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Man vs. Barbed Wire

November 29, 2011 Leave a comment

Have you ever had of those days where your EMS day starts off relatively quiet and then BAM—all hell breaks loose?  Well, this wasn’t exactly one of those days, but it did turn out to be a memorable one for my partner and I.

We receive a call from the local Indian Tribal grounds for an unknown incident.

Beads of sweat began to form on my forehead, my palms began to tingle, and the adrenaline began to rush in anticipation of what we might find.  Would evasive measures like intubation, or drugs be needed? How long will transport time be to a trauma facility or cardiac facility if patient is in arrest?  “Remember Time is Muscle!”

After arriving on the scene, we were greeted by several kids who told to us to proceed down a muddy road in the woods on foot for about a ½ mile to a mile. Also, we were advised that it was an ATV vs. barbed wire fence accident.

Upon arrival, the patient, a five-year-old boy, was alive but his neck was completely severed from the left ear to right ear.  One could see both carotid arteries pumping blood.  “We were riding ATV bikes in the woods and didn’t see the barbed wire fence,” said a friend of the patient.  There was a large part of the client’s throat still lodged in the fence where he struck it.

The primary concern was airway. The young boy was desperate and breathing in a fashion he was not a custom to.  I attacked this by sedation, intubating and holding the tube in place with my hand (there was no way to tie the tube off on his neck). With a bag valve mask attached to O2, I provided oxygen to the patient. Two large bore IMs below the tuberosity of the tibia with Normal Saline administered. I secured patient to backboard, put his missing trachea in a plastic bag and put it in our mobile refrigerator unit in the truck and floored it to the hospital.

Medical Control granted us permission to transport ground to a pediatric trauma center because no helicopters were flying that day. Our ground transporting of the patient took a long hour and a half to facility.  Days later we learned that he survived the surgery and was recovering well.

S. David Pomerantz lives with his wife and daughter in Deerfield Beach, Florida. He can be reached on Twitter at @flaparamedic or Gmail at squad51paramedic [at] gmail.com

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