Just as every catastrophic injury is unique and every victim is unique, so are the teams of medical and legal experts needed to handle the catastrophic injury victim’s care and their personal injury claim.
The most common causes of major burn injuries in the United States are fires and scalding from hot liquids. Although much less common, catastrophic injury burns from electricity tend to be severe because of the high temperatures involved with electrical arcing. Severe burn injuries will require specialized treatment in burn centers that are often attached to major trauma hospitals. Immediate dangers that must be managed include shock from fluid loss and edema. Following that, infection is the complication most often seen with major burns due to the body’s loss of the skin as the primary barrier against microorganisms. Once these immediate dangers are countered, other medical specialists become involved in longer term care:
Skin grafting, typically performed by plastic surgeons, is a common treatment for severe burn injuries at different stages in the patient’s care. Early on in treatment, grafts of the patient’s own skin, of donor skin, or of synthetic skin is often employed as a form of wound care to protect the subdermal tissues as they heal. Typically, the dead and badly damaged tissues are surgically removed, or “debrided” away from the healthy tissues. Then the grafts are laid over the damaged areas for protection. Later in treatment, grafting and other reconstructive surgery may be used to improve physical function in the area of the burn by replacing damaged tissue with healthy, flexible skin, as well improve appearance of the burned area.
Pain Management Doctors
Severe burn injuries can be extraordinarily painful, especially in early and middle stages of treatment when large portions of the patient’s skin may be destroyed or damaged and as skin grafts are harvested and re-attached. Doctors who specialize in the management of severe pain will often become involved to accurately prescribe powerful pain medications — including opioids like morphine — as well as other analgesics and medications for symptoms such as itching in the healing tissues.
Many severe burn injuries that result from fire also involve damage to the lungs and airway from fire and/or smoke. In the initial, acute phase of care pulmonary specialists may be employed to provide critically important treatment to keep the airway and lungs functioning enough to sustain life. As recovery progresses, their goal changes to one of improving and strengthening lung function either to a point of complete recovery or to a point of achieving as much regained capacity as possible.
Physical and Occupational Therapists
Severe burn injuries, especially those involving the limbs, may result in significantly limited mobility. Additionally, strength may be lost during the recuperative period when the burn patient may be unable to move and exercise his muscles. Physical therapists are able to employ a variety of treatments designed to increase mobility and gradually improve strength in the underused muscles. Occupational therapists are specialists who help burn patients recover and maintain their abilities to perform “activities of daily living” — the ordinary daily tasks of caring for oneself — as well regaining the capacity to work by adapting to any permanent limitations from the burns and by modifying the patient’s environment to adjust to his restrictions.
Psychiatrists & Psychologists
Severe burn injuries are psychologically devastating events. In addition to the extreme pain of the initial injury, patients may often require extensive periods of treatment and recovery sometimes last months or more and frequently involving multiple surgical procedures. The patient must also come to grips with the significant and often permanent nature of the burn scar disfigurement — when this involves the face, the impact is even greater. In these instances, mental health professionals including psychiatrists and psychologists may be included as part of the medical care team to help the burn patient cope.
Traumatic Brain Injuries (or TBIs) involve damage to the brain that can occur in a variety of ways and with a wide range of physical and cognitive results. Closed head injuries produce brain tissue damage without the skull and outer membranes of the brain being penetrated; open injuries involve actual fractures or penetrations of the skull. Causes of TBIs include motor vehicle accidents, falls, and violence. In the United States, TBIs in young children are most often associated with falls and with physical abuse. In older children, motor vehicle accidents become the most common cause, with occupational injuries becoming a significant factor in adults. In addition to direct damage caused by the initial injury – which can result from a direct blow to the head, from rapid acceleration and deceleration or rapid rotation such as in a “whiplash” event, or from the concussive force of an explosion – further and sometimes more substantial damage can result from intracranial bleeding due to blood vessel rupture than can cause swelling and intracranial pressure.
Neurologists & Neurosurgeons
A neurologist is a physician specializing in treatment of injuries and disorders of the nervous system, which includes the brain, spinal cord, and the peripheral and autonomic nervous systems. A neurosurgeon is a specialist in performing surgery upon these parts of the nervous system. In a traumatic brain injury, the most immediate goal for these types of doctors Is stabilization of the initial injury and control of any intracranial bleeding that may have resulted. This bleeding – often referred to as subdural or subarachnoid depending upon its location – may often result in significantly greater damage to the brain than the initial trauma, because the pressure it places upon the brain can cause widespread damage throughout the organ. Neurologists and neurosurgeons will focus early on determining and tracking the patient’s mental status and the presence of any obvious damage through tools such as CT and MRI scans. Neurosurgery may be required to control intracranial pressure and to stop bleeding (hemorrhage) and drain or limit pooling blood (hematoma). Once the acute phase of care is past, it will be the primary responsibility of the neurologist to diagnose the physical damage caused to the brain and to treat it. In addition to CTs and MRIs that can visualize this damage, the neurologist may employ other tests such as electroencephalograms (EEGs) to further define and locate the damage. The neurologist may prescribe medication to treat the symptoms of the damage and may refer the patient to other specialists such as neuropsychologists and neurosurgeons for further evaluation and treatment.
Neuropsychology is a sub-specialty of psychology that is focused on the interactions and interrelationships between the physical brain and the mental mind. As such, their expertise incorporates both the physiology of the brain upon which neurologists focus and the cognitive mind upon which psychologist focus. In a clinical setting, a neuropsychologist’s involvement with a traumatic brain injury patient is often to assess the degree and nature of change in cognitive function that may have resulted from the TBI. They have batteries of tests that specifically examine the TBI victim’s behavior, thoughts, and abilities to remember, think, and mentally function. This testing can help identify the specific functional problems that a TBI victim has suffered, and as a result point out treatments and rehabilitation options concentrated on improving those specific functional deficits.
