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Penetrating Skull Injures in Children - How would you handle this?
Make Believe Story: You arrive on scene and find a young boy who's father had been drinking too much while throwing darts. From the lack of visible metal from the dart
tip, you can assume the dart entered the skull over 1-inch deep. You arrive on scene... now what?
Update: I can't believe I was able to find the actual medical article and photos for this incident. For the purposes of this post, I invented the scenario but now that there have been a significant number of responses, here's the real story...
The Real Story: A ten-year-old child was playing darts with his older brother. He went to retrieve his throw from the dartboard when an errant toss struck him above the right eye. A case report... (Full Story)
Here's the X-Rays:
Replies to This Discussion
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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You are right on the money Norm. This is literally a 'no brainer'. Prior posts dealing with traumatic injuries and how you would handle them seemed to be an issue for some. One of my subtle points here is that any calls involving children are typically very emotional. Couple this with a dart sticking out of a young child's forehead... you have a very good chance that someone's going to lose it.
If there was ever a situation where cool heads needed to prevail, this would certainly be one of them.
Oldman's comments are salient to all of your runs, if you want to provide the best care for the patient. You must have a full understanding of the specifics regarding how to run the call and the confidence to stabilize the situation.
You are not only dealing with just the incident. Instead, you are dealing with out of control emotions of a mother yelling at her drunk husband that he was an idiot while you are trying to do patient assessment and stabilization, a young child traumatized by the event and injury and a blaring television set in the background.
These calls are typical and require a team approach to mitigate them. Depending on your response resources, separating the patient from the rest of the world should be a priority. The back of the ambulance is as good place to start sometimes, right Ralph?
Understanding that our 'world's' are all a little bit different, some things remain constant.
- asking for a LEO is a nice touch... let them deal with the family dispute issues but if you have to do it yourself then:
- turn off the tv
- talk confidently and do not yell back at emotional people...
- remain calm and professional
- watch your back
- protect your patient
- separate the patient from the rest of the family
- get the patient out of the environment and into yours asap
- go to the hospital
I know there are a lot of points to consider here and have only listed a few. The key point here is that pediatric calls really are not a lot different than others, other than the guarantee that emotions will be a factor for you to have to deal with. Good luck.
CBz
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Permalink Reply by Rob on
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Reminds me of this story from a few years back...
http://www.ssqq.com/archive/stupidity%20arrowhead.htm
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OUCH!
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Permalink Reply by Firewriter on
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Rob,
That has a really, really, high "oh chit!" factor!! Wonder how the victim is doing these days!!
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Permalink Reply by Capt.Alex Arnold on
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Scene safe, ABC, patient priority. It is that easy. CB I couldn't agree more with your statement about cool heads! I do want to through a bit of a wrench into the scenario though. I am speaking from the view of state requirements and will be different with each state.
In Washington State (especially Pend Oreille County), we are required to report the incident to LEO or CPS for a "review." This is because of a couple of factors. First, a minor injured by a potentially deadly weapon. Secondly, it was caused directly by a parent in the home who was under the influence.
We as EMS providers must know what the standing protocols are for handling cases like this involving minors and the parent. I am not saying jerk the kid outta the house but, I don't think playing William Tell with a steel dart is a positive environment for the child. Once again, that is my opinion though.
Remember, a call can go beyond the actual scene. An event like this goes beyond this. It is our morale obligation to that child to assure that we aren't going back there in the future for this same thing or worse.
Just some food for thought. Be Safe and learn something new today.
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Yeah, but dad wasn't too sharp, eh??
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Here, the ER team would talk to police who would most likely contact Children's Services due to nature of call and injury. Most definitely don't need to put the child back into an environment where they can, once again, be harmed.
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Permalink Reply by John Crabbe on
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Here, the ER team would talk to police who would most likely contact Children's Services due to nature of call and injury. Most definitely don't need to put the child back into an environment where they can, once again, be harmed.
I can understand if this was a case of abuse or something and perhaps this can be mentioned, but it seems to be taking things a bit far and I see this as a "jump to conclusions". Is the father a chronic alcoholic, or was this a friendly get together and the kid got in the way? I have a step son about the same age and he can find himself in similar situations despite how cautios an adult can be....that is why there are things called accidents. You could probably put a 10 year old in a padded round room and they can still manage to find a way to get hurt. Yes, the dad was drinking and throwing darts, but to insinuate this is a bad home environment can be a stretch as well. Maybe the kid was told to stay inside or out of the way, but didn't listen and so forth, there are just too many variables here to basically make the accusation that this was intentional or the child should be removed from a household.
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Permalink Reply by WestPhilly on
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A "heads-up" to the proper authorities is in order, but this is far from a prima facie case of abuse.
(Luckily dad was only throwing darts and not target shooting).
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John, I did not go into great detail ... guess I should have put in a little more info. Not jumping to conclusions nor insinuating home life is not safe.
It is not a "given" that DCS will be called; just a "likely". Any time a child is injured by an adult who is intoxicated, chances are good they will be called. They respond and interview child. If all is as it should be (dad/mom being stupid drunk, they were not aware child had left house, etc.) then it is a non-issue and everyone goes about their business - usually the case.
However, if it is a case where some intercession should occur, then so be it. They are not going to remove a child from their home for a parents stupidity - believe me, there would be a lot of empty homes! But, if their findings are more serious than a simple accident, then they step in.
Sorry for any confusion my previous post may have caused. Was not my intention to seem inflammatory.
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