma center if at all possible.  Remember, you're a motorcyclist: it's not a matter of IF you will crash, merely a matter of WHEN.   It took me 38 years, but it happened.

What about towing the remnants of your bike/car?

Ask the police to inform you of where it is going and for them to provide a phone number and address if available. The tow truck driver can also leave a business card with you or the police.  There are daily charges for impound and storage that you insurance may or may not cover fully.

Speaking of insurance...

Have your ICE person contact the insurance company if you are not in any condition to call Sooner is better than later. Once your people know you are on the way for treatment is the perfect time to call. If they have come to the scene, they can get business cards or at least phone numbers to contact all concerned parties.

Motorcycle insurance is not required in all states, but I highly recommend it none the less. Health and disability insurance are also nice to have, since the bills can easily exceed $100,000.00 for a two or three week stay in the hospital. Check your policies to see if you have personal injury protection and gap coverage if you're making payments. The bank wants their money and doesn't care if you are broken into little pieces.Check around and price shop for decent coverages, it will be worth the effort should you ever need it.

OK, now it's really starting to hurt !

When someone who has had severe pain episodes tells you that it is necessary to be ahead of the curve, listen to them. Waiting too long, until the pain become intense actually makes it a lot more difficult to get back under control. Paramedics may or may not be able to give you something for pain. If not, do you best to try to relax, breathe, and think about the most pleasant place you've ever been in your life, the most pleasant experience, etc. Take your brain away from the pain - it really can help.

Being moved around - Hey, be careful!

Broken bones hurt when they are twisted, so keep emergency responders informed about where you are injured to minimize that problem. Splints help, but aren't perfect at immobilizing limbs, especially when you are lifted and moved from gurneys and exam tables. Watch out for three person lifting teams if you weigh more than 180 lbs. as I do. A fourth person may be needed to move you carefully enough to avoid major pain.

At the hospital emergency room.

The doctors and nurses will probably come around and ask you, " On a scale of 1 to 10, 10 being the worst pain imaginable, what is your pain level right now?".

Tell them honestly where it hurts and how much pain you are feeling. Depending upon your types and levels of injury, you may not get much pain relief right away. The pain medications can have bad side effects that could interfere with treatment and your ability to breathe, so hang in there as long as you can against the throbbing. Nothing they can give you will take away all of the pain and allow you to be awake, and they have a million questions to be answered again and again. Once they get all the the answers they need, you will probably be given enough pain meds to allow you to drift off to sleep.

Staying Positive 

Keeping as positive a frame of mind as you can is probably the best thing you can do to aid in your pain level control. You may not be able to walk or even get out of bed, but you can try a variety of mental routines to distract yourself from the pain. It can really work. For a few minutes, riding in the back of the fire department aid car, the small scrape on my pinkie hurt worse than the leg broken into eight pieces. I had been talking to the paramedic about my bike and had become angry again at the jerk who caused the crash. Probably not the best sort of distraction, hey, it worked!

Next up in the series - What Is a Trauma Center?

Dave from Shoreline

My Motorcycle Accident: August 6, 2010

Motorcycle Accident, akeg - Eric Schmuttenmaer, FlickrHello and welcome to my eventful day on August 6th, 2010.

The ferry ride back to Seattle from Bremerton, WA was relaxing. I had finished paperwork generated from a day at the Puget Sound Naval Shipyard and was enjoying the sunny weather.
The Navy has a variety of fire suppression systems that I install, maintain and repair as needed.Sorry I can't go into more detail, but then I'd have to...you know.

Once back at the shop I worked from, I hopped aboard my 2007 Yamaha VStar motorcycle - my pride and joy machine. We took trips over Chinook Pass to Yakima, rode the Cascade Loop over the North Cascades into Twisp, back around to Wenatchee, and generally all around the state of Washington.

Around 5pm, August 6th, I was nearing home, going into a banked curve when a car suddenly stopped in front on me. The bike was already into a lean to the right when I had to brake - straightening up was not an option as that meant going head on into several cars and trucks in the opposite lane.

