I'm entertaining myself with writing some shorts while I wait for the main project to be edited, so I'm on to yet another thing, this time involving a guy being brought to the hospital. Since I've basically only New Amsterdam as a reference I would like to run the sequence of events by you. I'm not looking for extreme realism (I mean, the guy will be meeting aliens or angels later), but I don't wanna break suspension of disbelief. Accidental electrocution | small town (probably Sterling, Utah, for reasons amusing only to myself) - Ambulance arrives, paramedics (is what ambulance-doctors are called, yes?) check the patient where he's lying - Guy gets put on a gurney and shoved into the ambulance, his brother rides along - Paramedics do some more checking? - Paramedics wheel him in to the emergency room, his brother in tow - Paramedics inform the emergency room doctor of the guy's state (not in danger, unconscious - unusually long, for plot reasons) - Doctor checks the guy and orders an MRI on him From here on out I can fake my way onward, I think. Is there anything in the above that would possibly make you go "aliens, sure, but I'm not buying the emergency room thing"?
I can't answer that but the only thing I would question would be if a doctor would be waiting immediately in triage or if nurses would check him first. I don't work in medicine, so am not qualified answer, just giving you some perspective from a typical reader. I don't see anything that stands out as unusual, but I think it may help to get some information from paramedics and ER staff on how the hand off of patients usually occurs and if t.v. portrayals are realistic. This makes me think of another question: is there more than one 'ER'? Or separate entrances? I've gone to the 'ER' a few times, but have no memory of seeing anyone wheeled in suffering any trauma, but I'm assuming the ambulance entrance is totally a separate hallway.
Whether accidental or not, if it's electrocution, then he's headed to the morgue. If he has survived an electric shock, however, but is in critical condition, I imagine the paramedics would check vitals to make sure he's stable and call ahead to make sure he's not left lying beside the bleeding drunk and kid with a twisted ankle for five hours. My understanding is that someone in critical condition would be received as a matter of urgency, with as much info as the medics can ascertain. Brother may travel in the ambulance but won't make it very far within the hospital. I imagine different locations have different practices but am mostly replying on the use of electrocution.
If a critical patient was coming in, the doctor might very well be waiting. But the workup would be broader than an order for an MRI. Patient is wheeled into a slot generally divided by a curtain. If the patient isn't already getting CPR the patient is usually slid from the ambulance backboard which is on a stretcher to the ED stretcher. If they can't get him off the backboard they just slide that over and the ambulance staff pick it up later. Next, everyone goes to work at once, putting an O2 mask on, starting an IV if one isn't already running, drawing blood, getting the EKG leads hooked up and getting a blood pressure. At that point the doctor is probably checking the guy's pupils and reflexes and feeling his abdomen. Someone (could be nurses or doctor) does a head to toe check so they aren't treating one thing only to find the guy has an icepick wound to the heart or something that they missed. An MRI would not be ordered. If the guy is stable, a CT scan of the head would be. Or a full body CT if indicated which a history of an electrocution might be. They want to know, after the patient is stable, why is he unconscious. How much further do you want to go here? If they need his bladder empty they might put a catheter in. Or they might do it to check for blood. If there's an indication he is losing blood and they cannot see where it is coming from they will also do a belly tap to look for blood. A lot of what is done will be based on what they find such as in the neuro and lab workups. Back to the ambulance, staffing depends on the city and state. Some have only BLS attendees, some have ALS, one might find a paramedic in some cities. I believe the aid unit that came to transport George Floyd had paramedics but they were probably part of the fire department. In this city the paramedics are on the medic units, EMTs are on the aid units (both part of the fire department) and if they have a stable patient they might call a BSL unit (private ambulance company) to transport. In your scenario it would be a medic unit and they would transport. The medics here do a lot more than you would expect from performing a tracheotomy to jamming the IV into a bone if they can't get a line in. Which brings up the point if the guy wasn't breathing they would insert a trach tube and start bagging the patient.
Not sure what you mean "headed for the morgue"? Declaring a patient dead in the field is a tricky issue and if it is allowed then the coroner or medical examiner might pick the body up from the scene. Anything short of obvious the patient will have a resuscitation attempt in the ambulance and in the ED before they call it. Anytime an ambulance arrives a triage nurse will assess the patient. They don't wait behind any other patients in the ED though they might have to wait to be seen after being put in an ED space on a stretcher and assigned a nurse. From Wiki: Drowning is the same, not everyone who drowned dies. That one took some getting used to.
The emergency crew might be paramedics or they might be EMTs (Emergency Medical Technicians). I think (but I'm not certain) that paramedic is a step above EMT, and that in my neck of the woods (northeastern U.S.) most ambulance staff are EMTs rather than paramedics. I'm not sure his brother would be allowed to ride along. Checking and treating. They will be monitoring vital signs, probably have him on oxygen, and they will most likely have a portable defibrillator standing by in case he goes into cardiac arrest. The brother will almost certainly be sent around to an entrance to the emergency department's waiting room. I am not an EMT or a paramediac, but I have been zapped a couple of times, and I knew a guy who was struck by lightning. IMHO, anyone who was zapped hard enough to have been knocked unconscious is very probably NOT "not in danger." The guy I knew who was hit by lightning was declared dead in the emergcncy room, then revived in the hallway, An MRI? Why? What's that going to show. Answer: probably nothing. I'm also not a doctor, but I can't imagine any conceivable reason for putting an electric shock victim through an MRI in the emergency room. An MRI might be done after the patient has been stabilized and admitted to the hospital for treatment, but I doubt it would be part of the emergency room protocol. https://www.webmd.com/first-aid/electric-shock-treatment https://www.healthline.com/health/electric-shock?c=576812080619#medical-treatment https://www.electrocuted.com/2019/09/11/electric-shock-what-is-it-causes-symptoms-treatments-safety/
Ha, I did look it up, but after posting and cannot express my horror! I'm going with a self-satisfied notion that this is yet another example of dictionary writers eventually conceding to common usage, like starving means quite hungry and drowned is when you're caught in a rain shower. Electrocution did involve death when language was imprinted in my brain, but that was aeons ago ( aeons meaning decades).
