Dr Sarah BoutrosIt’s Monday afternoon on another long and busy shift in the paediatric emergency department. The crash call goes for the paediatric team to attend resus. I run in and find a trail of blood leading to the resus area. An agitated young person is bleeding from his leg and a nurse is shouting for security to be called. An experienced doctor is putting pressure on the bleeding wound, a nurse is escorting the young person’s friends out of the resus area. It’s noisy, many people are walking in and out.
I am tasked with talking to the young person. I know he must be frightened, he is in pain, he is on his own. I introduce myself and explain my role. I am standing close and trying to stay at his eye level. I am aware of all the noise and the people coming in and out. I wonder how I can best apply my trauma-informed skills in these circumstances. He is in pain and is given gas and air. I explain we are all here to help, I tell him we will look after him and he will be OK. He keeps on asking if he will die.
I try to get some important information from him as he will soon be ‘high’ from the gas and air. We still don’t have his full name or any details of a responsible adult.
I am going to hold off asking more detailed questions until his pain is controlled, the room is calmer and we have no interruptions. This is a challenging situation – what is the right balance between getting a history and supporting this young person during this frightening experience? I am aware he is likely vulnerable and may be involved in county lines and gang-related activity. How far can I go with this line of questioning?
I decide to pace the questions, starting with what happened today. He is vague but gives enough information so that we know how to manage his wound. I get some other essential information about him, his medical history, allergies etc. I find out about his school and take the opportunity to find out more about him. He likes school, he is good at it. I ask him about his hopes for the future. I find out about the complex family set up and involvement of other agencies. But we are often interrupted by his pain and his agitation at the situation. I stay there and reassure him, talk him through what we are doing and explain who is in the room. When the police arrive he becomes very agitated, I ask them to step out so that we can continue managing him safely.
In the end, I never did get a full story of what happened. I did not establish if he is being exploited, although it is clear he is very vulnerable. I did however manage to establish rapport with him and he thanks me for that – he is high on gas and air at this point and tells me I’ve been nice to him. I think that means he valued our interaction. I now have to trust that other agencies who are involved can help protect him from further harm.