eMJA: Doherty, So this is Christmas

Crisis

So this is Christmas

For many, Christmas is a time of religious celebration and joyous family reunions, while for those separated from family and friends it can be a time of great loneliness. For others it can be a time of great grief as loved ones die on our nation's roads.

Steven R Doherty

MJA 2001; 175: 585-586

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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?

Authors' details

Emergency Department, Tamworth Base Hospital, Tamworth, NSW.
Steven R Doherty, MB BS, FACEM, Emergency Physician.

Reprints will not be available from the author.
Correspondence: Dr S R Doherty, Emergency Department, Tamworth Base Hospital, PO Box 83, Tamworth, NSW 2340.
srdohertATmpx.com.au;
sdohertyATdoh.health.nsw.gov.au

Authors' details

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