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Tornadoboy
04-18-2006, 01:45 AM
Does anyone here know anything about ER procedure? I am writing something that involves the following scenario and requires facts I’m having trouble finding... well shy of busting a leg so I can talk to them in person:



Two people, a man and a woman, are brought into the ER suffering from hypothermia, with the woman being the more severe case. This all takes place in Massachusetts during January and they had been exposed to waters which were obviously cold.

The male had pulled the female (total stranger) out of a river after she had made a near successful suicide attempt by jumping off a bridge of maybe twenty feet high. She was not breathing and had no pulse when the male retrieved her but performed immediate CPR on the riverbank and got her breathing again, though she never regained full consciousness in his presence. He also became very hypothermic from the swim and lost consciousness shortly before rescue personnel reached them, but regained it during the ambulance ride. A couple of other notable facts are that she landed in the water feet first, her shoulder was dislocated by the impact but was accidentally reset by the male on the bank while removing her jacket, and she was also extremely drunk at the time of the incident.



So my questions are:



1 - Considering they are both breathing on their own and on arrival are at least semi-conscious, what would the logical procedure be for the ER staff to treat them? I'm not sure what appropriate body temps to assign them for the symptoms they are displaying, but said male's breathing and circulation never stopped while the female had been ‘down’ for about four or five minutes due to drowning before being revived.

I do know the trick for such trauma is not to warm them up too quickly or cardiac arrest can result, and that hospitals often use machines to bring up core temperatures such as one which provide warmed air to breath, electrically or air heated blankets, or in the worst cases one which warms the blood directly.



2 - How long would one expect the male to be kept assuming he shows no injuries or complications, recovers once his body temp is corrected and is not considered a danger to himself since he was injured in a rescue.



3 - What kind of complications could the female have from such a physically traumatic experience? For the sake of the story I don’t want her too seriously injured, though the injured shoulder is important. In fact I would like to have her back at work within a week, which has to do with her avoidant “work-oholic” personality and the plot.



4 - How would such a serious attempted suicide be treated? It is my understanding that they would keep her involuntarily for at least a 72-hour evaluation by psychiatrists, but beyond that I know nothing about the procedure.

Do the courts automatically get involved? Her attitude is not combative but not exactly cooperative either, initially she refuses to give out any personal info other than her first name. I’m debating whether to have her either ‘BS’ her way into some kind of psychological out-patient treatment (relenting on her full name / she has no suicide history) or even go as far as having her sneak out of the hospital, assuming that can happen with any credibility. At this period in the story I don’t see her willingly cooperating with psychiatrists, but just paying them just lip service if forced to see one.



I’m sure this is all a good example of “where the rubber meets the road” when it comes to doing one’s own research relating to their writings, but I thought I’d throw it out there and see if anyone here could point me in the right directions.

Tish Davidson
04-18-2006, 01:51 AM
Try posting this in Story Research: Experts and Interviewees Wanted. Colorado Guy is a physician and he sometimes answers questions there.

Tornadoboy
04-18-2006, 01:54 AM
Ah thanks! I'm going to move it there!

icerose
04-18-2006, 01:56 AM
Another thing you could do is go to the hospital when the ER isn't overflowing, tell them who you are and what you need and see if one of the staff can't help you. Offer to buy them lunch to discuss it, I am sure they would be willing to give you the time to answer your questions and they would be getting something back from it as well.

Tish Davidson
04-18-2006, 02:14 AM
Better yet, if you have a local newspaper, try pitching them a feature story about a day in the local ER. That way you'll get paid for hanging out there. And its a fun story to do. I did one in Princeton, NJ years ago. One of the docs told me how the Princeton ER never got gunshot wounds. He kind of missed them, having done his residency at Bellvue in NYC where gunshot wounds alternated with knifings. Literally not more than two minutes after he said this, a gunshot wound came through the door. That story was the first story I ever sold a reprint of. The paper bought it, then the hospital bought it with a little modification to put in their annual report. That really opened my eyes to the posibility of making money by recycling stories. So make your research time pay for itself and see if you can do a local ER story.

Jenan Mac
04-27-2006, 05:20 PM
[QUOTE=Tornadoboy]
4 - How would such a serious attempted suicide be treated? It is my understanding that they would keep her involuntarily for at least a 72-hour evaluation by psychiatrists, but beyond that I know nothing about the procedure.
Do the courts automatically get involved? Her attitude is not combative but not exactly cooperative either, initially she refuses to give out any personal info other than her first name. I’m debating whether to have her either ‘BS’ her way into some kind of psychological out-patient treatment (relenting on her full name / she has no suicide history) or even go as far as having her sneak out of the hospital, assuming that can happen with any credibility. At this period in the story I don’t see her willingly cooperating with psychiatrists, but just paying them just lip service if forced to see one.


