Four Wheels,Many Injuries

from Children's Magazine, Summer 2005

Story by Kristin Kelly

Photography by Tia Brayman

Tina and Greg Hart finally sold the four-wheeler this summer.

After an accident that nearly killed 3-year-old Caitlin and injured her brother Cody, 11, no one could bear to look at it anymore.

‘Mom, You’ve Got to Come Help Me!’

Tina Hart remembers the afternoon of April 18 like it was yesterday. She was balancing the checkbook for the family, who live on a farm in Berthoud , Colo. , when her 8-year-old son Colton came flying into the house.

“He yelled ‘Mom, you’ve got to come help me!’” Tina said.

Cody and Caitlin, who had been riding the four-wheeler in the hay field after school, had had an accident.

Tina didn’t think it was all that serious – after all, she and her husband Greg had both grown up on farms and had ridden four-wheelers much of their lives.

She asked Colton if the four-wheeler had landed on top of his sister or brother.

But Colton could only get out one word: blood.

Tina bolted out the door and ran across the field. By the time she reached her two children, Cody had gotten up and was running toward her with Caitlin in his arms.

She took the girl’s limp body from Cody and sat down on the four-wheeler, which was still upright.

“She wasn’t breathing very well,” Tina said. “All I could see was a huge lump on her head. I thought, ‘well, this isn’t too bad.’”

Tina figured she’d call Greg at work at Longmont Farm Supply and tell him to meet her and the kids at the hospital in Loveland.

But then she spotted some blood on Caitlin’s skirt. She folded down the waistband, and that’s when she saw it: Caitlin had a cut all the way to the bone on her left hip.

Tina calmly pinched the cut together with her fingers, but on the inside, she started to panic.

“I don’t handle things like that well at all,” she said. “I still don’t know how I handled it. Something came over me.”

Two Kids, Many Injuries

Seconds later, Caitlin passed out.  

Tina screamed to Greg’s grandmother, who also lives on the farm, to call 911.

The ambulance took Caitlin, Cody and Tina to McKee Medical Center in Loveland. Greg met them there.

The medical team at McKee quickly surveyed the damage: Cody had a split lip and bruises on his stomach – injuries easily treated at McKee.

But Caitlin, doctors quickly realized, had broken her pelvis and her left collarbone and had a cut on her liver. She also had major trauma to her left leg – the main artery was so damaged that doctors couldn’t find a pulse in her foot.

Caitlin was hurt so badly that she would need to be airlifted to a bigger hospital.

Tina was stunned.

“I was thinking that just her skin had been split open,” she said. “I didn’t have any idea it was as bad as it was.”

The helicopter arrived moments later, and Caitlin was lifted aboard for transport to Denver Health Medical Center, which specializes in complex pelvic fractures. But the copter was too small to accommodate Tina and Greg, who would have to make the hour-long drive on their own.

To Tina, that hour felt like days.

“It was horrible,” she said. “I was scared to death. I honestly thought she was going to die. I knew if it was bad enough that McKee couldn’t do it, it was pretty serious.”

Terrible scenarios scrolled through her mind: Would Caitlin lose her leg? Would she never walk again?

The helicopter landed at Denver Health 15 minutes later, and Caitlin went straight into surgery, where doctors fixed the fracture with two screws. Tina and Greg arrived about half an hour later, but there was nothing to do but wait.

Although injured children are taken to The Children’s Hospital in Denver for most major traumas, kids with complex pelvic fractures are taken to Denver Health, which employs one of the state’s best surgeons for this type of injury. Doctors at major metropolitan hospitals only see a few children a year with this type of fracture, and the equipment for treating it is very expensive. That’s one reason why Children’s has an agreement with Denver Health to treat these injuries, said Heidi Rosebrook, CPNP, MS, RN, nurse practitioner for trauma services at Children’s.

“It’s an excellent collaborative effort with Denver Health, and it ensures we don’t duplicate resources,” she said.

As part of the agreement, Denver Health treats complex pelvic fractures and any other emergencies, and then children are transferred to Children’s for the rest of their care.

Caitlin spent the night at Denver Health in recovery, hooked up to a ventilator to get more air into her bruised lungs.

“The doctors at Denver Health said they had done their part, and that the best place for her now was Children’s,” Tina said.

The next morning, an ambulance took Caitlin to the next hospital – her third in less than 24 hours.          

Children’s ‘The Best Place For Kids’

The first face Caitlin saw when she woke up that morning was that of Frederick Karrer, MD, chair of Children’s department of pediatric surgery. Dr. Karrer was the attending physician on call that Tuesday morning.

“Children’s is the best place for kids because we have the pediatric nurses, the physical therapists, the surgical specialists, who can see kids two to three times a day or more,” said Dr. Karrer, who performs 18 to 20 surgeries a month at Children’s. “Denver Health has a small pediatric service, and they don’t have the specialists we do – thus the reason for the agreement.”

The Children’s Hospital’s job now was to assess Caitlin’s other injuries and to ensure she was healing from the pelvic fracture. Her broken collarbone and the cut on her liver would heal themselves, Dr. Karrer said. But there was still much to worry about – Caitlin’s lungs were bruised. She still had no pulse in the main – or iliac – artery in her left leg.

“There was discussion about some type of intervention or surgery,”

Dr. Karrer said. “But Caitlin had a warm, pink foot, which indicated she had blood flow around the artery blockage. Plus operating on the arteries of a 3-year-old is not a slam dunk. If you try to open the blockage and fail, you could have a real problem. She could lose a limb.”

So surgeons made the decision to leave the artery alone in the hopes that blood flow would return.

On the Road to Recovery

During Caitlin’s first few days at Children’s, she wasn’t herself. Her lungs had healed enough for her to be taken off the ventilator, but she was still groggy and in a lot of pain from the pelvic injury, Rosebrook said. She wasn’t eating well – a sign that she might have an abdominal injury, Dr. Karrer said. Doctors told Tina and Greg that the team might have to put in a feeding tube.

The Harts were very worried about Caitlin – especially about the artery in her leg. On Caitlin’s second day at Children’s, she still didn’t have a pulse in her foot.

The team at Children’s also was on the lookout for other injuries that hadn’t yet been discovered.

“Injuries aren’t always immediately apparent,” Dr. Karrer said. “Sometimes serious injuries to the intestines can’t be seen on a CAT scan.”

In his 15 years as a pediatric surgeon at Children’s, Dr. Karrer has seen quite a few children who were injured on all-terrain vehicles (ATVs) or four-wheelers.

“I have seen a lot more than you would think,” he said. “Kids have no concept of speed or safety, but 20 to 25 mph is fast enough to get hurt pretty badly. These things are dangerous.

“Putting a 3-year-old on one of these things isn’t the best idea, but it’s a practicality of living on a farm.”

Rosebrook said she had seen at least four ATV-related injuries in just over a year in the trauma department.

In fact, from 2000 to 2004, Children’s saw 50 kids who were injured while riding ATVs. Many of them had neurological injuries – sometimes devastating ones. But in all of Dr. Karrer’s years here, he’s never seen a child as young as Caitlin or one as badly injured from an ATV accident.     

“The mom and dad were so guilt-ridden,” Rosebrook said. “They felt horribly. They took it very seriously. They had no idea a child could get this injured on one of those things.”

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