Speech and Language Pathologists
Traumatic brain injuries can produce a wide variety of problems in injury victims. Many specialists are available to treat these specific problems. For example, when a TBI has resulted in a speech or other communication disorder, a speech-language pathologist (also referred to as a speech-language therapist) may be included in the medical treatment team. This type of therapist can provide services intended to improve physical function, such as recovering or improving the ability to swallow and speak, as well as cognitive functions such as memory and the recognizing and forming of words.
The spinal cord attaches to the brain and the base of the skull and passes downward through the spine with attached nerve roots extending outward through the body and limbs. The severity of spinal cord injuries is most directly related to the amount of cord damage that has been caused and the level of the spine where it happened – typically, a significant cord injury will result in loss of feeling and/or movement for those parts of the body whose nerve attach to the cord at or below the point of injury. In the United States, traffic collisions are the most common cause of spinal cord injury, with falls, occupational injuries, and sports injuries following. Treatment of a spinal cord injury will initial involve an acute phase in which stabilization of the cord and the source of the cord injury – for example a fractured spinal vertebrae – is a primary concern along with sustaining vital bodily functions that may be impaired by the spinal cord damage. Later medical care will usual focus on recovering as much function as is possible given the nature of the injury, and finding ways to continue with daily life and work by accommodating any permanent loss in function.
Neurosurgeons will often be involved in initial care of spinal cord injuries in the surgical stabilization and repair of the spinal fractures that typically cause the cord injury. This is necessary both to prevent further injury to the cord, as well as to stabilize the spinal structure to allow for healing and eventually for rehabilitation.
Physical Medicine Doctors
Physical medicine and rehabilitation (PM&R) doctors, also known as physiatrists, specialize in treatment intended to restore and improve physical function in people who have sustained disabilities. Spinal cord injuries are certainly one form of traumatic impairment where this specialty can be beneficial. Very commonly, physiatrists direct multi-disciplinary teams of medical professionals during the rehabilitative process, depending on the nature and severity of the injury and resulting loss of function. They may order additional testing, such as electrodiagnostic testing, intended to identify specific functional loss from nerve injury, and they coordinate the work of specialists such as physical and occupational therapists.
Physical and Occupational Therapists
Early in the course of recovery from spinal cord injury, there may be some degree of recovery of function depending upon the severity of the injury. Once this period of time passes, the primary focus of physical and occupational therapists is help injury victims adapt to their functional losses and find alternative ways to perform “activities of daily living” — the ordinary daily tasks of caring for oneself — as well regaining the capacity to work by adapting to any permanent limitations from the cord injury and by modifying the patient’s environment to adjust to his restrictions.
Experts Utilized in Catastrophic Injury Cases — Legal and Medico-Legal Experts
In addition to the medical professional whose focus is on the care and rehabilitation of the victims of catastrophic injuries, there are several types of experts commonly employed in personal injury litigation whose function is to describe and prove particular elements of the personal injury claim so as to maximize the injury victim’s chances of a successful claim settlement or verdict.
Life Care Planners
Life care planners are experts with specialized training in describing and evaluating the types of medical care that injury victims are likely to require in their future lives. These experts are often nurses or other medical professionals with advanced degrees or certifications relating to this type of planning. They will typically consult with the injury victim’s treating physicians to determine what type of future care the treating doctors anticipate, then they determine the cost of this future care based on a variety of medical and insurance data resources. From this, they will prepare reports and provide testimony that specifically lists the anticipated future care and its cost.
Vocational Rehabilitation Experts
Vocational rehabilitation experts will often be consulted to prepare reports describing the impact of an injury on a personal injury claimant’s ability to work in the future — either in his or her current employment or in alternate fields of work – based upon the nature and severity of their disabilities and upon their work aptitudes. Their reports will typically quantify the amount of future income loss that has occurred and may also present the cost of rehabilitation and re-training efforts intended to move the injury victim into a more suitable type of work.
The work of experts such as life care planners and vocational rehabilitation planners establish an injury victim’s damages for the cost of future medical care, the loss of future income, and the like. Because these costs continue to accrue over the remainder of the injured person’s lifetime, they represent “future” dollars as compared with the “present day” dollars that a jury or arbitrator might award. It therefore becomes necessary to use the services of an economist expert to translate these future costs into “present value” for purposes of an award.
In addition to proving that the victim of a catastrophic injury was injured – which may be perfectly obvious from their condition – it is also necessary from a legal standpoint to prove how the injury occurred and who was responsible for it. In situations involving complex motor vehicle collisions, a plaintiff’s attorney will often retain the services of experts in accident reconstruction. These experts are often former police officers or are engineers, but all have advanced training in the investigation and evaluation of accidents. They will present their conclusions as to how a collision occurred by way of reports, testimony, and sometimes video reconstructions.
Once it’s proven how a motor vehicle accident caused an injury or how a premises defect caused a fall that resulted in an injury, it’s necessary to show how this cause resulted in the specific catastrophic injury that the victim suffered. Biomechanical experts are often individuals with medical training and experience who have gone on to study the specific motions and forces that events will produce in a person’s body and how those forces translate into the injuries that they suffer.
“Human factors” involves the study of how and why people interact with their environment in the way that they do. In the context of a personal injury claim for a catastrophic injury, human factors experts would be the ones to explain why a driver went in an unsafe direction when a safe one was available, why a worker used a tool in a manner that resulted in injury, or why a pedestrian chose to follow a path that resulted in injury rather than a safer route. These experts also often consult with employers to improve workplace safety conditions and with builders and architects to create safer homes and public buildings.
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