Trauma Care: What to Expect
Reprinted from the June, 2009 BMW Owners News, with permission of the BMW MOA and Roger Dr. Gary FInk
By Dr. Gary Fink
As Dr. Fink discusses, below, motorcycling has a degree of inherent risks. Riders do crash from time to time, and any one of us may find ourselves receiving emergency treatment, as well as longer term convalescent care as we recover. So, this view into the world of immediate trauma-care can better prepare us, should we experience a crash.
One critical point that Gary makes is this: Motorcyclists who chose to ride without adequate protection generally do so because of a pernicious and subconscious belief that it’ll never happen to them. Responsible riders fully expect never to crash (again, in some cases), but always prepare for the worst. Think about it! - Roger Wiles
Sometimes, in the midst of chaos, a little clarity or knowledge can go a long way.
Motorcycle riding, while immensely gratifying, does carry some increased, inherent risks. Some falls may be due to rider error, others are due to their surroundings: potholes, gravel, other drivers or suicidal animals. As much as no one likes to think about it, the trip to the local hospital or trauma center is best accompanied by a little understanding and advanced knowledge. My hope is to provide a glimpse into what to expect and perhaps, equally importantly, what to ask.
I’m a practicing orthopedic surgeon, involved in trauma care and all aspects of orthopedics for the last 25 years. I practice at the busiest level 2 Trauma Center in New York and unfortunately have seen more than my share of motorcycle accident victims. I rode in my early twenties and have recently started again. So while new again to motorcycle riding, as beautifully said by Joni Mitchell, “I’ve looked at life from both sides now.” With that in mind, I have even greater respect for safety.
As much as we like to deny it, accidents happen when we least expect them. (If we expected them, we’d be more careful!) So, as appealing as it may be to tempt fate, practice routine safety. That means appropriate gear and pads, a rated helmet, ID, a cell phone and any applicable medic-alerts. It’s hard enough to put people together again but without knowledge of your existing conditions and allergies, it’s like trying to do it blindfolded.
If you take a fall, try not to move unless you have to for your safety (don’t stay in the middle of the road where you can get run over if you can help it). Don’t hesitate to call 911. You may not be aware of the extent of your injuries and you’ll need a ride anyway. When help arrives, the emergency medical technicians will first ask if you are OK, check your airway, breathing and circulation, and stabilize any injuries. That means splinting arms or legs and neck, in order to keep matters from getting worse, and prevent pain.
They will most likely get you on a backboard and onto a stretcher and hoist you into the back of the rig. Then you get a ride to the nearest emergency room. The good news is that when you come in on a stretcher, you don’t have to wait.
When you enter the emergency department (ED) as a patient, either by ambulance or air transfer, you will either be placed on a regular stretcher for less serious injuries, or into the trauma room. This will get you first priority and the fastest attention. Trauma rooms are equipped with advanced monitoring and resuscitative equipment. The emergency team will likely cut off your clothing to assess for damages and start an IV to give you fluids and medications. This is not the time to worry about your gear. It’s a small price to pay for rapid assessment and without doing further damage. The IV provides a quick route for pain relief and you won’t need repeated injections; everything can go into that line.
Trauma Room evaluation is usually done, at first, by personnel with advanced training in trauma care. Most are ATLS (advanced trauma life support) certified. If after initial evaluation it is determined that additional trauma care will be required, a trauma surgeon or trauma team will be consulted. The trauma surgeon, usually a specially trained general surgeon, will become the quarterback of the team of physicians involved in your care. Specialists will be consulted for management of specific injuries.
The trauma team will do an initial assessment, review of x-rays, CT scans, MRIs and other studies and if needed, call in the specialists. Sometimes internal organs can be damaged—spleen, liver, bowels—and frequently these need to be addressed first, and usually by the trauma surgeon. Your level of pain will be assessed and usually intravenous pain medication will be administered.
Most orthopedic injuries can wait. Open fractures, those that communicate with the outside environment, or more simply put, where the bones “stick out of the skin,” usually take first priority. These need to be thoroughly cleaned or washed out, and frequently in the operating room, and usually under a general anesthetic. Depending on how dirty the wound is, some type of immobilization of the fracture will be undertaken at that time. It might range from a simple splint to external fixation or definitive internal fixation.
External fixation is a technique of drilling pins or wires above and below the fractures and connecting them to a erector set type frame on the outside of the extremity. Simply put, the bones are held together from the outside. This looks pretty impressive and is great for maximum sympathy. This can be done rapidly in an emergency situation and will serve to stabilize the bone and soft tissues and allows
for easy access to the wound for later cleaning. Many open fractures treated with an external fixator are brought back to the operating room several times over the next several days for repeat cleanings, again usually under general anesthesia.
Frequently, the external fixation is not the last step. Once the wounds are clean, internal fixation may be undertaken. This usually requires inserting plates, screws and or rods directly to the bone. These will usually stay in the patient until the fracture heals, or can stay in permanently. They provide a more accurate reduction, a closer putting together of the pieces and usually a better environment to heal than does the external fixator.
Timing of treatment of closed fractures can vary considerably depending on the severity of the overall injuries to the patient. If possible, and there are many variables here, trauma patients are best fixed quickly and mobilized rapidly. Sometimes the severity of injury to the soft tissues dictates that the surgery be delayed until the soft tissues have a chance to begin to heal and this may take several weeks or sometimes longer. Some simple fractures are handled by closed methods, realignment and casting. Others will require surgery, where more accurate alignment and rigid fixation can be
accomplished. Fractures that enter the joint surfaces can present a particularly challenging problem for the surgeon. Joints are meant to be perfectly smooth, like a baby’s bottom, to fit together perfectly. Fractures into the joint surface produce irregularities and no matter how well they are able to be put together, can lead to abnormal wear and tear in years to come.
So remember, even though trauma and orthopedic care has come a long way in the past few decades, not everything is fixable. Ride with care.
If you or a buddy ends up in the emergency department, ask lots of questions. It’s good to be informed. While they say that a little bit of knowledge can be dangerous, speaking even a few words in a foreign language can help get you where you need to go. Don’t be afraid to advocate for yourself or your loved one.
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The views expressed in MotoSafe are not necessarily representative of the BMW MOA, the BMW Owners News, or its staff. The views in this colum are solely those of the author or authors.
The BMW MOA Foundation’s “MotoSafe” is intended to present responsible viewpoints on thoughtful and safe motorcycling skills and practices; the authors, the Foundation, the BMW MOA and the Owners News do not guarantee readers’ personal safety and take no responsibility for readers’ application of this material. Professional motorcycle safety trainers are invited to submit articles for inclusion in the “MotoSafe” column. Please contact Roger Wiles (roger@rogerwiles.com) for submission guidelines and instructions. The BMW MOA Foundation is a not-for-profit, tax-exempt Public Educational Foundation dedicated to increasing and promoting the safe and enjoyable sport of motorcycling. Tax-exempt donations to the Foundation will provide funding for current and new Foundation Projects & Programs. Contact Foundation Headquarters at: PO Box 3982, Ballwin, MO 63022 - (636) 394-7277 for further information