Winter is finally over, and everyone is excited to be spending more time outside. With the change in seasons, we should remind ourselves about some of the different hazards that await us and our families as we become more active. One of the most common sources of injury, and one of the biggest causes of spring and summer parental panic, is falls.
The season of twisted ankles, bumped keppies, and broken elbows is upon us, and so is that one question that we have all asked at one time or another: “Should we call the doctor?”
Falls are almost always benign. Dr. Wendy Mogel’s The Blessing of a Skinned Knee suggests that falls can even be good for kids. They provide excellent parenting opportunities and help make a child self-reliant. (I highly recommend this book to anyone who has even a modicum of interaction with a child.) When children fall, there’s usually not much to talk about. If there’s a wound, clean it thoroughly, dab on some antibiotic cream, apply a dry sterile dressing (like a bandage), put on some ice if there’s swelling, and you’re done. But it’s not always that simple.
One major area of concern with a fall is a head injury. Head injuries are either external (a cut scalp, the dreaded “goose egg” swelling, forehead scrapes, etc.) or internal (skull fracture, concussion, etc.). External head injuries are usually manageable at home unless stitches are needed, but we’re always concerned if there’s an internal head injury. If a child has a head injury, and any of the following conditions exist, you should suspect an internal head injury and call the doctor or 911: loss of consciousness, endless crying, complaint of neck pain, vomiting, vision changes, unable to easily awaken, or unusual behavior. When an ambulance gets called for a child with a head injury, the first thing I always ask the parent is, “Is your child behaving the way he/she normally does?” If the answer is no, we get concerned. Regardless of the patient’s age, if you suspect an internal head injury, or trauma associated with the neck, call an ambulance and keep the patient’s head, neck and spine as still as possible. The ambulance corps will come and immobilize the spine so the patient can be transported without causing further injury. Serious head and neck injuries are rare, but they definitely happen. If you’re unsure whether you should call an ambulance, call and ask your doctor. If they don’t call you back quickly, call 911 anyway.
Another common question is, “Does it need stitches?” Much to many parents’ dismay I am not a physician so I am not trained on sutures, but since every mother of every child I’ve ever responded to with a laceration inevitably asks me that question anyway, here are a few of the clues I look for that suggest stitches are probably in the patient’s future: deep cuts (deeper than about ¼ of an inch); if you can see something you shouldn’t (muscle, bone, fatty tissue, etc.); cuts on a place that move a lot like the knee or fingers; and if the bleeding won’t stop.
One final point about children: try your best to remain calm and reassuring, regardless of the severity of the child’s injury. If you need to call an ambulance, maintaining your composure is even more important. EMTs need to focus on treating the child, and it’s difficult to do that with visibly upset bystanders. More importantly, children will react to their parents. If a parent isn’t calm, there’s almost zero chance the child will be.
Ryan Shell, EMT is the captain of the Bergenfield Volunteer Ambulance Corps. He has been a volunteer first responder for 20 years.
By Ryan Shell