::chiming in late::

In a previous life I spent waaaay too many years doing emergency intake and day treatment evals for mental health facilities. In Florida, rather than Mass., but I suspect the procedure is similar.

For someone who's been admitted to a medical ER, the general procedure would be to stabilize the client medically first (in the ER, or ICU, or a general medical unit, whichever is appropriate). Psych units, unless specifically designed to take medically unstable clients, generally will not. Medical units don't like taking really unstable psych patients, either, so it's sort of a toss-up. If she goes to a medical unit, she'd probably have a sitter (someone to stay at arm's length 24 hours, until transferrable). If she's clear enough to go to a straight mental health facility, she'd be sent under involuntary commitment, and placed on suicide precautions (at minimum, a locked unit, checks every 15 minutes and no street clothes).
After she's seen by a psychiatrist, and probably after the first 24-48 hours, she might be given the option to sign in voluntarily. But there's little chance, unless her psychiatrist is fond of lawsuits, that she's likely to be allowed to walk out the door before her 72 hours is up.
The cynic in me says that if she has no insurance you could probably get her out of the hospital faster, but that she probably wouldn't end up in day treatment because...well, no insurance is no insurance.

ColoradoGuy
04-27-2006, 06:35 PM
accidentally reset by the male on the bank while removing her jacket, and she was also extremely drunk at the time of the incident.
It takes a fair amount of force to get the most common form of shoulder dislocation (anterior type), at least the first time. Have her hit something in the water with her arm outstretched. It also takes a fair amount of pulling to relocate the shoulder, so just taking off her jacket is unlikely to work, although the motion could be correct: pulling on the arm straight down and then raising it up and out. However, if a person has previously dislocated a shoulder, doing it again takes much less force, both to get it out and back in. To make your scenario plausible I would make her have dislocated that shoulder in the past.
I'm not sure what appropriate body temps to assign them for the symptoms they are displaying, but said male's breathing and circulation never stopped while the female had been ‘down’ for about four or five minutes due to drowning before being revived.
I would make the man's "core" (i.e rectal) temp about 35 degrees centigrade and the woman's 33. Thirty-two degrees is sort of a breakpoint for major tissue damage: if she is conscious on arrival in the ED she could not have been that cold. Having no heartbeat for 4-5 minutes is usually either fatal or a cause of severe damage UNLESS the person is cold. So that part of your story works. (I once cared for a boy who survived 30 minutes submerged in a river in North Dakota during the winter.)
I do know the trick for such trauma is not to warm them up too quickly or cardiac arrest can result, and that hospitals often use machines to bring up core temperatures such as one which provide warmed air to breath, electrically or air heated blankets, or in the worst cases one which warms the blood directly.
Correct. The brand name for device that we often use is Bear Hugger. It is thing that looks like a vacuum cleaner and can blow warm (or cold) air into a mattress that goes on top of the patient. We also use IV fluids warmed to 39 degrees and warm air if the patient is on a ventilator; worst cases are sometimes put on cardio-pulmonary bypass with warm blood. (This rarely works, in my experience) Your scenario would only bring out the Bear Hugger.

How long would one expect the male to be kept assuming he shows no injuries or complications, recovers once his body temp is corrected and is not considered a danger to himself since he was injured in a rescue.
Probably overnight

What kind of complications could the female have from such a physically traumatic experience? For the sake of the story I don’t want her too seriously injured, though the injured shoulder is important. In fact I would like to have her back at work within a week, which has to do with her avoidant “work-oholic” personality and the plot.If you want her back to work in a week I'd just stay with the shoulder and the psych issues. You could break a leg, if you like. She would be home on crutches in that time frame after a simple ankle or lower leg break. She would have her shoulder in a sling, though, so it would be tough to get around on crutches

How would such a serious attempted suicide be treated? It is my understanding that they would keep her involuntarily for at least a 72-hour evaluation by psychiatrists, but beyond that I know nothing about the procedure.
Correct. If she wanted to leave after a "72-hour hold" you would need a court order, but those are not too hard to get in cases like this.

Do the courts automatically get involved? No

Her attitude is not combative but not exactly cooperative either, initially she refuses to give out any personal info other than her first name. I’m debating whether to have her either ‘BS’ her way into some kind of psychological out-patient treatment (relenting on her full name / she has no suicide history)That would work.
or even go as far as having her sneak out of the hospital That would not work. She would be closely watched.
At this period in the story I don’t see her willingly cooperating with psychiatrists, but just paying them just lip service if forced to see one.That happens frequently, actually

Good luck. I hope that this helps.