A Guest Post by M.J. Carlson

You’ve all experienced it—reading a thriller or watching a movie or TV show when a character is injured, sometimes severely, until the next scene, when they’re all back to normal and on with the chase.

In all fairness, the author may have never experienced that particular injury. Information about symptoms of injuries can be hard to find and difficult for the average person to interpret. So, to compensate, writers often talk to other writers about injury symptoms, paraphrase descriptions from other texts, or “just write whatever the plot needs to happen.”

To make matters worse, Hollywood has perpetuated a “hero as superhero” myth. Accordingly, Americans have come to expect their heroes to be bigger than life.

So, let’s take a realistic look at the ten most used (and misused) injuries in fiction.

#1
Probably the most used, and misused, injury in fiction is head trauma. It seems every time a character needs to be silenced, subdued, or moved, or if one character needs to gain entrance past guards or escape captors, someone gets whacked on the head, rendering them unconscious for exactly the necessary time. The injured characters almost universally awaken with minimal symptoms, usually treated by simply wrapping gauze around their heads.

If you’re writing a story involving real humans, though, some things to keep in mind are: any head injury resulting in loss of consciousness for more than a few seconds will probably result in:
– sharp, stinging pain at the point of contact (usually the scalp or face) with bruising
– headache
– dizziness
– nausea/vomiting
– confusion
– blurred vision
– ringing in the ears
– decreased coordination
– light/noise sensitivity

Concussion with loss of consciousness <5 minutes may take days to weeks for complete recovery.

A moderate or severe head injury of loss of consciousness >5 minutes may also result in excruciating headache, repeated vomiting or nausea, seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and confusion, restlessness, or agitation and may take months to fully recover from.

#2
Blunt trauma (probably fiction’s second most common injury) includes almost all transportation injuries, like motor vehicle collisions, pedestrians struck by vehicles, airplane crashes, and boating incidents, as well as jumping or falling from heights, blast injuries, and being struck by a firm object, such as a fist, crowbar, bat, or ball. In medical terminology, blunt trauma, blunt injury, non-penetrating trauma, and blunt force trauma are usually synonymous. In legal terminology, blunt force trauma implies intent. Blunt trauma can often lead to other types of injuries, including abrasions (road rash), contusions (bruises), lacerations, fractures, concussions, burns, and internal organ injuries.

#3
Strangulation involves lack of blood flow or oxygen to the brain. The three types of strangulation are: hanging (suspension from a stationary object by a cord wound around the neck), ligature strangulation (strangulation without suspension using some form of cord called a garrote—usually from behind), and manual strangulation (throttling—strangulation using the fingers, legs, or crook of the elbow, AKA the “sleeper hold” popular on TV and in police departments).

Your character will probably experience panic (they will panic), rapid heart beat, tunnel vision, weakness, euphoria, hallucinations, slowed heart rate, and unconsciousness, all in fifteen seconds to a minute. On awakening, they may have a sore throat, headache, dizziness, or nausea and vomiting lasting minutes to hours.

#4
A laceration is a tearing of the skin, not a clean cut (incision). The amount of pain involved is roughly proportional to wound size and edge irregularity. Skin wounds hurt because nerve endings are exposed to air, changing the pH. Depending on the severity, typical recovery time with stitches is 2-4 weeks, or months without stitches.

#5
A puncture wound (penetrating trauma) is any wound deeper than it is wide. A puncture wound can be Low energy (spears, knives), Medium energy (arrows, crossbow bolts, handguns, shotguns) wounds result in a sharp, “jolting pain” and typically need 1-3 months recovery time, or High energy (high-powered rifles). These injuries usually require 3-6 months recovery time, often with permanent residuals.
– Arrow or crossbow bolt – often a sharp, ‘searing,’ ‘jolting’, or ‘stinging’ pain
– Bullet—small caliber wounds are often described as “a mild to moderate stinging” sensation, may not be immediately noticed by the victim unless a bone is broken or a lung is punctured. This is more common on battlefields, where adrenaline is high. Oh, Hollywood? There’s no safe place to shoot a human being. Any puncture wound, even a shoulder or leg injury, can result in massive blood loss and death within a few minutes.