Didn't you know? Literally is the new Figuratively. Nothing means what it really means anymore, it either means the opposite of what it means or something sorta kinda close to what it means.
Around these parts we vary it up so to distinguish true meaning. So if you hear someone is drowned, then RIP. But if they're just drownded, come in and dry off.
A paramedic is an advanced practice EMT. That varies but I agree it is not common. Parents might be allowed to go with a young child. Most of the time there's no room for anyone to come with the patient.
In medical terminology there is a specific definition of drowned and electrocuted. They do not only mean a person died by those means.
I wouldn't even have thought about that if you hadn't brought it up. Good point. Maybe that's what I meant. I didn't take the time to check out either when I posted. Will do later. Poor guy will be going through enough as the story goes on. Let's not... Nope. I'm gonna go with 'he's fine'. And I'm changing it. EMT did already rattle around in the back of my head and it sounds more familiar now. Yes, I concur. But it's, like, plot-unconscious. I'm given to understand that's physically harmless. The idea behind an MRI (or the CT, or whatever magical brain-reading device) is that it seemed like a good way to make it clear to the reader there is a lot of activity in his head while he's out cold. At first that shouldn't mean too much, but near the end it'll suddenly make all the sense. Yeah, and when you put 'electrocution' and 'shock' together in the other post, it suddenly hit me as well. Whatever the notions may be, I'm going with shock. I'm not playing that game. I understand full well that language is a living thing that needs to evolve, but it's not always for the better. Literally-figuratively is not one of the good ones. Yet it's such a common trope that it made me wonder if there was some truth to it. It always seemed strange to me to pack an ambulance with people that were only good for getting in the way. I'm actually kinda happy you brought this up, because if I send the brother after the ambulance in his own car, I can basically skip the whole emergency room thing. In which case I apologize for wasting your time.
I don't think either an MRI or a CT shows brain activity. You may be thinking of an electroencephalogram: https://www.mayoclinic.org/tests-procedures/eeg/about/pac-20393875 Anyone who has been shocked into unconsciousness (even "plot" unconsciousness, whatever that means) has undergone trauma that it not physically harmless. Respectfully, if you are aiming for credibility here, you can't just finesse this. Electrical shock injury is serious stuff, which is why the experts recommend that anyone who has been shocked be transported to a hospital and examined, even if they appear to be okay.
I can only give you a UK paramedic perspective, but as our ambulance service is so different from the US and your story is set in the US there’s probably no point. I think we have a lot more autonomy here than in the US.
Maybe something the OP can have is the character gets shocked on a tall ladder, takes a near fatal fall, and is presumed to be brain dead. Just as a formality, they scan his brain before donating his organs. Then it could be "Doctor, can you check this, I want to make sure the equipment isn't malfunctioning." "This can't be right." "I know, his brain activity is 100X normal!!!"
If it helps the plot, the unconsciousness could be caused by something other than the shock (unless that's non-negotiable). Head trauma incurred when he fell down, inhalation of something, whatever. Or they don't know why he's unconscious. Hey, it happens. Maybe checking his vitals they see he seems to be doing fairly well but is unconscious for unknown reasons. Of course you'd eventually need to explain the reason, unless you're writing a 'stranger than fiction' type story. ... maybe he was just really sleepy? *insert Dr. Evil gif*
As an aside to this thread, your story sounds like something interesting to read, speckled with irreverent humour and the mystery surrounding its location. To be completely anal, I searched Google with "medical dictionary electrocution" and got this: electrocute (redirected from electrocuted) Also found in: Dictionary, Thesaurus. Related to electrocuted: electric shock e·lec·tro·cute (ē-lek'trō-kyūt), To cause death by the passage of an electric current through the body. [electro- + execute] Farlex Partner Medical Dictionary © Farlex 2012 Farlex Partner Medical Dictionary is a leading medical authority (based entirely on the fact that it led the charge on Google. No idea if it's definitive). It may also mean non-fatal injury but, personally, I wouldn't use it for that.
Electrocution can result in death or injury. If I was bringing a patient in that was still alive I would still hand them over as being electrocuted. A lot of the terminology is related to data reporting and statistics. Take drowning for example. Prior to 2002 there were multiple definitions and terminology being used that led to an inaccurate global picture of the incidence/prevalence of drowning. The definition of drowning and terminology used to describe patient outcome was then changed. There are now only three outcomes - drowning with no morbidity, drowning with morbidity and fatal drowning. Wherever you end up on that continuum you have still drowned according to the definition and outcomes. It’s a similar thing with electrocution.
But brain activity isn't shown by either MRI or CAT Scan. Those might be used to detect physical damage to the brain or skull, but brain activity is tested by EEG (electroencephalogram).
Fine if your reading audience is all medical professionals. To the general public, I respectfully submit that "electrocuted" and "drowned" both mean "dead."
Yeah, but wouldn't that still be something that could be requested if the OP wrote it that way? I'm not saying which machine should be used, but when one of my extended family members was presumed brain dead they still checked for brain activity before donating the organs (or at least they said they did).
In order of priorities one does the CT scan to rule out an acute process that needs to be addressed. If you are bleeding in your brain that has a priority. Once those immediate matters are addressed one gets to assessing the patient's mental status. An EEG will guide some decisions about what to do next. It may not be done until a neuro consult is ordered.
