Serious injuries, memory loss from accident

Christabelle · Oct 16, 2013

I've gotten the cause and results of the wreck in my WIP nearly figured out thanks in no small part to JClarkDawe

, but now I'm ready to focus on the victims of the wreck. The passenger must be a fatality, but I need the driver to survive - barely - and not remember the crash. However, I'd prefer that he have no serious cognitive damage other than a block of memory loss amounting to a few hours or maybe one or two days prior to the wreck. Several days of unconsciousness would be fine but caused by the accident or sedation doesn't matter. Is that realistically possible?

It would also be convenient for him to have chest injuries with difficulty breathing on the scene. I'm thinking broken ribs and collapsed lungs. Perhaps the seatbelt breaks his sternum. Would damage to the thoracic vertebrae be possible in a rollover accident? (I'd like to rule out cervical spine injuries.)

Considering the aforementioned injuries, would there likely be further damage (internal organs other than lungs, additional broken bones, etc.)? I want him near death for awhile and to have permanent spinal damage.

I feel like my specific research terms are taking me in circles. I tend to get more results for lawyers specializing in auto accidents than anything useful. I can find plenty of info about individual injuries but adding in the polytrauma aspect gives me little to work on other than ER procedures.

Also, in such a situation, would he be more likely to be transported by ambulance or airlifted?

Any thoughts would be useful. Thanks!

King Neptune · Oct 16, 2013

As I understand it, and I do not claim to be an expert in memory loss, the kind of injury is not a major factor, but the person generally would be unconscious for a day or two. Search: traumatic brain injury memory loss.

The results looked farily good. They are non-specific, because you and I could be injured in the exact same way, and I might have a stunned feeling, and you might be unconscious for a week and not remember anything from three days before the injury to a week after the injury.

kevinwaynewilliams · Oct 16, 2013

I think you are over-researching. There are a wide range of possible injuries and potential cognitive disorders resulting from a serious accident. If you needed something bizarre and specific like "could a disconnected turn-signal stalk poke through the driver's eye and injure his brain in such a way that he could no longer control his bowel movements?" then you would have to do a lot of research to make that plausible. Sticking to concussion, brief memory loss, spinal injuries and broken bones keeps you in a safe zone: pretty much anything you need to make your story work will also be plausible.

asroc · Oct 16, 2013

Christabelle said:
I've gotten the cause and results of the wreck in my WIP nearly figured out thanks in no small part to JClarkDawe , but now I'm ready to focus on the victims of the wreck. The passenger must be a fatality, but I need the driver to survive - barely - and not remember the crash. However, I'd prefer that he have no serious cognitive damage other than a block of memory loss amounting to a few hours or maybe one or two days prior to the wreck. Several days of unconsciousness would be fine but caused by the accident or sedation doesn't matter. Is that realistically possible?

Yeah, that happens, but you don't necessarily need a coma. Some degree of retro- and anterograde amnesia is not uncommon even with relatively mild brain trauma. Of course, with a more serious head injury they might induce a coma to allow the brain swelling to go down.

Christabelle said:
It would also be convenient for him to have chest injuries with difficulty breathing on the scene. I'm thinking broken ribs and collapsed lungs. Perhaps the seatbelt breaks his sternum. Would damage to the thoracic vertebrae be possible in a rollover accident? (I'd like to rule out cervical spine injuries.)

Possible, but damage to the cervical or lumbar spine is more likely. Rib fractures are also more likely than a sternum fracture. But it's possible.

Christabelle said:
Considering the aforementioned injuries, would there likely be further damage (internal organs other than lungs, additional broken bones, etc.)? I want him near death for awhile and to have permanent spinal damage.

I've been an EMT for going on ten years now and I've seen pretty much any traumatic injury you can think of in the various MVAs I've responded to. The sky's the limit here. A head injury can be pretty dicey, throw in a tension pneumothorax for added drama, damage to the lumbar spine causing paralysis from the waist down...

Christabelle said:
Also, in such a situation, would he be more likely to be transported by ambulance or airlifted?

Depends on where this happens. I'm in a largish city full of large hospitals and level-I-trauma centers and we effectively never fly patients. Even factoring in our horrible traffic, ground transport will be faster. But if you're in a rural area where it's ten miles to the closest hospital and fifty to the closest neurosurgeon you might think about asking for a helicopter.

I hope this helps!

c.e.lawson · Oct 16, 2013

Hi Christabelle,

I am a rehabilitation physician who treats brain injury and spinal cord injury patients.

The good thing about writing accidents/physical trauma in fiction is that every car crash is uniquely different, and every individual involved in a crash is uniquely different. Within reason, you really can tailor the injuries to what you need in your story.

