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On July 15, 2016, I was interviewed by Anthony Sarchiapone from McGraw Hill’s medical education podcast series. The focus of the interview was on what new medical students need to know about auto accident survivors when assisting them in the emergency room. A recording of the entire interview can be found on my website DrJamesZender.com.
In this blog I will highlight some of the points made in the interview.
Auto accident trauma is a world pandemic. Over 50 million people are injured worldwide each year and nearly a million and a half die from auto accident injuries. Sadly most accidents could have been avoided through improved safety behaviors. In the United States, over 35,000 people are killed each year and hundreds of thousands injured.
First. Many auto accident injuries are missed in the emergency room. The stress of a car accident releases endorphins and massive amounts of adrenalin. Often awareness of pain unfolds minutes, hours, days or weeks post-accident.
Second. Auto accident patients are often in a state of emotional shock and are poor informants when questioned about their injuries.
Third. Auto accident patients are frequently experiencing acute stress reactions that often develop into post-traumatic stress disorders. War is not the leading cause of PTSD. The leading cause of PTSD is auto accidents.
We need a shift to greater awareness and appreciation of the Mind-Body connection. What happens to the body is reflected in the mind and what happens in the mind is reflected in the body. For many in the medical profession, it is out of sight, out of mind. Pun intended. For many it is difficult to comprehend the emotional and psychological reactions that are in play beneath the surface of the physical injuries. Psychological mindedness is a skill that needs to be developed and nurtured.
Hospitals do not sufficiently address the psychological dimension of trauma. There is a need to involve trauma psychologists in acute care, particularly when dealing with serious car accidents, especially when fatalities or serious injuries are involved. Often these patients are experiencing severe PTSD symptoms such as re-experiencing the accident trauma and they need significant psychological and emotional support as well as psycho-education about what is happening in their minds and emotions. They need to know their trauma reactions are normal for the abnormal event they have experienced and with time and support these reactions will subside and can be better managed.
Emergency room medical care providers need to listen very carefully to their patients and family members to understand the true nature of their injuries and to be very thorough in their evaluations and documentation. Reports need to be accurate because auto accident cases are highly likely to end up in litigation of one kind or another, and the medical documentation from the emergency department will help to determine the future medical care these patients will be able to receive.
Emergency medical providers need to increase awareness of the neuropsychological dimension of auto accident trauma. We need to learn as much as possible about the topic of concussions, brain trauma, post-concussive syndrome and traumatic brain injuries.
Auto accidents are a leading cause of traumatic brain injuries. TBIs have been called a silent epidemic because in most cases you cannot see it on imaging studies. It is only seen through neuropsychological evaluation or prolonged clinical observation or family observation.
Over reliance on the question of “did you lose consciousness” is a mistake when evaluating the seriousness of the head injury. Often the acute accident patient does not know if they lost consciousness. Only after much reflection can pieces of memory or lack of memory be put together. There are over 100 billion neuronal connections in the brain, and these can be easily disrupted by trauma, blows to the head and acceleration/deceleration forces on neuronal tissue. The movie Concussion dramatizes the level of societal denial around brain injuries and should be required viewing by all medical students.
Last but not least, emergency care providers deserve our appreciation and much respect. Many of the patients I treat today for their psychological injuries would not be alive if not for their heroic efforts and many sacrifices. But when the trauma surgical team and orthopedic specialists have completed their evaluations and life-saving interventions, it is time to involve mental health trauma specialists in the acute care of accident survivors. Be aware that many auto accident cases will have acute stress reactions possible leading to PTSD and some will have TBIs which often go undiagnosed and unrecognized leading to significant life disruption.
