Gun Shot Wound: Dianna Benson, EMT

EMS expert and author Dianna Benson blogs today writing a first person account of caring for a gunshot wound victim. I love how she's written this post with such detailed information that portrays the medical info so accurately.

EMS 4. Gun Shot Wound. 123 Main Street, Apartment G. 

I flip my book closed—Jordyn Redwood’s newest suspense—and zip it inside my backpack. I rush from my station’s crew quarters to the ambulance bay.

My partner slips behind the steering wheel; I signal us en route to the call via our laptop nailed to the dashboard.

“Twenty-nine year old male, GSW in abdomen, conscious and breathing,” I relate the facts as I read them on the laptop screen. “Raleigh PD already on scene.”

I wait for further information to display; my nerves rev up. GSW calls often place EMS in deadly situations. Even if the scene is safe at first, bystanders, the shooter, even the patient can turn violent. Prepared for anything at any given moment is the hallmark philosophy to staying alive.

“RPD in process of securing scene,” I read the new information out loud. “Stage near the manager’s office.”

“Manager’s office?” my partner turns our ambulance left at an intersection. “That can’t be far enough.”

I hear the fear in his voice. Only six months ago, he suffered a knife wound from a patient’s husband who didn’t want us to resuscitate his wife. 

“I know these apartments,” I say. “Building G is in the back. Furthest away from the office.”

More information came across the screen.

“Patient took off on foot. Stumbled away from the shooter. He’s down. Gas station on corner of Hill Street and Brown Avenue.”

Once we arrive at the gas station and notice RPD has the scene in their control, I duck under the yellow tape blocking the public from our GSW patient lying supine in one of the parking spaces like a car. Five firefighters surround the patient, each one pressing towels to his abdomen, as countless cops hold the perimeter they’ve established.

The firefighters step away, allowing us to take over medical care.

    

 “Sir, can you tell me your name?” I yell over the chaos surrounding me.

“Ronald,” he uttered with a flutter of his eyes.

I peek under the wad of bloody towels to examine the wound in his upper abdomen. Since bullets often act like a plug, gun shot wounds often don’t produce heavy external bleeding. This one the exception.

“Package and go,” I say to my partner. “Ronald, what medications do you take?”

“Nothin’.”

Gunfire whizzes near my ear, busts the car window next to us. My heart is pounding as cops tackle some guy behind me. The scene is safe again.  

With the help of the firefighters, my partner and I log roll the patient onto a spine board, place the backboarded patient onto our stretcher, and wheel it toward our ambulance.

I lean my face near Ronald’s ear. “What about street drugs, Ronald? I’m not a cop, so it’s best for your health if you tell me the truth. I don’t want to inject any med—”

“Nothin’.”

“Okay.”

We load the stretcher inside the ambulance.

“Any health issues? Allergic to anything?” I continue to ask Ronald questions.

“No, no,” he says, squirming. “The pain. It’s bad. Real bad.”

“I’m sure. Hang in there with me, okay?”

One of the firefighters slip behind the steering wheel as two others hop into the back with me and my partner.

I place a bunch of bandages over the bullet wound, crisscrossing and stacking them. I spike an IV bag, as my partner inserts an eighteen gauge needle into our patient’s arm. As I connect Ronald to our cardiac monitor via a 12-lead, one firefighter maintains direct pressure to fresh towels over the bandages, the other wraps a BP cuff on the patient’s right arm then clips a pulse ox to his left index finger for a blood oxygen saturation reading.

I glance at the readings on the monitor. “Hypotensive and tachycardic,” I shout over the sirens wailing and engine roaring. “82 over 54. Pulse 160.” I feel his left radial artery. It’s thready. “Trendelenburg,” I say, instructing the firefighter on my right to lift the foot of the stretcher, a treatment of hypoperfusion (shock), this case hypovolemic shock due to blood loss.  

I’m thinking the bullet pierced the vena cava. If so, this patient is bleeding internally and surgery is vital.

