Table of Contents Introduction 1 art: An Overview of Trauma 1 Concepts and Terminology in Trauma Cares 2 Care ofthe Trawma Victim in the Field 2: Maange Ay ne Feds 3 The Trauma Center heya a oe 4 Care ofthe Trauma Patient Teokrenont How Cae se Lie The “Bumping” Seno OR amore at: Specifi Traumatic Injuries By Organ System ' Woad Trawmat From Concussion tothe Persistont Vegetative State «i the Operating Room 7 Tome ts {6 Neck and Spinal Cord Injuries: Snapped, Stabbed and Strangled 17 Chest Trauma: The iety Dozen Meiming Injuries ss Abdominal Trauma: Bows tm eA a gn» Ne Abo ney 9 Extromity Trauma: Cronched Arms and Legs Part Lk: Unique Traumatic Injuries 10 Bites: Animal Assaults 20 Sere Dies™ 1 jvies and Mutilation: From Fonding to Fences. 12 ef an glee ery 12 Traumatic Amputations and Replantation: Don't Lose the Missing Part! 1:0 ow «Pagers eyinted13 Borns and Frostbite: The Sears of Extremes 15) genie Ensrmct Tepentire Dense ex Se Si Sua) yin te Ca oes 14 Diving Aaidents and Altitude tlness 175 Ding Acie nd Te Consens Becomes Skt (The Ren) Nirges Neon (Rae fhe Ds) ‘Ae Noun Sens (ANS) ‘igh aide Pm Ee AE) ih Ais Cob Bema HACE 15 Assaulted Eder Ratored Women and Injured Kids: The Defenssless ss 16 Sexual Assault: Unspeakable Touma 20 ‘Whats Rapt ‘hy De Rape Woes? etna Baan Vn Set Act Cs 17 Orgen Donation: Who Makes the imate iH? 21 ‘Wo Dcemes tn Os Dn? ‘heat Obn Orso Doin ‘he est Perms Ors eit Bibliography 226 Glossary 225 Index 228 Introduction In fitecture, sin fs sooner o ater everyone becomes injured sec eially oes consequence of malice—somewhere inthe sory. THe writer must force characters to face conflict And that ince resting injuries. Every writer neds to understand how to cea utenti trav atic ijurtes as well a how wo del with her consequences, “The focus ofthis bok ison Velo injures that done result in eat, ‘Every writer comforted withthe dilemma of how severly to hut character must understand the consaquences ofthe physial avo rested Injuries should be realistic reflect the character ofthe person inflicting the insult and be ilored tthe neste ofthe plot More sophisti ‘ed than i the pst, today's readers have come avi ral cons ‘ersof media vilene. Hence, your story's aeients ad ines andthe ‘convalescence they ease mst ing re {OU writ what i refered o inthis book as a “injury i,” you must old te ting foe of autentity to your er. You'll Jearno review pertnet anatomy, asthe wold of our soy—whats thereto serve aba weapon and who's rsoat in he seen tous and decide what mayhem your al neds. These ae the clement of «auth prescription, ‘Whether the gear is mystery-murde, boro, romace or any of the varieties oF mansteam tiles, the writer's at hinges on accurately epctng human suffering. Ernest Hemingay insisted te what the ‘wer eaves out that counts most. The lite Cay Provost in similar ‘vein taught his wring student: Les is more, Richard Cohen Writer's Mind. isevcts: tion wing should imply there is «peat desl more ‘han what his been write. sing less material i the goal of good writing, why lara 0 ‘much about inflicting injures? In “The Snows of Kilimanjaro," Hemingway never describes the gangrenous leg that plays a central oi inthe sory. He alas tothe ‘offensive smell and te progression of gangrene and eve refets on how it egan with an element of neglect on Harry's part. At 0 po there an explicit desepio ofthe rong Te. Tn Tan Hamilton's biography ented In Search of, Salinger be eserbes the author of The Catcher in the Rye a he bocomes progres sively une, increasingly accomplisied a his craft. Following the2789 Tama publication of Satinge's “A Perfect Day for Bananaih:” Hamilton tes," Fanks to The New Yorker he was beginning to lun the ples ures of feader maniplition, of faving a sophisticated readership that fad been tained in the enjoyment of inconsequential sorow. He wes leaning how to feave things ou, o Maer and deceive” Herein lies te paradox of fii writing: You mst understand what to includ and what to leave out. In det to leave something out Uta scene, you ned o understand all of the elements that could (but should) be inched ‘Auhentity meres from personal experince, stage and then ‘undentacing. Cetin, Hemingway had soo his share of war wounds, Bur most riers have litle experience with waumatic injures. This book ‘escries in dtl wat you mas learn aout body impact andthe spec trum of potential injories in order to Select what details wo nce in Sour seen. Once you understand whats there and how it gets maimed. Soul fet the pain and know what aspect of te injury to describe. The Tenders visual imagery x enhanced bythe inclusion ofthe right deta By learning about parila injry, you may selec the mos visu ements and wie a sparse, fast-ped aston scene, ‘Rather han being anecdotal this ook describes the process. how to create cumatcinjry scene. Included are suggestions on ow to Incorporate the more complicated material nto your sory TNo writer can describe, allie 1 or choose to ignore something st she does’ understand. Aad you can bette treasury that before the ‘hubby cherub chortle, someone in your story is going to get hurt. IF its your traumatic ene, you'd Better know exactly how it happens. "Body Trauma provides a organized ment of injuries and a sug sented method of approach to guide you through te process of eeaing Shentic misery. Using the various examples preseted in conjunction ‘vith mastery ts (amen: of speci ijaris) foreach body sys ‘em, you may constrict innovative itsls and terible wounds oft the ‘specific demands of your pot, Not just ame laundry Tit of lic uiltions, this book deseribes how to cate novel impacts, Doily isrupions and agonizing tssve aura By emifying where the impact fccu and wht it does tothe body. you can pres weave the lent the disability int the drama, This called the me tn ofthe injury. ‘imaginable, ay injry is possible. By using the Meas presented {in his book, you'l earn how 0 fesse the deta. ‘Body Trauma is vied into te dstine parts inorder to organize nd hihlight fr easy we wht is at es complex materi eoascton/3 art one provides an overview of trauma as well at some base ‘concepts about the body. Pipes are explained regarding tissue n= cs, mechanisms of injury and how the trauma Viti is handled in ferent locations beth in and out of the hospital. Part wo isan intense discussion of major trauma, organized by bundy are. I inclodes detailed information about head and neck. chest, shdoming] and lib trauma. This secon represents inal all types ‘of major injury seen in a bay emergency room by trauma surges ‘ar thes inciies unig ins aon to ther cae rate than by body region. Sore ofthese foons of drags ae ute hob. Exam- es ram elassic and contemporary Irate are nce in pars 0 and three to demonsaate how aecompished authors handled bd inst. ‘At the end ofthe book. thee is a discussion of what accrs when am injred person des an the issue of organ donation arises. Siting on the cuting edge of high-tech medical ere, organ transplantation pro _rams struggle with a national shortage of organs suitable for donation. All seriously injured victims should be considered sb potential organ donors. And although nat ur primary concer inthis book, a discussion ofthe process of making this cherished git closes our discussion about broken bodes. I's an importaae wp for fiction wes. ‘So often in contemporary itn, 2 inthe movies, our spenson of ibeiessuetehed wo near rupire by violent body nels sequenced with an implausibly swift covery. On the aher hand it sem many rts have an nttve sense of what i biologically comet and this ook is intended to augment tat instinct. Not only will you eur How to wie your injury seenaies by using this book, bit by the end of the Sok, you should ve Become a sophisticated fist responder tothe injure. Tost as Fon is par of rel ie auma is larng rea-e epi demi awaiting its place in your ition. The lemma forthe write es in whar injury fii the word ofthe soe. Most of medicine is common seme. Have fun with he materia, nd don't pani atthe medspeak ‘Writing your trauma scene may be the only dine you can be the ctr, Ely in my’ supe cae. I performed my share of tas surgery, and many of my personal experenes have insinuated them- Seles into these pages. My professional fe inclodes busy rugial roctice as woll 35 teaching surgical residents and medical students. 1 trust some of that background will make this material inesing and Understandable,AN OVERVIEW OF TRAUMA ONE CONCEPTS AND TERMINOLOGY IN TRAUMA CARE Injures acer for 3 resto, Before entering the vor of rua, you nec to know 3 few basi terms. If you understand simple mechanisms of ljury causation, this part of modem medicine and its fanny-sounding verbiage will case to grasp. For your story to sound autbeatc, you need to know what youre talking aout, Trauna refers he physical wounds and innumerable body ass that rest from diet or indirect cotat with something in the environ ment Inthe chan history af medicine, sngeons Became the specialists ‘who assume the tsk of managing Waunatic wounds, Ueating tebe numbers of war castes from te merous confi ha sede every ‘etary. With ime, weaponry became more sophistiatd, more destruc tive Nonetheless, even the rock hatchet, spears, darts and aro of| ‘rimitve humans vere deadly. and the injures homibl Warors wear sas wih ride, and one wondesif physical conflict isour species orm. In humankind’ history seems ite possible that imentional wounding bas been more feguent than the oseurence of6/805) Tuma unanticipated tauma, A cursory examination of man's warring history teveale repeated, massive conflicts in Which large numbers of watiors came wounded. Mény died. But many survived thee injures o fight tin Scientia eer oan animal's Gclading maa’) response to con- frontation 2 the "ight o Night” reaction, te choice presumably deter- tied by a recognition of the ods. Man has a poor tack record of ‘oii the od of sistining raumatc injures “Traumatic eves ca thus be accidental or nemo Some inj es are more repugnant precisely because the asst is premeditated, an tack designed to ur anoher person. Butevenso-