The most common emergencies over the holidays

Trigger warning: This article references emergencies of a sensitive nature.

Accidents and emergencies around the festive season are expected. This year, our emergency units have picked a few of the more common injuries experienced over this time and we’ve written a guide that will hopefully reduce injury, if you find yourself in a similar situation.

Dr. Thea van den Heever, Head of Emergency Medicine at Busamed Bram Fisher International Airport Hospital in Bloemfontein says the reality is while some of the emergencies that will arise over this period will be fatal, other incidents can be treated well if protocol is followed.

“The most likely injuries we expect to see include vehicle accidents, drownings, lacerations, activity injuries (like those arising from amateur sport), sunburn, attempted suicide and the effects of alcohol intoxication.

Dr. Van Den Heever says valuable time is lost in deciding whether an injury can be treated at a general practitioner or if it needs emergency care. “Any motor vehicle accident from minor to major, a wound with uncontrollable bleeding, limb deformities, any pain from an injury that does not respond to analgesia, drowning irrespective of the duration of submersion, all suicide attempts and severe alcohol intoxication need emergency treatment. Sexual abuse should also be seen by a doctor at a designated site.”

Another major dilemma family members or patients face is whether one should be transported via ambulance or take a private car to the emergency unity. Dr. Van Den Heever says if one is in a rural area, an option is for an ambulance service to meet you halfway to take the patient to hospital. “If there are life threatening injuries then one must wait for the ambulance, as paramedics are trained in Advanced Life Support and have special equipment to secure the patient en route.” She says if you are unsure of which option to take, consult with the emergency service on the phone and they will advise what would be best and they will offer you knowledge on what to do to stabilise the patient till the ambulance arrives. Always remember to speak calmly and give the operator your name, location and the nature of the emergency in a clear way.

Suicide

Dr. Van Den Heever says the holidays are a time of depression for many who are battling grief and loss of any nature. “One must remember that many people suffer from depression and they might not talk about how they feel. They might just take action by trying to commit suicide and it could be fatal.” Suicide threats should also not be taken lightly.

“For the depressed patient there is a helpline available and if you feel like committing suicide seek the nearest medical attention so that you can be seen by a doctor and referred to a psychiatrist then one will cause the least trauma to oneself.”

Vehicle Accidents

Road traffic is also expected to increase over the festive season and this results in accidents that are unnecessarily fatal. Dr. Van Den Heever says the rule of only one passenger per seat in a car cannot be overstated and yet it is one law that is most often flouted. “The rule implies ‘no kids on the lap.’ Airbags are in all new vehicles. If a passenger sits in the front seat with a child on their lap, the most catastrophic injuries are absorbed by the child as the airbag deploys in their face resulting in suffocation and injury. Each child should be placed in a car seat with a seatbelt that straps over the shoulders.” She says the best seatbelts are those that consists of shoulder straps that fasten in a criss-cross manner over the nappy when using a car seat. Children should never be allowed to sit in the front seat unless they are 12 years or older in order to prevent harmful injuries from airbags. Dr. Van Den Heever adds that children standing in the middle of the front seats suffer horrific injuries when a driver suddenly brakes. “The child is catapulted forward into the windscreen and which results in major head injuries, multiple other body injuries and sometimes result in death.

Drowning

Finally, the most common accidents and emergencies happen right in the home where a level of safety is perceived. “Children younger than 5 years are likely to drown, and the numbers are as high as 500, 000 worldwide.” Dr. Van Den Heever says there are two types of drowning viz. dry drowning and wet drowning.

“With dry drowning water passes through the nose and does not enter the lungs, however laryngospasm develops and therefore all children that have a near-drowning experience should be taken to an emergency unit at a hospital.” She says even if CPR was done, the patient should be taken to hospital. “If laryngospasm develops asphyxia will follow, with even lung oedema that might develop. Cardiac dysrhythmias might be present with hypotension and myocardial depression. Other organs that are also involved include the central nervous system, kidneys, metabolic and gastro intestinal tract as well as haematological systems. The damage might be irreversible to these organs, and this will result in the death of the child.” Dr. Van Den Heever says most drownings can be prevented with the placement of a safety net over the swimming pool and supervision of the child when there is a swimming pool present. “One must also keep in mind safety around water slides as some of them have an area where water can accumulate and the child might aspirate some of the water.”

Body Injury (head)

“One should keep in mind of the Monro-Kelly doctrine when it comes to head injuries. This doctrine states that the intracranial contents (brain, blood and cerebrospinal fluid) must remain constant at all times. The cranium is a rigid structure and cannot expand with an injury. Once the normal intracranial volume is exceeded the intracranial pressure rises. Then the venous blood and even the cerebrospinal fluid will be compressed out of the container, as this will provide a degree of pressure buffering. If the pressure increases the brain tissue becomes ischemic (decreased flow of blood and oxygen) and this results in a certain degree of brain injury. Coma (inability to respond to stimuli) will most likely occur. One will then have to be placed on life support to reduce the amount of brain swelling and in some cases one might never recover from this.

Body Injury (leg)

With a sprained ankle it is very important to know that if with the first five steps the patient is unable to bear weight, then medical attention will be needed. “If the ankle is swollen severely causing pins and needles, is not responding to analgesia, has bi-malleolar swelling, experiences pain below the knee with ankle pain, has a visible deformity from the injury, has a pale looking leg or foot and is cold to touch, then medical attention should be sought and one should preferably go to a facility with x-ray capabilities.”

Dr. Thea Van Den Heever, Head of Emergency Medicine

Busamed’s Emergency Units are located in these areas. Call these numbers should the need arise.

Busamed Bram Fischer Private Hospital – Tel: +27 51 412 4269
Busamed Harrismith Private Hospital – Tel: +27 58 304 3064
Busamed Hillcrest Private Hospital – Tel: +27 31 768 8911
Busamed Gateway Private Hospital – Tel: +27 31 492 1234
Busamed Modderfontein Private Hospital – Tel: +27 11 458 2084
Busamed Paardevlei Private Hospital – Tel: +27 21 842 6642/3