LESSONS FROM GRAVITY AND TRAUMA CENTERS

“Oh, that was a big mistake!” This was my initial thought as I flew free into the air, 15 feet above the rocky ground. I had been in a hurry to finish a project and thought that I could reach that last bolt without taking the time to reset my ladder. As I stretched to reach that final bolt, my ladder shifted and catapulted me sideways into the air.
Time seems to run slowly, or the mind quickly in such circumstances. Strange as it seems, my second thought was “Gee, you knew that this was dangerous based on our trauma center cases….why didn’t you move the ladder?” In 2016, Clearwater Valley Health became designated as the second hospital in Idaho to receive certification as a Level 4 Trauma Center. St Mary’s Health followed shortly thereafter and also became a Level 4 Trauma Center. As part of that work, each month a multi-disciplinary team reviews every major injury seen in our Emergency Department. We do this to improve the care extending from the prehospital care onward. As a trauma center, we have reviewed well over 1000 cases in detail since 2016 with the goal of constantly improving the care and the system. From this process, I had ample knowledge of what the common mechanisms leading to major injuries in are our system. Fall from ladders is one of them.
My next thoughts as I plummeted to the ground were “TREE!” and “ROCK!” as I rotated to miraculously miss both of these objects. Next was a loud thud as I hit an extraordinarily soft area of ground absorbing most of the energy of the fall. Despite the high energy of a 15 foot fall, I somehow avoided any real injury. As they say, it is good to be good but even better to be lucky. That day, I was VERY lucky.
Unfortunately, not everyone is so lucky and each year, we see major traumatic injuries from a variety of mechanisms. Over the years, however, certain common patterns have emerged as the top causes of major injuries.
By far, most of the major injuries we see are from motor vehicle accidents including motorcycle accidents. This is not a surprise since travel in vehicles is very common and has a lot of energy and momentum. A frequent factor however is that a significant amount of the major injuries from car accidents involve people who did not wear their seatbelts. About 1 in 5 adults in our region do not consistently wear seatbelts yet they represent the majority of those seen with major injuries in our ER. Use of alcohol or drugs also is seen frequently in those with the worst injuries.
Ground level falls from standing height, although lower energy than car accidents, are a common source of serious injury as well. This is particularly true for our older patients or for those taking blood thinners. The risk of falls can be reduced by working on balance and maintaining fitness as we age. Injuries from ATVs are also significant. Many of these can be prevented by wearing a helmet and remembering to exercise caution while riding ATVs. Sometimes, the ease of access to ATVs makes us forget to be cautious.
Injuries from smoke or fire are often catastrophic but often could be prevented through the use of smoke alarms in our homes and campers. Although less common, unintentional injuries from firearms are sometimes devastating and seen with some frequency in our ER. Almost all of these could be prevented by simply following standard firearm safety such as is taught in the hunter safety courses. We need to remember safety as a priority when handling firearms.
On the list of major injuries is, of course, falls from height. Taking time to be cautious on ladders and roofs is well worth it. This is a lesson I learned the easy way but certainly could have learned the hard way. Hopefully, some of these reminders might help someone to avoid a major injury. Regardless, know that we are working constantly to provide the best trauma care possible for those in our ERs. Participation in the Idaho Trauma System helps us to do our best for you.