By Grace Bennett
All things considered, the news about those injured in the fiery Metro North crash that claimed six lives was heartening, according to an update relayed by a team of experts at Westchester Medical Center (WMC) earlier today.
The team also offered reporters gathered a detailing of the Emergency Room decision making process, otherwise known as triage, that took place behind the scenes as the crash victims arrived.
Dr. Joseph Turkowski, director of WMC’s Burn Center: “We were expecting a lot more and a lot worse injuries; fortunately the staff was mobilized well. Our concerted group effort really worked well.”
As of the 12:30 p.m. update, Patricia Wrobbel, Chief Nurse Executive, said one patient remained in critical condition, one in serious, four in fair, and two in good. Four patients were discharged by morning.
Beginning at 7:20 p.m. Tuesday, as the injured arrived, Wrobbel said 9 of the 12 patients presented with injuries severe enough that these patients received what is referred to as “Level 1 trauma activation.”
“After closer evaluation the triage specialists found that five of those patients were still in need of Level 1 activation: basically, mobilizing operating room resources and a group of specialists into action including a trauma surgeon. “Level 1 activation doesn’t mean the patient will be critically ill; we mobilize just in case,” said Dr. Miller.
As a regional trauma center, the WMC teams were prepared to receive dozens of patients when news of the crash reached them. “Our mission is to be prepared; every day, we get patients transferred to us from other facilities with fewer resources,” said Dr. Miller.
The 12 patients (all adults) arrived via ambulances from the Valhalla station. The WMC teams then began the time honored method of triaging. “Anytime you have multiple patients, you have to prioritize and see where the most diagnostic and treatment energy needs to be spent.
“Reports from the EMS technicians allowed us to pre-plan, direct patient to right staff, with doctors and nurses working together to redirect patients,” said Dr. Miller. There were also 40 patients already in the Emergency Room, including some children, upon the arrival of the crash injured victims. “Obviously those patients have needs too so all of this had to be done very carefully,” said Dr. Miller.
He said patients arrived with “burns, lacerations, flame and smoke inhalation, fractures, including open fractures–bone exposed to the air–with sometimes bone sticking out, crush injuries, dislocations, minor head injuries and scrapes. The degree of injuries ranged from stable to serious, said Dr.Turkowski, and ‘a silver lining’ was that the extent of the injuries were generally not as severe as they could be. “We have seen much more serious injuries here that can and do result in death.”
Helping Patients Battle the Pain of Burns
Still, three patients remain in the burn unit where managing pain is a key challenge. “There’s a lot of pain with burn injuries; there’s a whole side of the treatment plan dedicated to pain management, with wound care the most painful aspect,” explained Dr. Turkowski.
“The pain is there all the time. Patients are asked to walk around as much as they can too so they don’t lose function.” Smoke inhalation can complicate a burn victim’s recovery as well, he added.
Commenting on anticipated recovery time for the crash victims who sustained burn injuries, Dr. Turkowski answered: “I’m expecting a few patients to spend a week or two at the hospital; others will be sent home in a day or two.”
Dr. Miller made an observation about the wherewithal of some of even the most injured patients. “One theme in talking to people even with severe injuries: People focused on what they saw. I’m sure those people will never forget what they saw…it was almost like a wartime experience when you see people die right in front of you.”
Patricia Wrobbel noted: “A team of Chaplains and whole crew of social workers were available to speak to patients and also help family members who arrived wondering if their loved ones are ok.”
Dr. Miller pondered those who perished. “We know a number people died at the scene. I wish I’d had had the chance to treat six more patients…”
