Blast damage..

[Der Cute]

My first thoughts - before the ambulance and protocols (Hi Seshat) -
short debris flying around. You said cosmetic damage to building - masonry bits and chunks of stone. You said vest stopped blades - what about small parts? Would that vest reflect/redirect a hard impact?
You said she's also 8' tall. Fall backwards, yes concussion, mass blood (stupid scalp capillaries) and someone calls ambulance.
Hairline fracture of bone, tib or fib, due to compression change/damage?
Blown sideways or straight? Sideways blow hit bruise hip and tendons. Straight, hit corner of room /bricks with spine. Those 2 cause long term damage, not seen @ beginning.
Concussion - after xray, no issues. Didn't find bone chips floating around (Isn't Xray just procedure, not CAT or MRI? Correct?) Or nerve bruising/tendon bruise. Those would later (soon but not immediate?) cause movement. Throat? Inhale brick chips/grit?
Yell at asshole who sets this off?

[Fire_on_High]

One question: How much do the paramedics and ER personnel actually know about her kind (and medical treatment thereof)? I'm wondering whether her visit to the ER might be used as a teaching opportunity for staff who aren't actually treating her.

If this is in the COH-verse, all the weirdness is out in the open, so they plausibly would know.

[crazylegs]

Yes, there is. Especially if the patient is concussed or otherwise might not be responding properly to pain signals.

It is possible for a person to have spinal injury and not be aware of it because they're too loopy, or too focussed on some other injury. So (as I understand it), standard practice is to c-collar (cervical collar - neck immobilisation) anyone who, in the conservative judgement of the attending medical personnel - MIGHT have a neck injury.
Similarly, to strap someone to a backboard if they might have a back injury.

Pretty much exactly this.

For immobilisation a full history of the mechanism of injury is so vitally important - if the patient can't produce this as they lack full recall (aka lost a few minutes) then they would get boarded. There are procedures for boarding someone who is standing up see this video for an example.

Some areas are moving away from longboards as a means of immobilisation and moving towards scoop strechers/vacuum mattress - it would be worth having a check to see what the local protocols are.

The link to JRCALC I posted earlier has a much better explanation of when to board & when not too - if you not too sure on any of the terminology/procedures let me know

[kpzra]

I've responded to scenes where EVERYONE was collared/boarded, regardless if they were up and walking around. Four way stop, no one stopped. The all call to board was when I went to check on on pax and found their head on the way over, 10 feet from their body.

There are SOPs for most mechanisms of injury that dictate what need to happen. Blast damage with head injury, lay down on this for me. One medic I knew was walking around with a broken neck, his partner noticed the back of his neck looked a bit odd when they were checking out the rig and they went to the hospital. Turns out the dive into home plate had done it, he just felt sore. The sup had him immobilized after seeing the bulge, this was 18 hours after initial injury happened.

[Amanita]

I'll try and answer as many of these questions as I can:
First, with regards to her armorweave clothing, it's designed to resist penetrating trauma- shrapnel, bullets, blades. It might also have reinforcing plates over the spine, like a low-profile version of Klingon spine armor, all of this hidden under an attractive outer layer of fabric.

So it would protect what it covered against laceration. But like any flexible armor, it's not the best at stopping blunt force trauma. It might absorb some of the hit, but poor One New York Plaza's still likely to be bruised up quite a bit underneath it.

I'm seeing her being picked up by the blast and thrown a little ways, caught in a mess of falling cinderblocks, at least one of which is responsible for her head injury. She's lucky enough not to be slammed into a wall or blown through one.

With regards to how the paramedics find her, she's walking around- perhaps her sibling, or one of her skyscraper neighbors is already helping her out of that armorweave jacket, so the paramedics don't have to fuss with it- but I can see an ER physician being interested in it- perhaps wondering why she isn't banged around even worse than she is, or at least why she's not an absolute mess of cuts and scratches from flying debris.

I watched that video showing how to board a standing patient- Not only is our lady rather tall, but she's also heavy, probably pushing 500 pounds. She's solid muscle and her tissues and bones are somewhat denser than ours. With a patient that heavy, I wonder if the paramedics would welcome the assistance of other skyscraper-incarnates who were there? They're much stronger than us humans, and could move her easily. Or would that be a liability issue? They might also need somebody tall enough to reach her neck to apply that collar as well.