 The bike started to slide and slow as the car in front of me started moving again. We never made contact, but the front tire of the bike did come within a foot or so of the car's rear bumper as I noticed the front fork start to bend. (This is happening in real time of two seconds, maybe three) As I am trying to control the slide and see the fork bend, something on the side of the bike catches on the pavement and snaps rolls to the right incredibly fast. This is probably where my right leg was subjected to at least 600 lb-ft if force, since it takes a minimum of that much force to break the bones I did that day.

The car takes off , never to be seen again. A small black import - Acura, Honda, something similar. I didn't get a plate number since by the time I stopped skidding, rolling and bouncing, the car was out of sight. Jerk.

Rolling out of the traffic lane, I looked up and saw a car behind the scene stopped police-style, and was blocking cars from proceeding to smack into me and what was left of the bike. I thanked him for stopping and we decided that he would watch for inattentive drivers while I called 9-1-1 to get help.(Thanks again, plumber-man!)

I looked back at my formerly beautiful bike and then stood up. Oh.  To say that was a bad move is an understatement.

Standing there, glancing down at the lower right leg below the knee bending the wrong direction, I realized that I wasn't going to be running after the little black car and sat down.

A battalion chief from the Shoreline Fire Department arrived on scene first and took control. Police cars and the paramedics arrived a minute later. Fast response times and  professional attitudes every step of the way, guys. Thanks to you, all, too.

Thanks in part to the armored suit I always wore (and a good helmet), I had no other significant injuries. There were some friction burns on my arm from heat transfer through the suit where there was not an armor plate and a cut on my pinkie where a glove ripped. Nothing too bad -  besides a tibial plateau fracture and a broken fibula. In other words, my right leg was broken in 8 places, and some of the bone was pulverized, too tiny to count.

While being loaded in to the aid car, the medics asked where I want to be taken for treatment. Had I known what I now know, my choice would have been to go to the Harborview Medical Center, which has a level I trauma unit. I didn't know at the time that my first choice of hospital could not treat my injury and  that they would only stabilize me for transport to the trauma center.

The next portion of the saga will cover what to do now that you have had a serious accident and why thinking ahead before it ever happens can help save you from experiencing more pain that you need to endure.

Dave
Shoreline, WA

Required Reading For Pain Sufferers: The Pain Chronicles (A Book Review)

The Pain Chronicles by Melanie ThernstromPublished in 2010, Melanie Thernstrom’s book “The Pain Chronicles” covers the many aspects of pain in near-encyclopedic detail. Despite its staggering range of information  the book manages to connect on a personal level with narratives scattered throughout. None less touching than the author’s personal 12 year struggle with chronic pain.

The book was conceived by the author, who, as a journalist and a pain sufferer wanted to shed light on the topic at large. She proceeded to spend years experimenting, investigating causes, treatments, interviewing patients and observing some of the top pain doctors in the United States.  The results are depressing, hopeful, and thought provoking all at the same time.

The book is broken down in 4 basic components: pain as a metaphor, pain as a disease, pain as a narrative and pain as a perception. Each of the four sections is segmented out into mini-chapters; many of which pack the punch of scientific text coupled with poetic eloquence.

Thernstrom takes the reader on a tour of the cultural history of pain, reviews countless scientific studies and gives faces some of her statistics. She successfully navigates the necessary sensitives of writing on book on pain while managing to not sugar coat. To describe the book as comprehensive is an enormous understatement.

Whether you are chronic pain patient or not the book is highly engaging. The meticulous research and well formed prose provide an excellent backbone, but the true character of the book is revealed in the writing about the people. There are so many thoughts, fears and experiences splashed throughout the pages its difficult to wrap ones head around. Despite the many reasons for hope there are few perfect outcomes and even fewer certainties. As Thernstorn writes: “pain brings out the best or worst in people. . . . We write about pain, but pain rewrites us.'' 

Written By: Colin