I’ve jotted down a bunch of notes based on your OP and amended them a bit based on others’ responses. I included everything, even if it’s already been covered or it contradicts something someone has already said.
My recommendations are based on my training and experience. I’m a Wilderness First Responder. I’ve been first on the scene for several serious incidents, and I’ve been carted off on the “trauma-train” (hee!) myself. I’m pretty confident in the accuracy of what I’m reporting, but if a currently-working EMT, Paramedic, ER nurse or ER doc contradicts me, take their word over mine.
Also, a regular M.D. will be a lot less useful to you as a source of information than an EMT, Paramedic, ER nurse, or a doctor who deals with ER patients. Things are very different out there in the “real world” than in a doctor’s office. I would suggest that you write your section using the recommendations in this thread, and then have it looked at by various people who would regularly respond to a situation like the one you describe. If you offer to acknowledge them in your book, they’d probably be more than happy to help you out.
So, here are my suggestions and questions for you, in no particular order:
–Who called 911? Was it your character? Is someone else present? Or does he not know? This is important to making the actions of the EMTs realistic.
–In a case like the one you described, it’s unlikely that paramedics would show up, unless there happened to be paramedics sitting around looking for something to do. It’s more likely that EMTs would show up. (You don’t have to specify whether they’re basic or intermediate, unless it’s relevant for some reason.) There are generally more EMTs available to respond to things. Also, it’s unlikely that the fire department would show up. Basically, the training level below “EMT” is “First Responder.” A first responder knows how to secure the scene and start to stabilize the patient. Cops and firefighters are first responders at a minimum. (A Wilderness First Responder is technically at the same level as regular first responders, but the training is very very different–but that’s a subject for another thread. If I, a WFR, am in a non-wilderness setting, my responsibilities and authorizations revert to those of a regular first responder, with some exceptions.) If 911 is called, what their goal is to get someone of at least first responder level on the scene as soon as possible, and get EMTs of the right level and the appropriate equipment on the scene as soon as possible. In most cases, a cop can get there faster than the ambulance. If the fire department can get there faster than the cops, or if they have some firefighter/EMTs available, they might come first. But I think for the sake of your story, you should just leave the firefighters out of it. Depending on your narrative, you can either have the cops show up and then the EMTs a few minutes later, or just have the EMTs only show up. Usually, though, if EMTs are sent, cops show up too. If you want someone tromping across the freshly vacuumed carpet, have the cops do it.
–The very first thing that the EMT or the cop on the scene will do is try to stabilize the patient’s head with his or her hands and arms. Ask an EMT to show you exactly how it’s done for the different positions that the character might be in. They will move the patient as little as possible. So, if your character is sitting on the bottom step when they arrive, that is where he will stay until they are ready to actually put him on the backboard. Once the head is stabilized by hand, the EMTs will set up a cervical collar and put it on the patient if possible, relieving the need for someone to hold the head manually. (I saw an amusing scene the other day. I was driving by the scene of an apparently minor motorcycle crash. The motorcyclist must have been on feet when the ambulance arrived, so the EMT was holding his head stable in a standing position. What made it amusing is the biker must have been 6’6" and the EMT was a teeny tiny woman. She was on her tippy toes holding his head! I assume that someone a bit taller took over as soon as possible. But that tiny woman was standing stock still on her tippy toes holding that guy’s head perfectly still. EMTs are my heroes for a reason.) Basically, the whole point of the whole spine stabilizition procecure is to try to minimize any injury to the spinal cord. Say, for example, a patient has a broken vertebra. That doesn’t necessarily mean that there’s been any injury to the spinal cord (the nerve bundle) itself. If a patient is managed properly, it’s often possible to prevent sharp bits of bone from injuring the spinal cord. As you know, many people suffer “broken backs,” but have no paralysis. And if there is some injury to the spinal cord itself, proper handling can minimize further injury–so someone might end up partially paralyzed, but not completely. Most people don’t understand this, so a lot of what the EMT on the head does is try and convince the patient not to move. Sometimes, the EMT has to kind of yell at the patient because it’s really really important to keep things as stable as possible.
–I want to clear up an apparent misunderstanding that you seem to have–EMTs don’t really do any diagnosis beyond what is absolutely necessary for them to stabilize and transport the patient. In your OP, you mention that the EMTs “aren’t buying” the fact that he had a pain in his neck before the fall. That’s not for them to decide. As far as they’re concerned, there has been a significant mechanism for a spinal and head injury, and they will manage the patient as if he DOES have a spinal injury, regardless of what he says. They will note what he said about having the pain before, and will pass that information along to the ER docs, but they will not make any decisions based on it. Also, they won’t “gloss over” the bite mark on his neck. They will note it, but as it’s not bleeding, it seems like a lower priority than the possible spinal and head injuries, they will not do anything about it. Ask an EMT for the proper medical term to describe that kind of wound. Different types of wound have different names–a wound where the skin is torn away is called an avulsion, for example. I’m blanking on the right term for what you describe.