As my partner shoots morphine in the IV catheter, I notice our patient’s eyes are closed and he’s still and silent. Blood oozes from his mouth. His oxygenation reading drops to 91%

“Ronald?”

He’s unresponsive. I press my fingers to his carotid artery. Pulse still present.    

I suction blood from his mouth. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  

I read the newest vital signs on the monitor, “74 over 46. HR 168.”

My partner grabs the radio, switches it to the closest trauma hospital.

“Wake Med ED? This is EMS 4.”

“Wake Med. Go ahead EMS 4.”

“We’re en route with a twenty-nine year old male. Abdominal GSW. Tachycardic at 168. BP falling, last reading 74 over 46. Trendelenburg position. Administered morphine. Endotrachael in place. ETA five minutes.”

I glance at the cardiac monitor screen. “Astyole,” I shout out. “Take over bagging,” I tell one of the firefighters.

I begin chest compressions, as my partner injects epinephrine and vasopressin into the IV line. Nine compressions later, Ronald’s eyes flash wide.

I smile down at him. “You still hanging in there with me?”

He nods as we pull into the emergency department.   

**************************************************************************

       

Dianna Torscher Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book releases March 2013.

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. You can connect with Dianna via her website at www.diannatbenson.com. 

Up and Coming

Congratulations to the following three people who have won a personalized copy of my latest medical thriller Poison:

1. Heather

2. Michelle

3. Nancee

Ladies, I'll be e-mailing you within a few days on how to claim your prize.

I've been thinking of you New Englanders and all the SNOW-- praying for your safety.

For you this week:

Monday: Dianna Benson stops by to give a first-person account of treating a gunshot wound victim. I like when experienced professionals do this as it gets readers right into the shoes of what it's like to treat such emergencies.

Wednesday: What do occupational therapists do?

Friday: Do I need a coroner, a medical examiner or a pathologist? Garry Rodgers stops by to clear up the difference between these forensic specialists.

Have a GREAT week.

Jordyn

Deadly Toxin: Mustard Gas

To celebrate Poison's release, I'm giving away THREE personalized copies of Poison by random drawing to commentors on this week's posts. To be eligible, you must leave a comment that includes your e-mail address. Must also live in the USA. Drawing will take place midnight on Saturday, February 9th. Winner announced here at Redwood's February 10th.

I like book titles with double meanings. My first published book was titled, Proof. There were two types of proof the heroine needed. Proof to convict her assailant of his horrific crimes and proof of God in her life.

Poison, the second book in the Bloodline Trilogy, is releasing this month and in this instance—there is an actual nefarious agent (not giving away too much) and a side meaning as well.

What poisons your life? Is it a bad relationship? Is it believing a lie? Is it an actual toxin like dirking too much liquor, using illegal drugs or prescription drugs in ways they weren’t intended?

Writing suspense, particularly with a heavy medical edge, I think requires something unusual to be found. I’m a research hound. I love to learn about new things. And for Poison, I read a lot on different types of toxins.  

Aren’t toxins interesting? How minute substances can make a person ill or end up killing? This is the stuff suspense novels are made from and the lure for every author—finding that one poison—undetectable, fast-acting, easily transmittable or ingested without the victim knowing.

I remember as a youngster hearing the story of how a long-dead great uncle had passed. According to my grandfather, he’d served in the military during WWI and had died as the result of complications from mustard gas exposure.

So lately, in thinking about toxins, I began to wonder what exactly mustard gas was and how did it kill.

Interestingly, I discovered that term “gas” can mean more than just a vaporous substance and can be any chemical substance.

Lethal Gases: Lead to disablement or death.

Harassing agents: Disrupt enemy soldiers.

Accidental Gases: Gases encountered during war that are not related to a chemical agent like excessive gases from gunpowder during a fight.

Mustard gas falls into the first group—lethal gases. Tear gas, for instance, would fall into the second category. 

But how does mustard gas kill?