As far as memory lapses go, One New York would be able to describe events up until the actual blast- "Yeah, we had this little fire in my basement...We thought it was out, the firefighters were packing up their gear, and I was starting to head for my engineer's office to fill out an incident report, when all of a sudden, BOOM! Next thing I know, I'm on my ass with half the damn cinderblock wall down, with crap all over me..Was I knocked out? Yeah, I think I was, for a few minutes...I remember opening my eyes, and feeling a puddle of something sticky under my head"

So she could recall the accident itself, it would be the few minutes afterward that she was missing. Would that be as much of a concern?

As for the ER visit- would a hairline skull fracture be a huge concern? Bear in mind that the top of her crown is a bony crest of sorts, a few inches above her actual grey matter.

I like the bit about yelling at the asshole who caused it..but in this case, the cause of the blast is something of a mystery- it started as a fire in a decommissioned chiller unit. (FYI- chiller units in skyscrapers are massive, often measured in thousands of tons. Not sure if this is their actual weight or capacity of some kind) So they thought they had that fire well and truly out and were preparing to leave when the darn thing just...exploded. Details in that article are kind of vague, unfortunately.

[kpzra]

For a 400+ pound pt we would call for a lift assist. Generally by standers are NOT allowed to help lift due to liability, the FD would be called. If PD is around they would help if free. As for a collar, they just lay down on the board so I can do my thing.

In a situation like the towers going down, I'll take all the help I can get, just depends on the situation/scene safety. The company I was with has a lift test as part of the pre-employment physical...graduated weight going up to 150 pound to various heights and including stairs. Heavy lifting goes with the job.

[Amanita]

And in the story from my OP, it sounds like there would be plenty of firefighters around to assist- they were already on site, just getting ready to leave after putting out that fire. I'm still not sure how that explosion happened, after the fire was supposedly out, that's freaky stuff there.

[Sapphire Silk]

A tertiary impact. Internal organs, including the brain, get slammed against the bone or muscle structures that surround them.

This is called a coupe contra coupe injury.

So if she's conscious, would the paramedics have her take that stuff off herself, or if there's another of her species around, have them assist?

If she can take the stuff off herself, and they need access to do a secondary survey or start an IV, then they would ask her. I've had that happen to me when I was in a car accident.

Why doesn't she do the rational thing and sit or lay down? There might be a crowd of office workers milling around wondering what's going on- for starters, she might not want to show weakness to some of them. And to others, she might be trying to project reassurance- workers might figure that whatever happened, it can't be too bad if the building's avatar is still up and kicking, after all.

Lots of trauma victims move about in spite of the fact they should not do so. It's a natural reaction to injury; you have to move to avoid the predator that presumably nailed you.

What would happen once she got to the hospital? For a concussion, would hospital staff discourage her from sleeping? One thing I forgot to mention- these beings are psychic, very much so. I imagine she would be firmly discouraged from using those abilities- normally using them causes no strain or injury to their grey matter, but that might be a different story for somebody with a head injury, and doctors might err on the side of caution.

Assuming that psychic abilities are known and understood, they would likely be discouraged from using them until the initial injury heals. A CT of the Head is SOP for head trauma. Most of these CTs are normal, meaning the brain is merely bruised (concussion); these injuries often do not show up on CT.

However, with some closed head injuries (ie no open fracture), you can have internal bleeding with or without a fracture. These bleeds can be venous or arterial. Venous bleeds (usually subdural hematomas) are slow bleeds that may not show up on CT for 24-48 hours. Arterial bleeds are fast bleeds that usually show up right away. Either can be severe enough to cause the brain to shift within the skull (herniation).

The skull is a closed space that contains 3 fluids: blood, cerebrospinal fluid (cushions and lubricates the brain) and the brain tissue itself. The laws of physics state that two objects cannot occupy the same space. If blood leaves the circulatory system and leaks into the skull, it pushes brain tissue aside causing stroke like symptoms: changes in mental status, decreased reflexes, one sided paralysis (opposite side of body is affected), coma, and even death. If the patient survives, the damage may be permanent.

Death occurs because the brain gets so far pushed to one side it stops autonomic functions, especially if it herniates onto the brainstem. The place where the spinal cord meets the brain and becomes the brain stem is the only place left for fluid to shift (the foramen ovale of the skull).

Most cases are simple concussions. The patient goes home with someone to watch them for 24 hours. They can sleep, but should be woken every 2 hours. If they don't wake, or their behaviors change in any way they should return to the ER.

