The tree has been a neighborhood favorite for generations of climbers, including KC’s mom, Jessie. “This was my parent’s home, and we have many pictures of me sitting up in that tree with my brothers.”
One April evening, KC decided it would be fun to climb the tree to wave goodbye to friends who were about to head home. “I wasn’t paying attention and didn’t realize how high I was,” says KC, who was four stories up in the tree. Suddenly, the branches beneath his feet snapped. “I don’t remember much after that,” he says.
His friends ran inside to get his mom, Jessie, who had just gotten her three younger children settled so she could make dinner.
“I found him on the driveway covered in broken branches,” she says. “I saw his face move, and it looked like he was coming to, but when I saw his disfigured right arm, I decided to take him to Doylestown Hospital.”
During the 10-minute drive, she called her friend and neighbor Melissa Farrell, an emergency room nurse who used to work at Doylestown Hospital’s Emergency Department (ED). Along with some reassurance, Melissa gave Jessie helpful instructions, including details about where to pull in.
Arriving at the Emergency Department
Jessie pulled up to the emergency entrance. As she moved KC into a wheelchair, the triage nurse approached. “I felt a huge sense of relief at that moment, and the nurse took KC to the treatment room right away,” says Jessie.Recognizing the seriousness of KC’s situation, the triage nurse called Thomas DiEnna, DO, an emergency medicine specialist. “A vast array of injuries can occur with a fall, and KC appeared to be in significant pain,” says Dr. DiEnna. “Time to care is vital in emergency medicine and trauma care, and teamwork is the key to quickly identifying injuries and intervening.”
Dr. DiEnna called an internal trauma alert to ensure the resources KC needed would be immediately available.
Coordinating with a Pediatric Trauma Center
As the team carefully removed KC’s long-sleeved shirt, they saw that the skin on his right wrist was torn and bone was visible. He had what is called an open wrist fracture, an injury with a high risk of infection. He would need additional care at the Level One Pediatric Trauma Center at Children’s Hospital of Philadelphia (CHOP).Accredited trauma centers have a team of specialists and resources available 24/7 to care for severely injured patients. Dr. DiEnna coordinated KC’s care with the CHOP Trauma Team; a helicopter was standing by.
“We wanted to stabilize KC, get his pain under control, and quickly get him to imaging so we could determine the extent of his injuries,” says Dr. DiEnna. “Even though Doylestown Hospital is not a designated trauma center, we still manage and treat seriously injured trauma patients, including people like KC who arrive in a family vehicle,” he says. “Also, if a patient being transported by ambulance to a trauma center becomes extremely ill, the emergency medical technicians (EMTs) may bring the patient here.”
KC’s Condition
“I was pleased to see that KC was awake, talking, and able to answer questions,” says Dr. DiEnna. “He did incredibly well, and his mom played a significant role. She was calm and had the appropriate level of concern as we walked her through what we were doing.”“I loved how the team let me be by KC’s side, comforting him and praying over him while they calmly assessed his injuries,” says Jessie. “KC does not remember this, but he was joking around with the team. He’s a very social, funny kid.”
Initial Assessment
The team checked KC for spine, neck, and major head injuries. They stabilized his neck and gave him IV pain medication and antibiotics due to the risk of infection with his open wrist injury.“With a fall, you can have internal bleeding without knowing right away. So, we look for signs and symptoms during the initial assessment,” says Dr. DiEnna. KC’s vital signs, including blood pressure, oxygen levels, and heart rate were normal. He could move his extremities and his breathing and circulation were good. The team also checked for tenderness in his abdomen and signs of injury on the outside of his body.
A Look Inside
After his assessment, it was time to move KC to the CT scanner. As soon as the study was done, the radiologist walked through the results with Dr. DiEnna. “KC had multiple injuries, but we saw no evidence of bleeding in his brain or of a spine injury, which are significant concerns with a big fall,” he says.Care for a Life-threatening Condition
Although KC had initially stable vital signs, his assessment soon revealed life-threatening injuries. In addition to his wrist fracture, KC had multiple fractured ribs and a fractured pelvis. He also had two collapsed lungs. Air was leaking into the space between KC’s lungs and chest wall. The trapped air puts pressure on the heart so it can’t fill and squeeze properly. “This can affect your breathing pattern, make you short of breath, and eventually lead to a more compromised state when your heart can no longer circulate your blood,” says Dr. DiEnna.KC underwent emergent tube thoracostomies on each side of his chest to relieve the pressure and correct this problem. “We inserted a tube into his chest wall to drain the trapped air. This frees up space, allowing the lungs to fill,” says Dr. DiEnna.
Ready for Transfer
Once KC’s lungs expanded, he was stable and ready for transfer to CHOP. Due to inclement weather, he traveled via ambulance instead of a helicopter.KC fell on April 26, and spent nine days at Children’s Hospital of Philadelphia, where his care included surgery to repair his wrist, according to Jessie. By mid-June, his wrist bone had grown strong enough that he was able to have the pins and hardware removed.
KC is Back Home
KC has made a great recovery. He spent a week at camp and is free to take part in most activities, except contact sports.“I’ve been exercising, eating well, and doing what I should to improve — plus a little bit extra. I tried walking and did some other stuff I probably wasn’t supposed to do, but it all worked out,” says KC, who has already climbed the family’s famous tree.
“We will continue to climb trees,” says Jessie, “but we know we’re not going to climb that high ever again.”
Community Support
KC’s team extended beyond his healthcare providers and family. “We received overwhelming support from friends, neighbors, and our church. They provided meals and babysitting as we traveled back and forth to Philadelphia for appointments, and we had many people praying for KC,” says Jessie.About Calling 9-1-1
“It can be challenging to know when to call 9-1-1, especially when something happens to a loved one at home,” says Dr. DiEnna. “Ultimately, it’s your level of concern when you first look at somebody. If you feel it is a true, time-sensitive emergency, call 9-1-1.”Emergency Medical Services (EMS) providers are trained to assess your loved one’s condition and to identify which facility to take them to so they can get the care they need. EMS providers also can provide initial care and emergency life-saving procedures if the patient’s condition declines in the short time it takes for the patient to get to the ED, according to Dr. DiEnna.
About Doylestown Health
Doylestown Health is a comprehensive healthcare system of inpatient, outpatient, and wellness education services connected to meet the health needs of the local and regional community. The flagship of Doylestown Health is Doylestown Hospital, a not-for-profit, community teaching hospital with 242 beds and a medical staff of more than 600 providers who deliver the highest quality care in over 50 specialties. Renowned locally, regionally, and nationally, Doylestown Hospital provides superior healthcare and offers advanced surgical procedures, innovative medical treatments, and comprehensive specialty services. Now in its 100th year of service in central Bucks County, Doylestown Hospital is proud to educate and train the next generation of physicians through its family medicine residency program. Consistently ranked among the best hospitals in Pennsylvania and distinguished in both infection prevention and patient experience, Doylestown Hospital is the only hospital in Pennsylvania to achieve 17 consecutive ‘A’ grades for patient safety from Leapfrog Hospital Safety Grade. Learn more at doylestownhealth.org.
About Emergency Services
When medical emergencies arise, patients of all ages can count on the skilled physicians and specialized nurses of Doylestown Health Emergency Services. Fully equipped with private treatment areas, critical care suites and a designated pediatric/minor acute area, the Emergency department can handle any emergency while offering patients confidentiality and comfort. Dedicated resources for specialized care include the Woodall Chest Pain Center and a certified Stroke Resource Center, as well as affiliations with Jefferson Expert Teleconsulting and Temple MedFlight.