With traumatic injuries, what you can't see may hurt most

With traumatic injuries, what you can't see may hurt most
In disasters such as the Metrolink train crash, concealed internal wounds are often the most dangerous. Trauma centers at UCLA and elsewhere are designed specifically to treat such critical patients.
By Mary Engel, Los Angeles Times Staff Writer
September 22, 2008
In the 10 days since one of the worst commuter rail accidents in California history, the region's trauma surgeons have reknit shattered limbs, repaired battered organs and returned dozens of patients to homes and families, where many will now face weeks or months of painful recuperation.

Twenty patients remain in the region's hospitals as a result of the Sept. 12 head-on collision between a Metrolink commuter train and a Union Pacific freight train in Chatsworth. Four were still in critical condition Sunday.

The most obvious injuries were the open fractures, where splintered bones in arms and legs had punched through skin, spilling tissue and blood. But the biggest threat to those who survived the initial impact was the hidden mayhem inflicted on lungs, hearts, brains, livers and other internal organs when the train came to a dead stop, slamming bodies into seat backs, tables, the steel sides of the train cars and one another.

"It would be like standing against a wall and having a car hit you at 40 mph," said Dr. Henry Gill Cryer, trauma director for the Ronald Reagan UCLA Medical Center, where several of the badly injured were treated.

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