Some Injuries Too Much Even for Doctors to Handle Alone

In rare cases, even seasoned ER workers become traumatized.

ByLAUREN COX<br>ABC News Medical Unit
February 23, 2009, 5:56 PM

Feb. 24, 2009&#151; -- The wounds inflicted when a chimpanzee attacked 55-year-old Connecticut woman last week were apparently so gruesome that Stamford Hospital announced it was offering counseling services to the doctors, nurses and surgeons who spent seven hours treating the victim.

Charla Nash was flown in critical condition to Cleveland Clinic, in Ohio, where experts in reconstructive surgery are still evaluating the extent of her injuries. Recordings from the 911 call indicated that police on the scene could not tell if Nash was alive or dead, a man or a woman.

Doctors daily shrug off scenes from car crashes, accidents or stabbings that would give a layperson nightmares. But in rare cases, even first responders need help managing a nightmare case.

Medics responding to the attack told The Associated Press that the 200-pound chimpanzee, named Travis, had crushed Nash's hands and ripped off a substantial portion of her scalp, face, jaw and eyes.

"It's really hard to explain what it's like to people who weren't there -- even if it's people in the same field as you," said Dr. Vanessa Brown, an emergency room physician who treated Nash when she arrived at Stamford Hospital.

"Just the pure trauma of it, by far, was one of the worst cases I've ever seen," she said.

Brown said she felt grateful to have so many experts around to help with Nash's case and everybody involved put aside their reactions to help. But even with the first-rate help and the warning call from the ambulance, Brown said this case took its toll later.

"For me, you think if you see and see it, it gets easier," she said. "But it's just hard.It's always hard. It's hard to see somebody that's that sick."

Brown attended one of the initial communal counseling sessions offered to the staff after Nash was stabilized.

Hospital spokesman Scott Orstad said plans are under way to offer counseling to the medical staff who took care of Nash. The Stamford Hospital, where Nash was first treated, is a level 2 trauma center, meaning it employs specialists in plastic surgery and trauma, and the building is equipped to treat extreme cases.

But those who counsel doctors say even a level 1 trauma center sometimes has to call in for extra mental health professionals.

When Trauma Hits Home in the ER

"Trauma centers are designated by level 1, level 2, level 3 -- and level 1 trauma centers take the worst of the worst," said Linda Wilkerson, director of pastoral care for Parkland Health and Hospital System in Dallas.

Because Parkland Hospital is a level 1 center and sees so many severe cases, Wilkerson said the hospital offers 24-hour "pastoral care" or religious counseling to the patients and staff.

"We pretty much make sure that we go by and talk to the staff after every trauma," Wilkerson said. "Particularly if it was a rough case, where they saw something that was horrendous or when they worked really, really hard on somebody who didn't make it."

Rarely, the hospital calls in extra mental health professionals for the staff.

One such incident occurred Sept. 23, 2005, when a bus carrying elderly evacuees from Hurricane Rita caught fire near Dallas. Some of the elderly patients could not walk, and the quick-burning fire -- fueled by the oxygen tanks many of the people on the bus needed -- claimed 23 lives.

Wilkerson said the survivors of the blaze were sent to her hospital, which is the only specialty burn center between San Antonio, Texas, and Oklahoma City.

"There were a lot of fatalities on the scene, and also some when they came in here," Wilkerson said. After the fire, the hospital called one of the Critical Incident Stress Management programs to bring in trained counselors to talk about what happened.

"It's typically the younger folks [who need help], but when it's really a tough case it sort of cuts across the ages of everyone," Wilkerson said.

Increasingly, medical schools and hospitals are incorporating mental health help and training into their programs.

Brown said many programs did not offer a class to help physicians cope with emotional or mental shock when she attended medical school in the early 1990s.

"I think after I graduated they started this topic called wellness," Brown said of her alma mater, the University of California at Los Angeles.

"Right after I graduated, there was a big push to make doctors more human, including teaching people beside manners," she said.

Dr. Alex Rosenau, a member of the board of directors for the American College of Emergency Physicians, said treating doctors' emotional stress is more than a kind thing to do. Rosenau said it can make a difference in work performance.

"Stress can disturb people's thinking, so that later on, in time, they can have flashbacks or memory problems," said Rosenau, who is also the vice chairman of emergency medicine at Lehigh Valley Health Network in Allentown, Pa.

"At a trauma center like mine, we've seen just about anything," he said. "But, just like soldiers on the battlefield, emergency staff is sometimes exposed to things even beyond what they normally see."

When to Call Professional Help

Rosenau has been present during counseling sessions, called "debriefings" under his charge. He said for a hospital system with 9,500 employees, he typically saw only one or two debriefings in a year -- for instance when a child died on the operating table, or when a nurse saw an industrial accident.

"That person was called to the site of an industrial accident where the worker's hand got caught in a roller," he said. "When she arrived what she had was a patient crushed, lying on the floor already dead."

Hospital administrators that spoke to were more likely to report similar small, unpublicized cases when the Critical Incident Stress Management program was called. However, these same crisis teams can treat bystanders, victims and emergency workers in the case of a larger disaster.

The Critical Incident Stress management program came to the aid of firefighters, emergency workers and families during the aftermath of the 2003 Station Nightclub fire in West Warwick, R.I.

Started by a stage light show, the fire quickly engulfed the whole nightclub, killing 97 people and leaving many in the small community in grief.

"Most hospitals and medical institutions realized that if there's something big and traumatic, it's important to have a debriefing with all those involved," Brown said.

For her case, she was glad to go along with her staff to the meeting.

"The hospital I'm at, we have all the different specialties, thank God," she said. "I think that's one of the best things that we have in this country is that were able to mobilize resources so quickly and so effectively."

The Associated Press contributed to this story.

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