Child Abuse vs Vasovagal Syncope

Saturday we had two calls, both of them mutual aid for the same department (let’s call them “M Ambulance”) to our north. “Mutual aid” is an agreement between departments to cover each other in specific circumstances. My guess is that in big cities these circumstances are limited to when there are a lot of calls. Around here, circumstances calling for mutual aid include things like: a department’s single ambulance is in for repairs; a department’s one active medic decided to spend the night with Jack Daniels; the fire frequency is down so they can’t hear their pages, etc. I don’t know why “M” wasn’t getting out Saturday, but is was certainly a nice day out, and I could have used that time…

Relatively early in the day I hear our neighbors get toned out for “a 10 year old female with injuries to the face, uncontrolled bleeding and difficulty breathing”. Given the time (before 0800 – I don’t know exactly when because it was before coffee could engage my hippocampus), I doubted that the kid was outside playing. Given the news in the paper Sat morning (a two-year old died from burns inflicted by her mother – she spent several days at home before mom decided there was a medical emergency), I was thinking the worst. I just don’t know why, but I could feel that M Ambulance was not going to get out and I headed down to the station just in case. I had just gotten to the station when we were toned out to the call. Within four minutes we had our chief, a driver, a medic and me rolling.

We walk in the door see the patient lying on the floor with her head on a pillow and a blanket over her. Mom is on floor stroking patient’s forehead and dad is standing looking embarrassed.

Initial assessment of patient: Alert and oriented X 3. Rescue has taken a full set of vitals and they are all within the normal limits. Patient looks fine – skin, eyes, smile all indicate a healthy and happy kid.

All three tell the same story: Family is in bed snuggling and mom and daughter move at the same time, with mom’s elbow connecting with patients nose. Profuse bleeding starts, at which point mom (who has a history of “fainting at the sight of blood”) starts to panic a bit. Daughter subsequently begins to react and, according to dad, “blacks out”. How long had she been bleeding before she went out? Less than 15 seconds. Both mom and dad claim they doubt the blow to the nose was hard enough to cause LOC. Daughter is smiling the whole time and joking about getting her mom back. No headache, nausea, vomiting or dizziness. Pupils are equal and reactive to light, her smooth persuit eye-movements are fine, and she reports that it was the blood that caused her to “freak out”.

What about difficulty breathing? Parents describe a mild case of hyperventilation which stopped when they gave the patient some TLC and told her things were going to be OK.

We leave the patient in care of her parents with instructions to call us or go to the ER if headache, nausea, sleepiness, etc. emerge over the next 24 hours. Dad apologizes profusely for calling us out, saying he should have known his daughter would react to blood the way his wife does. We, of course, tell him to never hesitate to call us as it is better to call when we are not needed than not when we are…

Second mutual aid call of the day was cancelled en route. I HATE getting my adrenaline pumping, dropping what I am doing and getting down to the station, on the road, only to have dispatch call us off one minute from the scene.