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Tornadoboy
04-18-2006, 01:56 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 (feasible?), and she was also extremely drunk at the time of the incident (.1 BA at hospital).

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 (with her relenting on her personal info / 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 or opening up to any psychiatrists, but if forced to see one she would just pay them lip service and tell them whatever she thinks they want to hear.


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.

ideagirl
04-19-2006, 03:44 AM
Before you get to ER procedure, my question would be whether it's even possible for the man to do what you're describing. Jumping into a river in Massachusetts in January, dragging an unconscious woman to the bank, pulling her out, and doing CPR seems pretty close to impossible to me: it's hard enough to drag an unconscious person out of a river in good weather, let alone to do all this in the winter. If the water is as cold as it ought to be in Mass. in January, the man would be overcome by hypothermia very quickly. I just don't think he would be able to get into the river, get ahold of the woman, swim her to the bank, haul her out, get himself out, and deliver CPR while soaking wet in January temperatures. That's extremely strenuous and it requires more energy than I think a person would have under such conditions. (Note that it's not just the exposure to cold water that's giving them hypothermia, it's also exposure to January air while soaking wet when they come out of the water).

So, can you have her fall very close to the bank, or something? I mean, can you have her fall or be pushed by the current to within a few feet of the bank, so the guy could get her out just by wading in, without having to actually swim out to get her?

Here's a link to a page that describes hypothermia due to cold water. Note that people can become hypothermic from water under 70 degrees (!)--the water you're describing is a hell of a lot colder than that, probably under 32 degrees (below freezing--but not frozen solid, because it's moving; I'm assuming this is a river you're describing, since there's a bridge over it).
http://www.seagrant.umn.edu/tourism/hypothermia.html (http://www.seagrant.umn.edu/tourism/hypothermia.html)

Also, while I can imagine someone jumping into the water in January to save their child or spouse or a beloved friend, I have trouble imagining someone doing that for a complete stranger--seriously, I think their innate survival instinct would kick in and stop them, because there would be no powerful love/emotion/etc. to overcome the survival instinct. If you want him to do this, you're going to have to come up with a reason that he does it--it could just be his character, whatever, but you're going to have to know what his motivation is and convey it to the reader, because I think the natural response of a reader is to not believe a person would do this... UNLESS you make it clear that he's in some way not a normal person. It could be anything: maybe he's depressed and doesn't care if he lives or dies himself, so he's more prone to take risks. Whatever. But it has to be something that takes him a little out of the ordinary.

It would require a lot less explanation--I mean it wouldn't be nearly as hard for you to convince the reader that he would do this--if she's close to the bank so all he has to do is wade in. Then he could still become hypothermic because he still gets wet and then sits on the bank while wet--particularly if it's harder to get her out than he anticipated and he slips, gets wet up to the waist, etc.

By the way, how does the ambulance get there: does someone else witness all these events and call 911?

Tornadoboy
04-19-2006, 05:49 AM
All superb points, the date isn't set in stone so if having it happen in January seems a little outlandish it can be moved, though it seems a convenient time for me to set my plot in motion because of other considerations. The point of the scene, which happens in chapter one, is having these two people meet at particularly bad moments in their lives, her's in particular (obviously), and things develope from there, but of course none of that matters if it isn't believable from page one.
They're both rather desperate people and he has a few personal reasons as to why he'd take such an enormous risk to stop a total stranger from commiting suicide, the way I've thought him out he's a guy whom given his background simply couldn't just stand by and not try to save her.
However all that being said you wouldn't know those details until later so I wonder if I'd lose the reader before he/she would read long enough to learn those things, again you make a valid point.
One reason I chose such a late time in the year was because I wanted her to be able to drown in cold enough water to be clinically dead for a few minutes but once revived minutes later (10 at the absolute most) still have it be feasible for her to physically recover with no permanent damage. But I think you've got a great idea about her landing closer to shore, it may make my male protagonist initially more believable until I can reveal more about him, because you're right that normal people simply wouldn't do such a thing for a total stranger. Only problem I see with that is she can't jump into too shallow a waters or she would do serious damage to herself, initially I have her jumping high enough to dislocate a shoulder on impact (again, another item to research) and there is only so much 'drift towards shore' that is going to be believable, but I think I've got a work around to cover both problems.
As far as who called the ambulance it is a store clerk; male protagonist witnesses female protagonist's jump, runs in and tells him to call 911 before running out and trying to save her.
Bottom line with the whole scene is I think I have to move it back so I give the characters much more context, its something I've pondered before and have gone back and forth on. And while the scene works for them in my head its finally starting to sink in that it doesn't mean it will work for the reader, so I guess that's why they call writers like me 'amateurs'. http://www.absolutewrite.com/forums/images/smilies/biggrin.gif
Either way I still plan to use it and the emergency room visit afterwards, its a vital plot element, though obviously with a lot of tightening up and research.