#6
Blood loss & shock: After more than about 1 liter of blood loss your character will start to experience:
– Confusion
– Rapid heart rate
– Rapid, shallow breathing
– Weakness and chills, starting in the extremities, moving toward the heart
Typical recovery time with intravenous volume replacement is 1-2 days, and without is 2-4 weeks, Hemoglobin replacement without transfusion for 1 liter is approximately 3-6 months.

#7
Sprains and fractures are extremely common injuries in fiction. A sprain is stretching a joint’s tendon past its limit and a fracture is any disruption of a bone’s structure. The pain from either can be immediately incapacitating, sometimes resulting in shock and loss of consciousness. Typical recovery time for sprains and simple fractures is 4-6 weeks.

Sprains can be Grade 1 (a stretched tendon with no tearing), Grade 2 (some tearing of the tendon), or Grade 3 (complete tearing, resulting in an unstable/unusable joint).

A simple fractures is a broken bone, while a compound fracture involves a bone fragment poking out through the skin. As you can imagine, this is usually an incapacitating injury.

– Sharp, sudden, nauseating pain with a sickening “snap” or “crack” as the bone breaks
– Deep, aching or burning pain in the area of the injury
– Probable inability to move the extremity
– Possible numbness if nerves are involved
– Lightheaded or dizzy from shock (the character may pass out)

#8
Burns can be radiation, thermal, chemical, or electrical. Burns are categorized according to the depth. A first degree burn is a superficial, painful burn, often resulting in reddening of the skin and little or no lasting damage. A second degree burn results in partial thickness damage to the skin in the form of blisters or killing skin cells at the top of the dermal layer (a dry, white look to the skin).

A third degree burn is painless, because the skin and nerve endings are dead. However, the surrounding skin is very painful because it’s at the second degree stage. These injuries always result in scarring, and usually contractures (inability to move the extremity in certain directions). Third degree burns usually require hospitalization and greater than 60% are often fatal. Rehabilitation from third degree burns is slow and painful, and usually involves rehabilitation hospitals, physical therapy, and removal of dead tissue.

#9
Cold injury is also graded according to damage and depth. First degree is initially cold, then numb, with mild superficial pain on warming. Second degree is usually painless because of the numbing effect of cold. It’s a deeper injury, associated with blisters and peeling skin. Pain starts with warming of the area. Third degree is almost painless, because the skin and the nerve endings are dead. As in burns, third degree cold injury always results in extensive, deep scarring and contractures and probably the loss of fingers/toes, etc. Greater than approximately 10% of the surface area almost always requires hospitalization for dehydration and pain control, and may involve amputations of the affected body parts. Greater than 30% third degree cold injury is usually fatal.

Chilblains is a phenomenon where the extremities are exposed to hours or days of constant wetness and temperatures above freezing. Chilblains sometimes results in nerve/blood vessel damage.

#10
In decompression injury (AKA “leaky spaceship syndrome”), symptoms of air hunger, shortness of breath, confusion, panic, blurred vision, and rapid heart rate start as air pressure drops below 8 lbs/sq in. Exposure to a vacuum does NOT instantly freeze skin. Heat loss through convection actually slows due to lack of a medium to absorb the heat (it’s a vacuum). Exposure to a vacuum doesn’t cause the body to explode. The surface blood vessels will rupture (most noticeably in the whites of the eyes). Gas expansion in the lungs is a problem, though. As blood vessels in the lungs explode, the lungs fill with blood.

Going the other direction, at ocean depths more of than a hundred feet, nitrogen from the air is forced into the blood by higher pressures. When the pressure is reduced back to sea level too rapidly, the stored nitrogen returns to gas and can cause bubbles in the blood, resulting in severe joint pain (gas trapped in joints, AKA the bends), heart attack, or stroke.
In conclusion, Super Hero Syndrome and Hollywood Healing are a fantasy. If you’re writing a superhero character (John McClane, Jack Reacher, etc.), this information probably won’t directly apply to your main character, but the characters they interact with will still be subject to normal human frailties. If used judiciously, this information can serve to enhance your storytelling and more fully engage your readers, thus providing them a richer, more enjoyable experience.

The story you choose to write is entirely within your control, as is your character’s (and ultimately, your reader’s) adventure. This concept is only one of many to consider when providing your reader with a fulfilling vicarious experience. If, by the end of the story, you and your reader are satisfied, you’ve been successful.