I'm not sure what you mean by rule out cervical injury. Do you not want a cervical injury for some reason? Cervical injuries are much more common in MVAs due to the head not being secured with a seat belt like the thoracic spine usually is. Thoracic and lumbar spine/spinal cord injuries are not seen as often with three point restraint seat belts, and are actually somewhat rare in low to moderate speed crashes with the seat/shoulder belt in place. If he's wearing a seat belt, then a high thoracic injury would be more likely than a mid or lower one - i.e. T1-T2. If you want him to have a spinal cord injury with paralysis, then his deficits (arm/trunk/lower extremity involvement) would be different, depending on the level of injury so remember to take that into account.

As far as the memory loss goes, amnesia around the time of the accident is seen quite a lot in brain injuries. If you want your character to not have cognitive problems, however, and only the period of amnesia, then I'd say you'd want him medically sedated for a few days as the cause of him not being conscious, rather than coma as the cause. The longer the period of unconsciousness due to head trauma, the more likely the patient will have long term cognitive deficits. If his chest injuries require mechanical ventilation for a few days, then sedation so that he doesn't fight the ventilator is often used. That would be a better reason for him to be unconscious while at the same time avoiding the issue of cognitive impairment.

melindamusil · Oct 16, 2013

Christa - I was in a serious car accident when I was 17 and was in a coma for 11 days. Hopefully my experience can help you...

Christabelle said:
I've gotten the cause and results of the wreck in my WIP nearly figured out thanks in no small part to JClarkDawe , but now I'm ready to focus on the victims of the wreck. The passenger must be a fatality, but I need the driver to survive - barely - and not remember the crash. However, I'd prefer that he have no serious cognitive damage other than a block of memory loss amounting to a few hours or maybe one or two days prior to the wreck. Several days of unconsciousness would be fine but caused by the accident or sedation doesn't matter. Is that realistically possible?

As far as traumatic brain injury - I will reiterate, you have a wide range of possibilities. Even with the exact same injury, one person might be mildly stunned and another might be in a coma for days. In my case I was in a coma for 11 days, and it was caused by the accident. Depending on the injury, a sedation coma is also possible (look up Gabby Giffords).

As far as memory - personally, I don't remember the accident AT ALL. I have virtually no memory of the hospital - just a couple of foggy memories. No memory of getting multiple IVs, feeding tubes, catheters, etc. (and I'm ok with that!). But with amnesia, again, it varies widely. Some people might remember everything, others remember nothing. You have wide latitude.

It would also be convenient for him to have chest injuries with difficulty breathing on the scene. I'm thinking broken ribs and collapsed lungs. Perhaps the seatbelt breaks his sternum. Would damage to the thoracic vertebrae be possible in a rollover accident? (I'd like to rule out cervical spine injuries.)

For me, the seatbelt snapped my collarbone like a twig. I also had massive bruising all over my body, including a bruise where the seat belt crossed my torso.

Considering the aforementioned injuries, would there likely be further damage (internal organs other than lungs, additional broken bones, etc.)? I want him near death for awhile and to have permanent spinal damage.

I feel like my specific research terms are taking me in circles. I tend to get more results for lawyers specializing in auto accidents than anything useful. I can find plenty of info about individual injuries but adding in the polytrauma aspect gives me little to work on other than ER procedures.

Also, in such a situation, would he be more likely to be transported by ambulance or airlifted?

Any thoughts would be useful. Thanks!

My accident occurred due to bad weather (ice and snow storm). I'm told that, if the weather had been good, I would have been airlifted, but given the storm, it was not safe for the helicopter and I was taken to the hospital in a regular ambulance.

Another thought - it may depend on where your accident is located. If you're in a busy metropolitan area and the accident occurs just a block away from the major teaching hospital, there would be no reason to airlift. On the other hand, if you are way out in the country, it would be more likely.

Christabelle · Oct 16, 2013

King Neptune said:
As I understand it, and I do not claim to be an expert in memory loss, the kind of injury is not a major factor, but the person generally would be unconscious for a day or two. Search: traumatic brain injury memory loss.

Thanks. I just don't want to sound too outlandish.

kevinwaynewilliams I think you are over-researching. There are a wide range of possible injuries and potential cognitive disorders resulting from a serious accident. ... Sticking to concussion, brief memory loss, spinal injuries and broken bones keeps you in a safe zone: pretty much anything you need to make your story work will also be plausible.

I'm an obsessive researcher.

If I'm remotely uncertain, I derail my work for days hunting for answers ... and usually digging up way more info than I ever wanted!

asroc Yeah, that happens, but you don't necessarily need a coma. Some degree of retro- and anterograde amnesia is not uncommon even with relatively mild brain trauma.

I don't want a coma, just short term unconsciousness or sedation.

asroc Possible, but damage to the cervical or lumbar spine is more likely. Rib fractures are also more likely than a sternum fracture. But it's possible.

Thanks. Good information!

asroc I've been an EMT for going on ten years now and I've seen pretty much any traumatic injury you can think of in the various MVAs I've responded to. The sky's the limit here. A head injury can be pretty dicey, throw in a tension pneumothorax for added drama, damage to the lumbar spine causing paralysis from the waist down...