L M Ashton
04-19-2006, 01:27 PM
As far as shoulder dislocation is concerned, what you're describing is possible with a couple of caveats.

There is a fairly wide range of what's possible in shoulder joints. As an example, my shoulders come out of joint very easily. I can do it simply by lifting something heavy the wrong way. But then, they also go back in very easily and painlessly. My ligaments (I think it's them, not the other things - uh, tendons - I get them confuzzled easily) are loose, and how loose they are also varies with my hormone levels. It's a genetic thing.

You could have the woman have looser joints by nature, but of course, not as loose as mine. Or you could give her a previous shoulder injury which would cause her joint to come out easier.

I'm suggesting those as possibilities because it might be the only way to plausibly have the guy accidentally pop her shoulder back in.


Disclaimer: I'm no medical expert. I'm only an expert at the funny things my own body does.

Shwebb
04-19-2006, 04:43 PM
A stranger diving in to save someone else is, to me, perfectly plausible. People do it all the time--and die, themselves, as a result. (When a plane crashed into the Potomac River, a man did just that--dove into freezing water--to try to save some of the passengers. I think it happened in the late seventies or early eighties.)

The rule with submersion patients is "they aren't dead until they're warm and dead." Warming can be done with I.V. fluids that have been heated; with heat packs placed at armpits, groin, behind the knees; and with heated blankets. If she has been submersed for ten minutes, I can't imagine they'd get her back to conscious in the back of a squad, though, or even breathing on her own if she was in freezing water for that long.

There's not necessarily a mandatory hold on someone who has tried suicide, unless he/she is refusing voluntary admission. If she agrees to sign herself in, the stay can be as little as one or two days, depending on how she appears to be doing and if she can vouch that she is safe from herself.

My husband is a professional paramedic (I used to be an EMT) and if you want more detailed info either about ER procedures, rescue, or psych inpatient procedures, just PM me and you can pick his brain.

Tornadoboy
04-19-2006, 04:49 PM
I used to have that problem with both shoulders when I was young, although in my case it hurt like HELL when they would pop back in on their own which would usually happen a few seconds later.
In fact ironically I once threw them both out while, you guessed it, jumping off a bridge, though in my case it wasn't an attempt to kill myself, but considering the pain it might as well have been.
At least my female protagonist isn't conscious to feel it, she should thank me for that, well maybe aside from the fact I have her getting half the Atlantic dumped down her throat, but hey being fictional is tough sometimes.
:tongue

I remember that Shwebb, it was a commercial airliner (flight 90?) that had iced over and smashed into a bridge before going in to the Potomac, and I remember the video of that woman's rescue vividly. The water was full of ice and covered in jet fuel, which had blinded a woman whom was one of I think nine people who were still alive. They were trying to tow her in with a rope but she kept losing it so finally a bystander, and you could read it in his body language before he dove in, said "to hell with this!" and boldly swam out and saved her, truely a couragous act that could have cost him his life.

I can shorten the length of time she is lifeless, its just that for the story she has to be dead then revived, and I just wanted to be sure she gets hypothermic enough to suffer no permanent damage. Realistically, assuming she treads water a bit after jumping while my male protagonist has enough time to get the clerk to call for help, I could probably trim down her actual 'drowned and lifeless' time to maybe two or three minutes, I'm rewriting it so he doesn't actually have to swim to get her, pulls her out and starts CPR much quicker, and is in much better shape to do so.

ideagirl
04-20-2006, 04:24 AM
I agree that for the sake of the woman's recovery it needs to be very cold water. I think having her closer to shore could work very simply: just have the current push her close to shore. Have you ever seen floating objects (branches, etc.) kind of stuck against the shore, repeatedly pushing against the shore as the water rushes past? And then other floating objects that come near them get kind of caught on them and slowed down? It's very easy, happens all the time--it just depends on the direction of the current and the shape of the bank at that particular point. She could've jumped in at the middle, bobbed to the surface, and been swept right over to the bank, or very close to the bank. You could have the guy see her go in and head over towards the river, not sure what the hell he's going to do but unable to just watch her die, and then when he sees that the current has pushed her close to shore the decision is easy--he just has to walk out a few feet or whatever and grab her. She could easily be unconscious almost immediately due to the fall, the shoulder pain, and the cold, so she would just be lying there, not fighting the current or the man.

