My toughest case:
About 15 years ago I was quite junior in the accident and emergency department. Pre-hospital care is much better organised these days but back then fire brigades would often just shout for the nearest A&E department if they got into trouble.
I was called to a car crash on the M62. There was a 16-year-old girl who had been trapped in a car for over an hour. She wasn’t actually unwell, she had no other major injuries, but her foot was jammed underneath the engine block, which had been driven back into the passenger compartment. Her foot was trapped between the engine and the car floor and they’d failed to get it out.
They asked for someone to send a doctor or nurse to quickly do a leg amputation. I’d never done anything like that before. It’s difficult to make it a nice job but it’s quite easy to do – so I kind of knew what was involved. When I got there I was faced with this young girl who was perfectly well but they wanted to chop her leg off. We would have had to amputate her leg between below the knee and the mid-shin bone with a saw. She was totally conscious and talking but she was scared, cold and tired.
I didn’t have much of a conversation with her; I just spoke to the firemen about what they had done so far and what they were trying to do to get her out. All I could think about was what they were asking me to do: what if we waited and her foot just slipped out? I delayed everything as much as I could because she wasn’t getting any worse. It was truly and simply that they couldn’t free her and that they had been trying for ages. It was a difficult situation. It wasn’t like she was trapped in a drain with water rising.
The other people in the car weren’t seriously injured: the driver, her father, had got out, it was just a freak thing. She was the only one still left in the smashed-up car. So we got all the kit ready; there is a kind of amputation pack. In those cases you would inject the patient with ketamine as it’s a very powerful anaesthetic but doesn’t stop you breathing. So we were all set to go, but I still continued to delay it and eventually, the fire crew got her out. I was as relieved as she was.
She had a few broken bones in her foot where it had been trapped but other than that she was fine. In emergency medicine you’re expected to dive in, but sometimes it’s alright to sit back and wait a bit. In this case, I’m so glad I did.Tags: amputate, amputation, ketamine