The ABCs of head trauma

The accident: Two landscapers tied off a large tree limb overhanging a glass roof so it wouldn’t fall when they cut it. The fulcrum system failed, however, and one worker ducked as the limb crashed down. The branch struck his partner in the head and chest, causing a depressed skull fracture – in which part of the skull enters the brain cavity – six broken ribs and a collapsed lung. The uninjured man put his coat under his co-worker’s head and neck and wrapped the sleeves around his skull. He made sure his partner was breathing, did not allow him to move and called 911. Emergency personnel reinflated the victim’s lung, and surgeons repaired his skull. He had no brain damage and left the hospital after 10 days.

What the expert says: Using a jacket to both stabilize the victim’s head and neck and to slow bleeding from his scalp was “genius,” says Dr. Joshua Kugler, chairman of the emergency services department at South Nassau Communities Hospital in Oceanside, New York. Maintaining common sense and good judgment in caring for someone with a head injury is difficult because the scene is often gruesome, he adds. Yet doing so is imperative.

Memorizing a set of steps that corresponds to letters in the alphabet can help:

A, for example, is for airway. The first thing you should do is ensure the victim’s airway is open. Lift their chin and remove teeth or dentures if they are obstructing the airway. Then call 911.

B is for making sure the person is breathing adequately. If not, pinch his nose and perform CPR. The brain regulates breathing, so people with head injuries can have breathing problems even if their lungs aren’t damaged.

C is for circulation. Begin cardiopulmonary resuscitation if the person doesn’t have a pulse. Everyone working in a landscaping environment should have basic life-support training, Kugler says. Ask your employer to provide this training if the company doesn’t already. The American Heart Association offers courses in every state. If the person is bleeding, put pressure on the wound. In addition to wrapping an injury as was done in the example accident, you can fold a jacket or towel and press it onto the wound.

D is for disability checks. Ask the victim if he can feel and move his hands and feet. If not, tell emergency personnel as soon as they arrive.

E is for exposure. Evaluate the victim to see if a toxin that could have incapacitated the person, causing a fall and subsequent head injury. In landscaping, this would most likely be a chemical substance. Use water to wash toxins as well as dirt and debris off the victim’s body.

Don’t move the person unless the environment is unsafe. He could have a neck injury and movement might result in paralysis. As difficult as it might be, if you can’t move the victim out of an unsafe area or if reaching him would put you at risk, wait for emergency personnel. Having two victims instead of one is the worst thing that can happen, Kugler says. Care-provider safety is as important as victim safety,” he says. “And in the heat of the moment we sometimes forget that.”

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