Tornadoboy
04-20-2006, 05:10 PM
My husband is a professional paramedic (I used to be an EMT) and if you want more detailed info either about ER procedures, rescue, or psych inpatient procedures, just PM me and you can pick his brain.

Thanks, careful what you wish for for! http://www.absolutewrite.com/forums/images/smilies/wink.gif
Actually what I'll do is write an outline of the whole scene, filling in the relevant details as I understand them and then PM it to you and let you and your husband critique it, and see if there's anything blatantly wrong, any big gaps or if there's anything you think should be added. Thanks for your help!


I think having her closer to shore could work very simply: just have the current push her close to shore. Have you ever seen floating objects (branches, etc.) kind of stuck against the shore, repeatedly pushing against the shore as the water rushes past?

I think its going to be a combination of things now, with her treading water for a few moments and trying to make it to shore, then her drifting closer after she drowns, and he wades out chest deep and uses a piece of debris to snag her.

Shwebb
04-20-2006, 06:04 PM
Tornadoboy,

Not a problem! Whenever you're ready.

sparkleyshoes
04-27-2006, 07:48 PM
A very interesting discussion here, and it seems like things are shaping up.

Just wanted to comment that I think it is feasbile for him to put her shoudler back into place as part of the rescue. My husband dislocated a shoulder playing flag football. When he got to the ER and went for pre-treatment X-rays, the tech asked him if he was okay to stand up. He said yes, then proceeded to pass out. The tech caught him underneath the armpits and voila! shoulder was put back in place. My husband isn't particularly loose-jointed and the force wasn't that great.

For what it is worth!

ColoradoGuy
04-27-2006, 08:55 PM
See my post in the other thread in this forum. Why are there two, anyway?
http://www.absolutewrite.com/forums/showthread.php?t=31316

Tornadoboy
05-02-2006, 05:57 PM
See my post in the other thread in this forum. Why are there two, anyway?
http://www.absolutewrite.com/forums/showthread.php?t=31316

The other thread I mistakenly placed under the "Novels" forum, I abandoned it for the one I placed here but the administrator moved the original so now I have two.
Thanks for your help on the other thread, lots of EXTREMELY useful info!
I've got a detailed, revised timeline written out based on your info and other's, if you want me to PM it to you for disection let me know because you certainly know your stuff and I'd love to get your feedback!
Shwebb I just PM'd you a copy, thanks again to all of you for your help!

Jenan Mac
05-04-2006, 06:44 PM
[QUOTE=Tornadoboy]The other thread I mistakenly placed under the "Novels" forum, I abandoned it for the one I placed here but the administrator moved the original so now I have two.
Thanks for your help on the other thread, lots of EXTREMELY useful info!
I've got a detailed, revised timeline written out based on your info and other's, if you want me to PM it to you for disection let me know because you certainly know your stuff and I'd love to get your feedback!


Tornadoboy, I posted on the other thread, but feel free to PM if you have any psych questions I might be of use with.

Tornadoboy
05-05-2006, 05:56 AM
[QUOTE=Tornadoboy]The other thread I mistakenly placed under the "Novels" forum, I abandoned it for the one I placed here but the administrator moved the original so now I have two.
Thanks for your help on the other thread, lots of EXTREMELY useful info!
I've got a detailed, revised timeline written out based on your info and other's, if you want me to PM it to you for disection let me know because you certainly know your stuff and I'd love to get your feedback!


Tornadoboy, I posted on the other thread, but feel free to PM if you have any psych questions I might be of use with.

Thanks, I may take you up on that, I could use some help working out the psychological profiles of my two protagonists since they're both troubled people, with obviously MC1 being the more severe case.