Sunday, September 26, 2010

The Independence Day Accident

PNG's Independence Day is September 16; it fell on Thursday this year.  Since a lot of our staff like to have a long weekend, the hospital administration decided to stay open on the 16th and close on the 17th.  So it was pretty much business as usual for us on the morning of the 16th.

For me, Thursday morning is Talipes Clinic.  I've written several blogs (also here) previously about my work with kids affected by talipes (clubfoot). 

 Taking a cast off one of my talipes babies.  Another is waiting her turn.

I do the talipes work in the orthopedics area, adjacent to the emergency room.  I was finishing up, just before lunch time, thinking about going to the house for some food, a cup of coffee and the chance to sit down for a few minutes, when Judy (who was there helping me with the talipes clinic) told me that a vehicle had just arrived carrying 13 victims of a motor vehicle accident. We have something called "Public Motor Vehicles" or "PMV"s.  These are privately-owned, but licensed to carry passengers for hire.  Some are small vans, some are larger buses, and some are open-bed trucks fitted with benches that can carry 20 or 30 passengers.  It was one of these that had slipped off the road on a steep slope and rolled down the hillside.  The accident occurred about 45 minutes travel time from the hospital.  We never found any evidence of alcohol use on the part of the driver.

Me, working on one of the motor vehicle accident patients

As I looked up I saw that there were already patients on most of the exam tables in the ER, and they were starting to bring a patient into Ortho.  As I was finishing with the last of the talipes babies and sending him on his way, our medical student Charlotte arrived, and the two of us started screening the patients.  An ER nurse started phoning the wards to ask any nurses or nursing students who could to come to help.  The initial screening process consisted of feeling for a pulse (if the pulse rate is normal, there isn't much blood loss), seeing if they were breathing, and asking the patient where they were injured.  If they could respond that also told us something about their mental status.

Nursing staff working with MVA patients

As extra help started arriving, I instructed that each nurse or student should attach themselves to one patient, get full vital signs and evaluate them in some detail.  A piece of paper was placed with each patient to record the vital signs, and other information as it was gathered.  Very early in the process, Dr. Susan Myers came over from Outpatient.  Also, Dr. Steph Doenges was already there, but was tied up treating a child with severe facial injuries from a different incident; she eventually was able to join us in the fray.

Family members watch at the ER window

Only one patient stood out in the first round of screening, an older lady who seemed to have injuries in several areas of her body, and a rapid pulse rate.  I ordered IV fluids and some x-rays.  The trouble was, the x-ray staff had gone to lunch, and one had the morning off.

Then staff called me to re-evaluate a young lady that hadn't seemed too bad on the initial check, whose pulse rate was only a bit up, and who was talking at first.  They called out to me that she was struggling for breath.  We quickly started ventilating her with a bag and mask, and then intubated her trachea so that we could ventilate more effectively.  Immediately, air started accumulating under her skin, indicating major injuries of her lungs and airway.  She died within moments.

Family members (or curious onlookers) outside the ER window

We all continued working our way around the patients.  Eventually the ones who needed IVs had them in.  Patients with fractures had splints on to stabilize the injured limbs.  Before long the x-ray folks got back from lunch, including the one who had had the morning off, and x-rays started coming back.  Dr. Graham Wetzig, our volunteer surgion had been in the operating room all morning.  He was able to come in and take over the supervision of the situation.  Eventually the rest of us were able to go get some lunch.

One other young man seemed to have some internal injuries, and Graham took him to the operating room later that afternoon, and cleaned out a large accumulation of blood from behind his bladder.

Later we learned that 2 men had died at the scene of the accident, and hadn't been brought to the hospital at all.

The old lady with multiple injuries died later that evening.

A number of less-seriously injured patients were brought in throughout the afternoon.  Altogether we believe that we treated over 20 survivors.  Many were treated and released, but a good number were admitted.  Most have now been discharged.  One little girl will undergo some skin grafting on her face later this week.

 A boy with minor injuries waiting to be treated

I was pleased at how well things went.  Staff worked well together.  Patients were evaluated in an orderly way and treatment started promptly for those who needed it most urgently.  Thank you for your prayers--it is God's strength that keeps us going every day.


Tuesday, September 21, 2010

She's Not Heavy, She's Sombody's Grandma

Walking past one of the grassy areas by the hospital this afternoon, I saw three nursing students helping an elderly lady out of a wheelchair so that she could sit down on the grass.  The urinary catheter trailing out from under her skirt confirmed that she was a patient.  She obviously preferred to sit on the ground over sitting in the wheelchair.

I was impressed with how tenderly the students were treating her.  They couldn't have been more gentle and kind if she had been their own grandmother.  Who knows?  She could have been a relative of one of them.  It's a small country, and it's not rare that a relative of a student or staff member is a patient here.