What kinds of drugs might somebody with a concussion and overall lots of bruising be given? Anything that would make a person loopy, or would that be a bad idea- after all, if somebody starts talking or acting strangely then, it might be a real pain to figure out whether it's the drugs or the head trauma causing it.

We don't give much in the way of drugs to a head injury victim. Opiates can alter mental status, which is monitored closely as changes are a sign of a worsening condition, so we don't give them. NSAIDs might be given if the patient has a normal Head CT and little risk for bleeding, but that would be it. Tylenol is a better choice. If the doctor is confident that the concussion is mild, he might give something like T3 or Vicodin for one or two doses because the patient will have a severe headache. But that would be about it.

One question: How much do the paramedics and ER personnel actually know about her kind (and medical treatment thereof)? I'm wondering whether her visit to the ER might be used as a teaching opportunity for staff who aren't actually treating her.

A case like that would definitely be a teaching case. How much they know before hand depends on your universe and how much research scientists have done on her kind.

And knocked out would work- the initial blast and falling debris would do it.
What happens when somebody presents at the ER with that, not to mention the scalp/crown laceration that causes a nice little blood pool to form under her head?
For what it's worth, she's ambulatory- up and moving around, despite her brother's protests. So by the time she gets to the ER, she's got no problem moving on her own, or responding to ER staff's questions.

Scalp lacerations are usually repaired with staples, because then the hair does not need to be shaved for sutures. Sutures are used if the laceration is more than superficial (ie goes to the bone) because the repair has to be done in layers.

Would they collar and board somebody who was up and walking around when they arrived? By the time first responders get there, my skyscraper lady has already gotten up and is moving around. If the patient's mobile like that, is there much point to immobilization? I imagine the fact that she's missing a few minutes of time from where she was blacked out would be a cause for concern. That and the fact that so soon after the incident, that head wound is still bleeding like a stuck pig.

They absolutely would collar and board her. I have seen many many patients with C spine fractures with NO deficits. The standard of care is to immobilize until cleared by X ray.

All head wounds bleed a lot. The head is very vascular. Direct pressure to the wound is the initial treatment until the wound is explored and the correct type of repair is determined by the ER doc.

[Amanita]

Interesting stuff. In this universe, her kind have been out for a while, so a fair bit is known about her kind and their abilities. So I can see some ER doc telling her "Use your words, cool it with that telepathy before you make things worse!"

I can see her (being the avatar of an office building) making jokes about the staples, if that's what was used on her. "Damn, if I had known you guys were gonna do this, I would have just grabbed the stapler from my property manager's desk and done the job myself!"
Now, she is bald, so shaving anything's a non-issue. Might that make a difference when deciding between staples and regular stitches? Her kind have no body hair at all, aside from eyebrows, eyelashes, and nose hair.

What's the difference between minor and major concussion? Would it mean the difference between hospitalization and being sent home?

Being the telepathic things her kind are, her neighbor skyscrapers immediately know something's up, and come out to investigate. So when EMS arrives, she's got a few of them with her-They might already have assisted her in removing that armorweave jacket, but there's still the issue of the rest of her clothes- how much more is eventually going to have to be removed?
If almost all of it's going to need to come off, her skyscraper friends have one trick they could use after she's been boarded- A little something called Astral Gating- it's where they can disappear an object back to the astral plane, or call one forth from there. It's usually used for defensive purposes- Keeping a weapon stowed on the astral until it's needed- pulling it back to this plane, using it, then disappearing it again. They could also use this trick to remove some of her clothing, such as her boots, and even her pants and shirt if needed. It's a hell of a lot faster than trying to cut it all off!

Once poor One New York's been boarded, the exchange might go like this:
Two New York, to one of the paramedics "You guys are probably going to need to get the rest of her clothes off at some point, right?"
Medic- "Most likely"
2 NY- "I think we can save you some time here", while gesturing to the trio of female skyscrapers standing a few feet back. "Umm, you do have blankets in the back of that rig, right? Better go grab one!"
Immediately after, he and another one of the neighboring skyscrapers form a barrier between One New York and the various humans gathered around. They fan out their overcoats to form a sort of screen, preserving their friend's dignity, while allowing plenty of room for the paramedics to work.
A few seconds after they started, the skyscraper women are finished, and now One New York's laying there with just her undergarments- a sports bra and a breechclout style loincloth, no metal that could interfere with an x-ray later. Hence the need for that blanket!
Decembers in NYC are rather cold after all!