–I don’t know how much detail you want to put in about the EMTs and the patient’s interactions with them, but just in case, here are some pointers about how EMTs talk: One EMT will be in charge of the situation, usually the one who is “on the head.” Also, the one on the head will be the one who does most of the talking to the patient. An EMT will usually introduce herself and identify herself right away. She might say “Hi, my name is Joan. I’m an EMT, and I’m here to help you. What’s your name?” Also, if she can learn the patients name, she will use it a LOT. “Okay, Bill, can you feel me squeezing your toe? Bill, do you know who the president of the United States is?”
–The EMTs will ask the patient a lot of questions and relate lots of information to each other about the patients vital signs and condition. They will ask the patient when he last ate and if he is on any medications, for example. They will mention to each other things like his blood pressure, breathing rate, and color and condition of his skin (pale and clammy) for example. The questions that they ask and the data that they gather are pretty standard, so it would be easy enough to get a full list. You mentioned the mother character. If she’s present, and if you want to either do some character development or add some funny bits, this would be a good place to do it. EMT: “Have you used any illegal drugs in the past 30 days?” Mom: “Does he look like a druggie to you?! How dare you? My son is an honor student!”
–The EMTs will also probably cut open some of the patient’s clothes and do a full body exam. They’ll palpate all parts of his body and ask “does this hurt?” over and over. You mentioned in the OP that they would “splint” his sprained wrist. I’m not sure what you mean by splint in this case. Chances are, they’ll just make sure that the wrist is immobilized, but won’t spend a lot of time or energy on the splinting. They may not even do an actual splint, and might immobilize it against his body. The wrist is of a much lower priority than the spinal and head stuff, so their goal will be to make sure that it doesn’t sustain further injury and that the blood flow is not cut off. They’ll also try to minimize the pain that it causes, but that is less important than the other things. A likely scenario is that your character will be in a lot of pain from the wrist, and be frustrated that the EMTs are seemingly paying very little attention to it.
–One thing that no EMT or medical person will say in this case: “He’s in shock.” This is one of my pet peeves on doctor shows and in movies. Shock is a specific and very serious life-threatening physical condition. It does not refer to someone who is upset or hysterical and needs to be sedated. It doesn’t sound like your character is in shock.
–Speaking of which, some posters above stated that the EMTs might give the patient oxygen or set up an IV. I’m not sure I see why they would do this. It seems like the patient is breathing just fine and doesn’t appear to be in immediate need of fluids or IV-administered medication. EMTs usually try to minimize the actual treatment that they do because starting one treatment might well interfere with another treatment that is deemed necessary at the hospital. They’ll do what they have to do to get the patient to the hospital in a stable condition, but they won’t do more than necessary. Your character might well get an IV once he’s in the ER, but I don’t see why oxygen would be used at all. Unless someone can explain why it would be deemed necessary, don’t have the EMTs do the oxygen or the IV.
–You noted that the patient will spend some time strapped to the backboard, and thus couldn’t look around. EMTs and ER personnel know that when people are on a backboards, that they can’t look over to see who’s talking to them. So, they will make a point of getting into his field of vision to talk to him if they can. From the patient’s perspective, this looks pretty weird, especially if he’s not used to it. They’ll be only able to see a little section of sky or ceiling, and then suddenly, heads will pop in and talk to him. They kind of look like floating disembodied heads. Also, the patient’s hearing is affected, as he can’t turn his head or see who’s talking. It makes it pretty hard to hear what you want to hear–but at the same time, it sometimes makes it easier to overhear stuff, maybe because you’re not as distracted. Given the nature of your story, these perceptual anomalies could be useful. Perhaps you could arrange to have yourself put on a backboard sometime. It’s a weird feeling.