Depends on where this happens. I'm in a largish city full of large hospitals and level-I-trauma centers and we effectively never fly patients. Even factoring in our horrible traffic, ground transport will be faster. But if you're in a rural area where it's ten miles to the closest hospital and fifty to the closest neurosurgeon you might think about asking for a helicopter.

I hope this helps!

All that works for my story. Setting is a suburban area on the outskirts of a large city. I don't really need to show either means of transport. Like I mentioned previously, I'm obsessive when it comes to research.

c.e.lawson

I'm not sure what you mean by rule out cervical injury. Do you not want a cervical injury for some reason? I wanted to rule that kind of injury out because of the physical deficits to the upper extremities. Cervical injuries are much more common in MVAs due to the head not being secured with a seat belt like the thoracic spine usually is. Thoracic and lumbar spine/spinal cord injuries are not seen as often with three point restraint seat belts, and are actually somewhat rare in low to moderate speed crashes with the seat/shoulder belt in place. That's what I suspected. If he's wearing a seat belt, then a high thoracic injury would be more likely than a mid or lower one - i.e. T1-T2. If you want him to have a spinal cord injury with paralysis, then his deficits (arm/trunk/lower extremity involvement) would be different, depending on the level of injury so remember to take that into account. A mid-level injury with paralysis between T4-T7 was what I'd been thinking for this character, but higher, as you mentioned, would work. Would it be impossible to realistically lower the injury for the character to have better trunk stability?

As far as the memory loss goes, amnesia around the time of the accident is seen quite a lot in brain injuries. If you want your character to not have cognitive problems, however, and only the period of amnesia, then I'd say you'd want him medically sedated for a few days as the cause of him not being conscious, rather than coma as the cause. Excellent point. The longer the period of unconsciousness due to head trauma, the more likely the patient will have long term cognitive deficits. If his chest injuries require mechanical ventilation for a few days, then sedation so that he doesn't fight the ventilator is often used. Perfect. That would be a better reason for him to be unconscious while at the same time avoiding the issue of cognitive impairment.

Thanks so much for your insights! This is extremely helpful!

melindamusil
As far as memory - personally, I don't remember the accident AT ALL. I have virtually no memory of the hospital - just a couple of foggy memories. No memory of getting multiple IVs, feeding tubes, catheters, etc. (and I'm ok with that!). I'm sure you're glad to have no memory of that!! But with amnesia, again, it varies widely. Some people might remember everything, others remember nothing. You have wide latitude. That's good.

For me, the seatbelt snapped my collarbone like a twig. I also had massive bruising all over my body, including a bruise where the seat belt crossed my torso. Ouch! But could be useful in the story.

Another thought - it may depend on where your accident is located. If you're in a busy metropolitan area and the accident occurs just a block away from the major teaching hospital, there would be no reason to airlift. On the other hand, if you are way out in the country, it would be more likely. So true.

Thanks for sharing your experience, Melinda. That helps me out a great deal!

I appreciate all of your feedback!!

melindamusil · Oct 16, 2013

Just for "setting the scene"...
I am not a person who bruises easily. Never have been. But I'm told that after my accident, I was a purple-and-blue mess. Like I said, I had the the seat-belt bruise across my torso. I had a bruise on the outside of my left arm (my parents were told that probably resulted from my body hitting the car door). I had an impression of the steering wheel across my face and the bridge of my nose, just below my eyes (I also broke my nose), plus two black eyes. The rest of my body was just covered with here-and-there splotches of purple, from when my body was thrown around. Also, I had a gash below my eye that wound up needing stitches.

Point being - even if your character isn't badly injured, you could easily have plenty of bruises and even a couple of lacerations that need stitches. Might bring in some good descriptive words with this.

melindamusil · Oct 16, 2013

Christabelle said:
All that works for my story. Setting is a suburban area on the outskirts of a large city. I don't really need to show either means of transport. Like I mentioned previously, I'm obsessive when it comes to research.

Just re-read this. FYI my accident was in just this kind of city - a suburb outside a big city. Feel free to pm me if you have any questions.

Christabelle · Oct 17, 2013

melindamusil said:
Point being - even if your character isn't badly injured, you could easily have plenty of bruises and even a couple of lacerations that need stitches. Might bring in some good descriptive words with this.

Melinda, thanks for the great personal experience insights! I'm still plotting and outlining, so when I get to writing and adding details, you'll probably be hearing from me.

I was in a rush yesterday at the end of my post, so I didn't get a chance to comment fully on the later replies. So much good information here!

Serious injuries, memory loss from accident

Christabelle

King Neptune

kevinwaynewilliams

Be blunt: I appreciate it

asroc

Alex

c.e.lawson

melindamusil

practical experience, FTW

Christabelle

melindamusil

practical experience, FTW

melindamusil

practical experience, FTW

Christabelle