If a major concussion's not enough to keep her overnight, I'll have to pick and choose something from all the ideas offered here to complicate things for her a little bit.

[Der Cute]

If there's a blast, and gravity still works, why not have something fall on her? Sharp pointy objects like a clock or some ornament on outside of building.
Or a straight up big ass rock, causing the head trauma Panacea's described. So hey, "Oi, headache, ostrich egg sized bruised." EMT: "hey. Stop. Board NOW. Do NOT move and tell your brain to go to low mode" (basic function, 5 senses).
She does.
She tries to fire up psy @ hospital; interference w/ CT scan lol and Tech says : LOW MODE DAMMIT.
Nurse/Tech explains that "you run psy stuff you're going to really interfere with our testing and your healing. Shut it off for 48 hours, ok?"
So there, she's got injury and hindrance /limited for the next 48 hours. She COULD cheat and send off short bursts like texting but no steady streaming. The hospital (protocol if there's a brain bruise? ) keeping her overnite, but having her in Faraday room or some other "controlled" environment so she can't use the psy part, making her rest.

[Amanita]

Here's what One New York Plaza looks like from the outside:
http://upload.wikimedia.org/wikipedi...of_BSt_jeh.jpg

Not a lot of heavy stonework or ornament to come loose, and the blast was indoors, in the sub-basement. But as mentioned earlier, there's lots of cinderblocks down there, which would do the job nicely.

Now, she can control herself, she's been taught to use her abilities from childhood, so if told to keep a lid on it, she could. But she might send out short telepathic messages, to let her clanmates know she's okay.

An interesting fact about skyscraper-incarnates- since they don't reproduce biologically, they trace their primary family lineage through their architects. So any other skyscrapers designed by the same architects would be considered her family.

Earlier I mentioned some concern regarding removal of clothing, especially where others might see her- her species isn't freakishly modest, but still, there would be concern for her dignity. I don't think cell phone cameras were as ubiquitous in 2001 as they are now, but One New York would want her dignity, not photos of her nearly nude, bruised and battered body being passed around and snickered over by disrespectful tenants and others, or worse, showing up on the news.

[crazylegs]

Where the patient has only minor injuries then exposure would be done (if need be) in the vehicle - or if spectacularly close by then at the hospital. Complete exposure would only generally only be done on in the street in the case of major trauma (like a high speed motorcycle collision).

[kpzra]

It depends. If I can see blood but can't find the source or you can't tell me where it hurt (freaked out), you're getting naked until I find the leak. I'd usually try to do this in the ambulance if I could though. Only person who got naked in the street was a pinned motorcyclist in full leathers with a blood pool under him.

[Amanita]

In One New York's case, the source of bleeding would be pretty darn obvious- it's coming from the flat crown of that bald head of hers. And she would be coherent enough to be able to say where she hurt- that most of the pain is coming from her head, and the rest seems to be nothing more than bruising- under that armored jacket, she's got short sleeves on, so that much would be visible- if aside from that jacket, the only substantial metal on her is in her boots and belt (easily removed), and she doesn't appear to have serious damage anywhere but her crown, would it even be necessary to remove the rest of her clothing to x-ray her?

Another thing about her species is that they can sense internal trauma through laying on hands- they receive training in how to do this as part of their martial and psychic skills. So her neighbors already on the scene might be able to tell the human first responders that as far as they could sense, her spine and internal organs didn't seem to be compromised in any way, the only area of concern was her head. In a world where these beings were a relatively common sight (at least in urban areas), some credence might be given to that ability- experiments might have shown that these beings have an extremely high accuracy rate when it comes to sensing internal abnormalities and damage. Although I imagine x-rays would still be done to confirm this, it might calm things down somewhat, where worries for the patient's safety are concerned.

[wolfie]

I like the bit about yelling at the asshole who caused it..but in this case, the cause of the blast is something of a mystery- it started as a fire in a decommissioned chiller unit. (FYI- chiller units in skyscrapers are massive, often measured in thousands of tons. Not sure if this is their actual weight or capacity of some kind) So they thought they had that fire well and truly out and were preparing to leave when the darn thing just...exploded. Details in that article are kind of vague, unfortunately.

I recall reading somewhere that "tons" was an old method of sizing air conditioning units, and referred to how many tons of ice per day would be needed to provide the same amount of cooling.