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On the last "normal" working day before Christmas 2000 many hospital
departments were in wind-down mode. Office parties, long lunches and
early pre-Christmas drinks promoted an atmosphere of relaxation
before the festive season holidays. Emergency departments rarely
have such luxuries, although, on this particular day, a buffet was
spread out in the tea-room. The local paper that morning screamed out
headlines about the carnage on country roads. In the preceding 48
hours, in separate crashes in our area, one woman had been killed and a
pregnant woman had been flown to Sydney with spinal injuries. The
police were hoping that these would be the last major incidents in our
region over the festive season.
Just after lunch the emergency physician on duty asked if I could leave
intensive care and help in the emergency department. There had been a
car accident about 50 km away. Initial reports were that there were
three vehicles with three dead, a baby on its way by helicopter, a man in
shock at the scene and an elderly couple coming by road.
The "unknown male" baby arrived accompanied by paramedics. He was
probably about three months old with an obviously fractured humerus,
conscious and crying loudly. He had a lot to cry about. His parents were
both killed in their small hatchback vehicle. In the newspaper
photograph the following day, their car was unrecognisable. He had
been in a child restraint in the back seat and appeared to have no other
major injuries. However, he was transferred to a paediatric facility
because of concerns about occult injuries, and was subsequently
ventilated for a closed head injury.
The paramedic advised us that the "man in shock" was really a man with a
few orthopaedic injuries. The elderly couple had only minor
injuries, but one of them had had ischaemic chest pain. The medical
retrieval unit then phoned to say that the "man in shock" was being
flown to a tertiary centre and wouldn't be coming to us.
The elderly couple arrived and I started to assess them. The woman had
been driving at the time of the accident. The baby's parents in the car
in front never had a chance. An oncoming car just suddenly drifted
across the road and drove them backwards. The driver of that vehicle
died too. The elderly woman tried to avoid the wrecks, but clipped into
them. She had a bruised knee and, after a series of investigations,
went home. Her husband's ischaemic pain had settled, but he had a
painful and tender neck, although nothing wrong according to his
x-rays.
Just before the "man in shock" arrived — it seemed he wasn't going to a
tertiary centre after all — Santa came in. One of the local general
practitioners has traditionally dressed as Santa and brought in
gifts, usually of the liquid and chocolate variety, for emergency
department staff working over Christmas. I think he realised as soon
as he pushed open the resuscitation room doors that he'd come at a bad
time.
The "man in shock" was the passenger in the car that drifted. He was 22
years old and had open fractures of his right hand and right ankle and a
fractured left radius. He had no more serious injuries. He verified
the story told by the elderly woman. His brother, who had turned 26
three days previously, had been driving.
After the casualties were sorted out the bodies started to arrive. The
dead parents had names, the baby had a name. Before the baby's
transfer, and long after the others had left, the nurse who had
received him into the emergency department was still there, stroking
his hair and waiting for the retrieval team. He would never again know
the sound of his mother's voice, never again suckle at her breast.
Some time before this, the mother of the two brothers had phoned. The
police had given her the news. With a broken voice she asked me about her
other son. It was some consolation to be able to tell her that he was
battered and bruised, but not in any real danger.
A female resident, 20 weeks pregnant with her first child, arrived for
the evening shift. She wasn't involved with any of the patients, but
was upset by the whole event. She asked me if things like this get harder
as you get older. I don't know if they do or not. Does experience harden
or mellow you? I told her that I believed these events became harder
after you had your own children. Your own children give you a
perspective on life you never knew existed. You understand the
mother's grief on a more tangible level. You understand the changes
this baby will face on a more tangible level.
The solemn staff went about their work; counsellors were called to see
the survivors of the crash and their relatives, as well as the staff.
Only a month before I had spoken at the Australasian College for
Emergency Medicine annual scientific meeting. I presented on the
differences between rural and city trauma. Fatigue, speed and
alcohol are all more frequently associated with car smashes in
country areas. These vehicles were all doing about 100 km/h, and all
undertaking long trips. The baby and his parents were on a journey of
978 km, the two brothers 513 km, and the elderly couple 859 km -- massive
distances in anyone's language. At the meeting I also presented 1999
Roads and Traffic Authority (RTA) figures; in New South Wales 572
people were killed and 26 748 people were injured in motor crashes.
Sixty-five per cent of fatalities occurred in country areas, where
only 30% of the population live (Mike Adams, Traffic Accident
Research Unit, RTA).
The police and the RTA preach preventive driving all the time. Yet
hundreds of people still die on our roads. The incidence increases
every holiday season, with Christmas no exception. Perhaps, though,
at Christmas, the impact of the road toll, repeatedly tallied on our
televisions and in our newspapers, hits harder. In the 2000 Christmas
and New Year break, 77 people died on Australian roads, 39 in NSW.
Notwithstanding the work of the police and the RTA, the medical
profession, and emergency physicians in particular, are in a great
position to become more proactive in road trauma prevention.
Programs need to be developed, starting with children in our schools,
and they need to be repeated at various stages of their progress
through school. Indoctrination? Perhaps, but something needs to be
done. We need to develop a society that knows the dangers of driving and
understands the main contributors to road crashes, most of which are
not "accidents".
Christmas 2001 is approaching, and sadly the same horror stories will
occur somewhere this year. They will keep recurring. For some this
will be the real Christmas. A Christmas of tragic loss or painful
memories. Are we, as a profession, doing enough to lessen this trauma?
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