By E. R. Haroldsen
In August, 2001, I was in my Dad’s house at the time of a family wedding. It was dark outside, but there were all sorts of things going on: kids here, kid there, friends, neighbors, a fun busy time. Then a kid ran in and told me that Melissa, a friend of my daughter, Nicole, had fallen and broken her arm. They came to me because at that time, I was trained as an emergency first responder. I didn’t know who Melissa was, but I knew what to do.
I found her laying flat on her back underneath the zip line. This was a rope strung between some trees. The kids would climb a few steps on a ladder, grab a handle tied to a pulley on the rope, and zip down to the other end. Apparently, when trying to use the zip line, Melissa had lost her grip and fallen on her left arm.
Nicole was kneeling and holding Melissa’s head so she was looking straight up. I thought it unusual that Nic knew that one of the first considerations in an injury was to keep the head immobilized. I learned later that her purpose was to keep Melissa from looking at the condition of her arm. It was definitely broken, probably in two places, near the wrist and again near the elbow.
Melissa’s first concern was that she didn’t want to go in an ambulance. “They are expensive.”
That left me with the question of securing the broken arm and transportation. In boy scouts and various first aid classes, I had learned ways to immobilize a broken limb, with wood boards, large magazines, wraps and bandages. We had such things available around the house, thought I didn’t know how convenient. Then I considered the nature of the break. It looked ugly. To move her, I’d have to secure the whole arm and I could imagine the bones grating against each other and cutting muscles and tissue. In medical terms, this is called crepitus. In non-medical terms, it’s called, “Ahhhhhhhh.”
I considered her request for about 5 seconds. It was obvious. We had to have an ambulance.
I sent someone to call for the ambulance. I assigned one young man to hold her hand. “That’s the only thing that you’ll do.”
Keeping a person calm is an important part of the process and the personal touch was a form of moral support and a way to reduce the possibility of shock. Nic had already made a big step in that direction by holding Melissa’s head.
I sent a person to go out by the road and to intercept the ambulance and give directions on how to get to the accident.
Then I started the patient assessment. There is a standard way to do this. Start at the head and work down.
“I’m going to check you out,” I said. “If anything I do hurts, sing out.”
First, I looked at her eyes. I was looking to see if both pupils were the same and if they responded to light. If they were different sizes, it could indicate a brain injury and the need for prompt attention at a hospital.
I felt around the head and neck. I was looking for swelling, blood, softness where it shouldn’t be soft or any unusual warm areas. I checked collar bones, the shoulders and rib cage. I applied enough pressure that if something were wrong, she and I would notice. I felt her belly, feeling for any hardness or unusual warmth which could indicate internal injury or bleeding. Frequently I asked, “Do you feel anything there?”
I pressed firmly on both sides of the pelvis. The pelvis is such a good structure that it can be broken but still remain intact.
I checked her legs and her right arm. I lifted then a short distance and checked that the joints worked and there was no pain.
I didn’t do much with the left arm. I wouldn’t have learned anything I couldn’t already see. She had significant pain, enough that she had to work to keep from crying. She looked like she was smiling but she was really gritting her teeth.
Finally, I checked her capillary refill on all four limbs as an indicator of blood flow. If you squeeze a finger, then let go, there will be a whitish impression that quickly goes back to pink. (For dark skinned people, you have to press on the beds of the finger nails or the toe nails.) One to two seconds for color to return is normal. In the case of the broken arm, it was important to know if blood flowed to the fingers. If it wasn’t, then we had another serious problem and it might be necessary to reposition the arm–something I really didn’t want to do.
I checked her pulse in her right wrist. This is called a radial pulse and in addition to indicating the heart rate, it is also an indication of blood pressure. A patient’s pulse and blood is the body is working to stay alive. As stress on the body increases, the heart rate and blood pressure climb. If these vital signs drop, the body had stopped fighting and the situation is deadly critical.
Soon, the ambulance arrived. They wheeled their stretcher over the bumpy lawn to a convenient location, several feet from Melissa.
I gave them my assessment: “There doesn’t seem to be any damage to head, spine, ribs, abdomen or of her legs or right arm. Capillary refill is about two seconds on all extremities. Radial pulse about 82.”
Not like in the movies, the paramedics weren’t in a hurry to move Melissa to the stretcher. First, they gave oxygen with a nasal cannula, a plastic air hose placed under the hose. Then they checked all her vital signs. They put in an IV and gave Melissa something for the pain. Brenda held the flashlight so the paramedics could see to work. One of the boys held the IV bag.
“If things were immediately life threatening,” said one of the paramedics, “We’d be moving much faster.”
When they finally left in the ambulance, one of the girls went along and Brenda followed in a car. Being an angel to an injured person is her area of expertise.
The next day, we visited her at the hospital. Her whole arm was wrapped in thick bandages, a plaster case and ice with just the fingers and thumb sticking out. The doctors wanted to see the fingers so they could monitor capillary refill. She looked much happier now.
We took down the zip line.
Copyright © 2011 by E. R. Haroldsen. All rights reserved. For additional information, contact erharoldsen.writer (at) yahoo.com.