Wednesday, 15 September 2010

Trauma: Life in the ER

Thursday was Independence Day, and PNG was celebrating the 35th anniversary.  And of course many celebrations would be taking place across the country.  The hospital was open for business, with plans to observe the holiday as a three day weekend.  I was sure it was going to be a quiet day in the outpatient department.  After all, wouldn't our patients rather take part in the festivities than wait in line to see a doctor?  Or so I wished...

I was finishing up with a procedure in the emergency room about noon.  There were only a few patients left in the OPD line.  I figured we would be done with work shortly after returning from lunch.

Suddenly a man burst through the front door of the ER carrying a 10 year old girl.  He said that there had been an accident, a PMV (public motor vehicle) had crashed.  Apparently the vehicle had lost a tire and rolled down the side of a mountain.  Several people had died and many more were injured.  This little girl was the first to arrive.

Jossina's face was covered with blood and badly lacerated, her eyes almost swollen shut.  The nurses quickly took her vital signs and started an IV.  I looked her over from head to toe.  She was conscious and responded to questions and commands.  There didn't appear to be any injuries other than the deep cuts on her face.  I washed the dried blood from her skin and the dirt from her wounds.  I began to suture the lacerations, and prayed as she cried.
A few minutes later, a truck pulled up in front of the ER entrance.  The back was filled with more than 20 victims of the accident.  Some were carried into the ER and other limped.  Soon the beds were occupied with the most critical patients.  A nursing student or officer was assigned to each patient with the task of triaging and taking vital signs.  More trolleys were brought to accommodate the injured, and those with minor bumps and bruises waited on the floor.  The doctors made their way through the room, assessing patients and ordering stat labs and x-rays.  Someone called for an ambu bag and crash cart.  Mournful wails filled the room as one woman was pronounced dead.  Several were admitted.  One man was taken to surgery for a pelvic hematoma.  Lacerations were sutured and fractures splinted.  Another woman later died on the ward.  

This was definitely one of those days when I didn't want to be a doctor.

PMVs or "public motor vehicles" are the major for of public transportation in PNG.  A PMV is most commonly a passenger van, but can also be a Land Cruiser or open backed truck or just about any sort of a vehicle that can carry a lot of people.  Traveling by PMV is dangerous for multiple reasons... over crowding, lack of seat belts, high speed on a bad road, poor vehicle maintenance, rascals, etc.  (You can understand why we docs dread PMV accidents.)  But the average person in PNG has to depend on this system to get around from place to place.  It is the only transportation available for those who cannot afford a car.  The situation is similar in many countries around the world.

According to the WHO
  • More than 1 million people die as a result of traffic accidents every year.  This makes road crashes the #11 cause of death world wide.  Wow!  And most of these deaths occur in low or middle-income countries.  
  • 20 to 50 million are injured or disabled every year.  
  • Traffic accidents cost the world billions and billions of dollars every year.  I can think of many other things to spend those billions of dollars on.
  • Correct use of seat belts reduces the risk of death in a crash by 61%.  Seat belts are used much less frequently in low or middle-income countries.  
Don't worry Mom and Dad... I never leave the station without a seat belt!

(A few pictures may be added later.)

"I will turn all my mountains into roads, and my highways will be raised up."
~ Isaiah 49:11

1 comment:

  1. sounds like an episode of ER, except when watching ER, I knew it was just a show. Unfortunately for you and these accident victims, this was real. I can understand why that was a day when you didn't want to be a doctor.