- I'm Dr. Armand Dorian, the Chief Medical Officer
of USC Verdugo Hills Hospital, also an ER physician
trained in trauma.
We're here to talk about the video game
Red Dead Redemption 2,
specifically about the traumatic events in the video game.
We also wanna break down what would happen
to the individual in the late 1800s where the video game
is depicted, versus what would happen to somebody now
with modern medicine technology.
(body falls)
(bell dings)
So in our first clip, we see an individual
throwing somebody else off a cliff.
We have a lot of information about this
from a traumatic standpoint.
There's a thing called LD50 which is a height or distance
where if you were to fall off of,
you have a 50% chance of survival.
And that's basically about 40 to 50 feet.
So that's around four to five stories.
So if you fall from a four or five story building,
the chances of you living after hitting the ground
is about 50%.
That's not to take into account the fact
that you may be paralyzed, may never be able
to get out of a bed from that point further.
The treatment for somebody that would have
a traumatic fall in the late 1800s
would basically be supportive.
They would basically put him in a bed and hope for the best.
Hope that he would have no significant internal bleedings,
understanding the fact that wherever it hurts,
don't move it, and then they would just give him time.
Obviously they would be doing some supportive stuff
like giving him water, but there was no real,
significant pain medications,
and there was no significant concepts of splinting
or doing anything intra-operatively in an operating room.
Nowadays, we would do a lot of things.
We would take you immediately to an emergency room.
We would put you through a CAT scan
where it would be able to analyze your entire body,
look for fractures, look for bleeds,
and then we would be able to address each one
of those problems one at a time,
obviously taking the most critical first
and then working our way down in a setting
where we could make sure to preserve your life,
and then also make you comfortable through the process.
(water rushing)
(frogs croaking)
In this next clip, we see somebody who's actually
tied together and throw into a river to drown and die.
Well, in the 1800s, drown dead is the same
as in the 21st century drowned dead.
There's no saving this person.
We have a lot of information about drowning injuries.
There's really two types of ways people drown.
One is called a dry drown, one is called a wet drown.
The dry drown is when your larynx actually spasms
and because it spasms, trying to stave off any water
getting into your lungs,
you actually choke yourself to death.
The second is when actually water enters into your lungs
and you flood the area that's supposed to be used for air
to get oxygen with water, and then you die from that.
Both are traumatic, both are disastrous,
both can be recovered if the person is brought
to an emergency department
in the appropriate amount of time.
You've got five minutes until you can't get blood
to the brain and then you're brain dead.
If you consider the 1800s, actually,
if you consider the 21st century,
if you're in the middle of nowhere in a river tied up,
thrown in a river bank to drown, I can guarantee you
you're not gonna come out alive
because we're talking minutes for your survival,
so consider this person dead.
The most graphic part is the manner in which he was killed.
(body hits ground)
In this next clip, we see somebody getting tossed
from the back of a train.
Two important things here.
One is the actual fall from the height,
the second is the fact that the train is moving.
When you consider both of these things, unfortunately,
today, especially in Los Angeles in which where I practice,
we see a lot of motor vehicle accidents.
We see a lot of people being projected outside of cars.
Here's the thing.
Those forces are very high, higher than you think.
Falling off of that height is not gonna cause
a lot of trauma, maybe a broken bone or two.
But when you're falling off of something that's moving,
the forces are higher and the potential for trauma
inside your chest and your abdomen is high,
which causes internal bleeding and death.
So let's consider the two different treatments here.
In the late 1800s, if somebody fell off a train like this,
if they had no internal bleeding in the chest or abdomen,
they would be able to live.
They would have disability and they would have pain.
Today, if somebody came like that to the hospital
and they did have bleeding, we'd be able to resolve it.
If they had fractures, we'd be able to splint it,
and within six weeks, we'd get them back
to where they once were.
(gunshots)
(yelling)
In this next clip, we see somebody getting shot in the leg.
Nowadays, we see a lot of people getting shot in the leg.
Unfortunately, it's a daily occurrence
in urban emergency departments.
Getting shot in the leg is not a life-threatening injury.
However, in this clip, the shot actually blows
this person's leg off and it's like an amputation.
Even amputations are salvageable if know what to do.
The number one most important thing is to actually
tie off that leg so you don't exsanguinate,
you don't lose blood.
In the late 1800s, there was no significant concept of this,
and even if there's somebody who's smart enough to do that,
once you're tied off, you need to then repair that leg.
In the 1800s, there's nobody that's gonna repair it.
Nowadays, this is salvageable.
This is something we can take care of you,
and with bio-prosthetics that we have today,
this guy could be actually walking very shortly
with a bio-prosthetic.
If he has appropriate gear on,
you may not even know that he's missing a limb.
(gunshots)
- Get away from me.
Please, just stop.
(dramatic music)
- In this next clip, we see somebody getting shot,
getting back up after falling down,
and then slowly bleeding out.
We see a pretty significant amount of blood on the floor.
That's actually pretty realistic.
We have five liters of blood in your body,
and a lot of times when you get shot,
the actually bullet's not what kills you.
Actually most of the time it's not that.
Most of the time, it's the fact that you lose blood.
Having said that, sometimes the blood is in your chest
and your belly, you don't see it.
Sometimes it's on the floor.
So that's a good indication of what type of bleed you have
and the potential for death.
When you see a lot of blood on the floor,
obviously, the chance of death is extremely higher.
Why is this guy able to get up?
It's very common.
When you get shot, your heart rate goes up,
your blood pressure goes up,
it's a fight or flight response.
The body is built to try to get away from that angry bear,
so as soon as you get shot, you're able to get up, run away.
You probably don't even feel the fact that you're shot.
But very short thereafter, the blood starts seeping
away out of your body, the blood's not going to your brain,
you start getting weak, tired, you lose consciousness,
you fall, you're dead.
So if you actually see the time in which this person dies,
that's the key with regards to treatment.
In the 1800s, that guy had about 30 seconds,
maybe a minute to live or a chance to survive.
No one's gonna be able to save him in the 1800s.
Even nowadays, the only chance that guy would have,
and I'm telling you, it's a minimal chance,
is if he was shot in the emergency department.
So that type of a bullet wound almost always,
99.9% of the time, regardless of what century
you were shot in, you're gonna die.
Doctors in the 1800s had limited ability to do things.
They had the same desire to help.
They had the same heart and need to try to help people
who were in traumatic events or who were sick,
but they just didn't have the tools.
Nowadays, we have a lot more tools, a lot better ways
of actually helping saving lives.
(adventurous music)