Mustard gas is also called sulfur mustard and its name is derived from its foggy yellow appearance and mustard like smell. It’s a blistering agent/alkylating agent and comes in many forms: vapor, liquid or solid. When a person comes into contact with the agent, it damages the skin and mucous membranes inside. The chemical liquefies tissue.

Since it freezes at a high temperature, it’s not very effective when it’s cold. It doesn’t spread easily and would fall to the ground before soldiers could be exposed. This property also made it a good weapon because it could stay low on the ground for weeks depending on the temperature and expose unsuspecting troops going into the area. Another factor that made it a good weapon—people adjusted to the smell quickly.

Mustard gas was used first by the Germans in 1917 and was born out of the trench warfare era where new military strategies had to be devised to get men out of their bunkers. The agent was fitted onto artillery shells which were then shot to toward the enemy lines without the accompanying explosion which I’m sure seemed strange to the soldiers at the time.

Hey, why didn’t that thing blow up? What exactly is that yellow fog?

Unfortunately, mustard gas doesn’t often kill expediently. The first symptom was generally red blisters to the skin that developed within 2-24 hours. If the gas was inhaled, these blisters would slowly develop and seal off the airway.

Other symptoms:

•  Eyes: Irritation, redness, burning, inflammation and even blindness
• Skin: Itchy redness that is replaced with yellow blister
• Respiratory system: Runny or bloody nose, sneezing, hoarse throat, shortness of breath, coughing, sinus pain
• Digestive system: abdominal pain, diarrhea, fever, nausea and vomiting

It was possible for the body to heal if there was a short, brief encounter. Longer, more frequent exposures proved to be more deadly. 

By the end of WWI, chemical agents inured 1 million soldiers and civilians and killed 100,000 people.

Likely, mustard gas wouldn’t be considered favorable to use in chemical warfare these days because of its prolonged activity. 

This link goes to a very powerful article on mustard gas and its effects and was used heavily in the writing of this piece—the italicized areas are from the article. It is definitely worth the read.

What about you? What interesting things have you researched that have ended up in a novel?

The Truth About False Memories

To celebrate Poison's release, I'm giving away THREE personalized copies of Poison by random drawing to commentors on this week's posts. To be eligible, you must leave a comment that includes your e-mail address. Must also live in the USA. Drawing will take place midnight on Saturday, February 9th. Winner announced here at Redwood's February 10th.

During the 80s, there were a number of children who falsely accused adults of molestation. Some of these adults were sent to prison and later found to be innocent.

You can read a little bit about that here. 

For my second book in the Bloodline Trilogy, Poison, I researched how false memories can be created. I came across a non-fiction book called My Lie by Meredith Maran.

In her autobiography, Maran outlines how she began to believe she had been molested by her father, when in reality, she had not.

At the time, Maran was a journalist doing a number of pieces about child molestation. She was observing family therapy sessions where incest had occurred. Suddenly, very innocent things from her life (like dreaming about her father's hands) became evidence that her father had harmed her.  Obviously, when she came to know the truth, her relationship with her father was significantly damaged.

There was a definite craze in the 80s about recalling repressed memories under hypnosis. This is problematic for a couple of reasons. One, is there such a thing as a repressed memory? That being that something traumatic is witnessed by a person and as a form of protection, the mind bundles it up and tucks it away until a later time where recalling the memory is safer.

Some say yes-- absolutely. Others say, no. You can read more about the different thoughts here which is a lengthy treatise but very interesting, balanced information.

The other problem is that hypnosis places the mind in a suggestible state and perhaps, a therapist with ill intentions, could use this suggestible state to introduce an idea into someone that they then begin to believe is true.

Is that possible? Hmm . . . you might have to read Poison to find out.

What we know from every day life is that some people believe things that are NOT true. And this belief in a lie can become great fodder for suspense novels. The eyewitness who falsely accuses. Possibly believing harm has come to you as a child when in fact, like Meredith, nothing insidious happened.

The question becomes, how do we prevent these false memories or false beliefs from harming other individuals? Is there a way to have a "perfect" justice system where only the truly guilty are imprisoned. 

I don't know . . . sounds like another book.