–You mention that your character is "bratty"and might lie in response to some of the questions he is asked. First of all, being strapped to a backboard tends to make people much more cooperative than normal. Second, medical personnel know how to deal with obnoxious people. So, I don’t see his intentional lies as being very likely to be the factor that gets him admitted. But it’s easy enough to get him admitted and into his own room. Just give him a set of symptoms that CAN be indicative of increased intracranial pressure, but aren’t necessarily sure signs of it. The fact that he lost consciousness is a very serious warning sign. But you can add other stuff that can be explained away. The nausea and vomiting is good, especially if he conveniently forgets to mention the stomach flu to the EMTs and the first round of ER nurses and docs. Give him a splitting headache, too. That can be a result of dehydration due to the stomach flu. As he’s rehydrated by the IV, the headache can subside. Often, people with increased ICP have what is known as DIChead syndrome. I forget exactly what the D stands for, but I think the I is irritability and the C is combativeness. So, if your character is bratty and obnoxious, there might be some suspicion of DIChead syndrome that turns out to be just his personality. In fact, this is sometimes a problem for EMTs–how do they know whether the guy has DIChead syndrome as a result of a concussion or whether he has a permanent case of it? I said that your character intentionally lying in response to questions is unlikely to be the single factor that gets him admitted into the hospital, but you can work it into the mix. If he gets too bored on that backboard, he might well start changing his story in response to getting the same questions over and over. So, if he says that he’s having double vision, the nurses might well be pretty sure he’s lying, but they’ll want to play it safe and make decisions based on the possibility that it might be true. Two signs of spinal or brain injury that are NOT easily explained away: uneven pupil dilation and numbness in the extremities, so don’t go there.
–You can easily put him in a room by himself without having to justify a true “private” room. Since you have him in a private hospital and not a county hospital, conditions may well not be crowded at all. Just put him in a regular room with two beds, and have the other bed be empty. Have the nurse tell him that he’s lucky that he came in on a slow day. Or, you could put a patient into the other bed, and have him have some kind of an emergency in the middle of the night that requires that he be transferred into the ICU.
–Some hospital rooms have showers. Some don’t. If your patients has been cleared for a spinal injury, and is being held for observation because of suspicion of a brain injury, they wouldn’t let him take a shower. They would sponge bathe him if he was dirty. If you NEED him to take a shower, you can always have him sneak in, but that would be kind of tricky with an IV.
Just saw your last post:
–When I was in the hospital with food poisoning, I was told by the ER docs that most cases of “stomach flu” or “24-hour flu” are actually mild cases of food poisoning. I don’t know if that’s true, but it does seem that the symptoms of “stomach flu” are more consistent with the symptoms of mild food poisoning than influenza. I don’t know if fevers are at all common with food poisoning. I don’t think that it’s really necessary to specify that whether it’s actually food poisoning or not. Stomach flu is a term that is pretty much universally understood. But I’d check to see whether fevers are associated with mild food poisoning, and decide what you want to do accordingly.
–I’m not sure that your character would have even been on the “trauma train.” I’ve never heard that term specifically, but when it was done to me, it was referred to as being “trauma teamed.” I was hit by a car while biking and landed on my head. I was backboarded and rushed to the hospital. As soon as they had me out of the ambulance, I was immediately surrounded on all sides by doctors and nurses. They hooked me up to every monitor available and did every test you could think of. Basically, everybody was poking me and prodding me all at once and yelling STAT! a lot. They were checking me for spinal and head injuries of course, but also for internal bleeding and other scary stuff. As it turned out, I only had very minor injuries (I always wear a helmet), and was released within a couple of hours. Compare that to when I was rear-ended while driving and had significant neck pain. I was backboarded and taken to the hospital in an ambulance, but there was no urgency in the way I was treated. Urgency was unneccessary. Your character’s fall may be more similar to my bike accident than my car accident, but I’d check before you assume that the trauma team would be called. Your psychologist could still use the term, though. I agree that it’s priceless.
–I realize I didn’t answer your question about whether the doc would have him wear a c-collar after release. After my car accident, which was this year, the doc told me that they don’t usually have people wear c-collars any more unless there’s a specific reason. He said that for general cases of soft-tissue injuries (whiplash), they don’t help much and they may even interfere with healing. Obviously, there might be a specific reason why your character is given one, but I wouldn’t assume that he’d be given one automatically. After the doc told me that, I realized that it used to be common to see people walking around with big fat white c-collars, and now you almost never see that. You do see people with neck braces, but of a different and seemingly more effective type. I guess if someone needs a neck brace, they give them one of those.
Here’s the scene: Our Hero has just fallen down the stairs, suffering a sprained wrist and a bump on the noggin, which knocks him out cold for a few minutes. He’s also got a severe, stabbing pain in his neck, which happened BEFORE the fall, but of course the EMT’s aren’t buying that. (The doctors later determine it’s a muscle spasm, although for supernatural/psychosomatic reasons, it feels much, much worse. As for being knocked out – when he comes around, he’s unable to move or speak, and doesn’t even know his name at first, but once the neck pain floods back he remembers everything. At least, that’s the way I wrote it…I can change it, if necessary.) OK, here are the details I’m hoping to get answers for:
