Medical Dumps for Writers: Basic Trauma Medicine

Welcome, writers, to your basic trauma medicine lesson put together by your favorite veteran, who spent 5 years performing trauma medicine in the Marine Corps. Today we’ll learn about the ABC’s, which are key to keeping your characters alive in traumatic situations. The ABC’s are just what you expect them to be: Airway, Breathing, and Circulation.

Before we begin on the ABC’s, the first thing you’ll check after you witness a violent traumatic event is to assess for a massive hemorrhage and stop the bleeding as fast as possible. You have 120 seconds from the loss of a limb to bleeding to death. You can only place tourniquets on limbs, and have to find other ways to stop massive hemorrhaging in other areas of the body. A tourniquet is placed on the upper part of the limb at least 2 inches from the joint. Once a tourniquet is placed, you have about 12 hours to get your character to a hospital or risk losing the entire limb.

The first thing you’ll do after a violent traumatic event is assess for breathing. If your character isn’t breathing, you’ll have to look for anything that might be obstructing their airway (with your EYES, not your fingers). You might have to place a nasopharyngeal (NG) airway, which slides through your nostril down your throat just past your mouth, or you can perform a cricothyroidotomy in the throat to maintain an active airway. If you thought you were about to get a crike tutorial, you’re wrong.

If the airway is open and your patient is still having breathing issues, it’s time to look at the body. You’ll perform a thorough sweep of the entire body and limbs, looking for entrance or exit wounds from bullets, lacerations, gashes, or puncture wounds. A character with a bullet wound to the chest area will have difficulty breathing and you will need to patch in case of a tension pneumothorax. To do this, you apply a plastic seal around the entrance/exit of the bullet wound, taping three sides, leaving one side open to “burp” the plastic to release any extra air.

In the final step, you’ll reassess the tourniquet and decide if your patient needs a second one (they might!). You can gain IV access at this time and start pumping fluids and pain medication, but the most important step is to get them evacuated and to a hospital as fast as possible.

Trauma medicine is incredibly important to discuss and get right in fiction. By getting key details in your novel correct, you have an opportunity to keep your story as realistic as possible and great ideas to throw a bit of chaos into the mix.

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