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Gupta: Determining critical patients from crash

Story Highlights

• Gupta: Airway status, blood pressure and heart rate must be established fast
• Gupta says it's a team effort to save lives -- paramedics, docs working together
• Gupta: Biggest concerns are head and abdominal injuries, and broken bones
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ATLANTA, Georgia (CNN) -- Six people, including four college athletes, were killed Friday when their tour bus crashed through a wall and plummeted 30 feet from a bridge onto a busy interstate.

Twenty-nine others were taken to area hospitals, including 19 treated at Grady Hospital, the largest trauma center in the Southeast. CNN chief medical correspondent Sanjay Gupta is the associate chief of neurosurgery at the hospital. Here, he describes the scene for users.

GUPTA: Nineteen patients is a lot of patients for any hospital. So trauma surgeons have to decide pretty quickly about who is critically ill and who is part of the walking wounded.

They have a pretty good idea of their status before the patients even come into the emergency room by talking to the paramedics. Those patients who are thought to be more critically injured will go straight to the CT scanner. They'll typically do CT scan of their brain, of their chest, of their abdomen and of their pelvis.

Those are some of the standard places where they are going to look for any injuries or any bleeding.

So what you're seeing in the ER is a lot of movement. You're seeing a lot of people quickly examining patients and making decisions as to where the patients are going to go. Are they going to stay in the emergency room? Are they going to go to the CT scanner? Or are they going to go into the hospital to be admitted?

QUESTION: How critical is it for first responders to be there within five to 10 minutes like they were today?

GUPTA: People talk about the time sensitivity of taking care of trauma. ... Certainly the quicker you're getting them extricated from the accident and into the emergency room, the faster they can get that treatment.

There are lots of different parts. Certainly, the five to 10 minutes for the EMS is critical. But also having surgeons standing by in the emergency room ready to go is critical. Also having the resources available -- literally having rooms available, having blood available, having the operating theater available -- are all part of that equation as well.

Q: What goes through your mind as a doctor when you're talking via walkie talkie to a first responder who is describing a patient in need of urgent medical care?

GUPTA: There are some very standard things you need to know right away. You need to know if the patient has an airway, meaning if they can breathe on their own. And you need to know if they're bleeding [both externally and internally]. If you have a broken leg, you might be bleeding into your leg. There might not be blood pooling around you, but you're still bleeding.

So you can check that by quickly getting somebody's vital signs: their blood pressure and their heart rate. Their airway status, their blood pressure and their heart rate are absolutely critical.

Then, obviously you want to know if they're conscious or sleepy. You also want to know what the circumstances are of the accident.

For example, if someone was on the window side of the down side of the bus, you might be a little bit more worried about that person than if they were someone who seemed a little bit more protected or if they didn't have a direct blow for some reason.

Q: Is it more difficult to determine the extent of injuries in an accident like the bus crash?

GUPTA: It's very difficult. Typically in car accidents, you get very specific information: Driver of an accident bent the steering wheel with his chest, which automatically tells you he's going to have chest injuries. Or if they hit the windshield with their head, then you really worry about head injuries.

Here, it's much more chaotic. You don't know where people were sitting exactly. There's a good chance many of them were not restrained in any way -- not wearing seatbelts. So their bodies may have actually moved around the bus. Where they were found may not be where they started. So you don't know what sort of injuries they may have suffered from being displaced from within the bus.

Q: What kind of critical injuries can one receive in a crash like this?

GUPTA: There are several things you think about. I think about head injuries first as a neurosurgeon. That's what I'm focused on. But you can also have "crush injuries" -- portions of the bus hurting someone's abdomen or pelvis. You can damage organs within the abdominal cavity and cause significant life-threatening bleeding.

People talk about the walking wounded with broken bones. But broken bones can be serious as well. You can actually have significant bleeding around the bones.

So head injuries, abdominal injuries and significant "long bone" injuries are what we're focused on.

Q: In an accident like this, what do you tell mothers and fathers about their child when they are so far away, like Ohio in this case?

GUPTA: It really depends on the extent of the person's injuries. With trauma, you can often get a sense pretty early on -- not only how critically injured someone is, but what their prognosis is for the future.

As doctors, we want to relay facts as much as possible. And I think arming parents, especially parents who are far away, with the best information is our best strategy as physicians: Making sure we've collected all that information, all the studies available and then we can say, "Here are the nature of your child's injuries and here's how we think they're going to recover. Or we think they need an operation soon to be able to address some of these problems."

I have always found that before you make the call [to parents] to collect as much information as possible. That always seems to be the best strategy.


CNN's Sanjay Gupta is a neurosurgeon at one of the hospitals that treated the victims in Friday's crash.

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