He was laying in the middle of the street surrounded by police cars as neon beams of red and blue lights bounced off his mangled body on an otherwise dark night. The police had blocked off the street and were eagerly awaiting our arrival, pointing to him like trained hunting dogs. I could hear his desperate screams as soon as I opened the ambulance door. I slung the trauma bag with my equipment over my shoulder and made my way to him, kneeling down beside him once at his side. We began our rapid head to toe assessment to look for major injuries starting at his face. To say he woke up on the wrong side of bed would be an understatement, he had seen better days for sure. His face was so swollen and he could barely open his eyes or talk. covered with bruises, blood and major swelling. As I made my way down his body during my exam I noticed a pool of blood on the street next to his leg. I cut off his pants for further investigation and made a shocking discovery. The 2 bones which supported his lower leg (tibia and fibula) were sticking completely out of his leg about 12 inches, after cutting the pants off they liberated themselves from the confines of his garments and were pointing in the opposite direction from the rest of his leg. This was an interesting site indeed as now the majority of his lower leg had little structural integrity. To see a human being so mutilated is unnatural and I immediately started thinking of a butcher shop or the meat department at your local supermarket when analyzing his injury.
A river of bright red arterial blood flowed from his legs around the injury site. It was near impossible to tell the exact location(s) of the severed artery so in addition to a makeshift tourniquet we also covered the open wound with a special powder called “Celox” which is a hemostatic agent that stops bleeding. Due to the severity of the arterial bleeding it took our priority as an immediate life threat. Unfortunately moving the patient into the ambulance and splinting his leg was not so easy. The poor fella was confused from his head injury, but was still conscious. There was no way to splint his leg or even move him off the street in the position we found him with the bone at such an unusual angle, in addition to this the injured leg had no pulse. This was a rare kind of compound fracture and precluded most splinting and moving procedures. To make matters worse, the ambulance service here is undergoing major changes and at the time of writing this has no IV pain medication such as morphine. My partner and I really felt bad for this guy, but we had no choice and began to manipulate his leg to relocate the entire thing in a neutral position in which we could safely move him and his leg and also control the bleeding. We had to transport him to the hospital and there was no other way. His lips opened wide and tears ran down his face as he screamed in agony while we manipulated the leg and splinted it. He almost passed out at one point and I wish he would have. I felt terrible, but there was nothing I could give him for the pain today and we had to save his life by taking him to the trauma center and stopping the major bleeding. All I could do was hold his hand, but only for a moment because I needed both my hands for the procedure. It was truly a primitive and medieval thing to do, but unavoidable. Re realigned the leg as best as possible and as non-invasive as we could. Once the leg was splinted we applied more celox and began our transport to the hospital. Upon arriving at the hospital the emergency doctor immediately called for an orthopedic surgeon to come down and they began to give this guy the works, along with much needed pain medication. A week later I spoke with the doctor and he said we did an excellent job of stopping his arterial bleeding and dealing with his injuries. He was satisfied with how we dealt with the leg considering what we had to work with. The injured man will have several surgeries on his leg, and also for his skull and facial fractures, but he will make a recovery, although it likely won't be %100. The patient was a victim of a hit and run accident as a pedestrian. Luckily the police caught the driver and the patient did not have any major brain damage.
Sorry for the lazy writing this week folks, I was in a hurry, promise the next story will be written better.
