Israeli Paramedics Association
9
The Israeli Paramedics Emergency Medical Journal
Chief Editor - Paramedic Neomi Zvi
TRAUMA --> Case Report
25 Ton's Container
By
Paramedic Neomi Zvi
That Wednesday night , is certenly deserve to be call:
The Trauma's Night, 9:20 PM.
We were on our way back from the Trauma Center , after 'refreshing' the
equipment , and doing some cleaning...
We stopped at the fast food restaurant opposite the seaport.
The EMT - Ariel was dead hungry and already finished his first double burger when
the trainee and I got our take-home bags.....
Well , if you are a paramedic - I guess you know what comes next...
The dispatch center asked about our location .... half second "freezing" of "who's
gonna put his meal and answer the radio". "Opposite the Seaport" answered Ariel
(a great guy - double meaning..:-)
......"Gooood" said the dispatcher.( here goes our meal...)
"Inside the Seaport area , the security patrol is waiting for you at gate No 5, a worker
was run over by a forklift "
By the end of her sentence - we were on the scene.
Thinly rain , darkness...at least 80-90 workers around .
Our trauma pt., had an open crash injury all over his right leg up to few cm below the
groin line, only the back skin was connected - to make it short - amputation , and from
there up to the Iliac crest point a partial transverse amputation .the right half of his lower
abdomen was widely open. He was bleeding like hell....
The port's EMTs were already there , Oxygen mask on the pt's face , one - supporting
the head , the other was desperately trying to control the bleeding .
I looked up - the 2.5x6 m loaded container was hanged on the air by the forklift's arm,
right above the pt., and oily drops were falling on us...not to mention the greasy ground..
I ordered to remove the Oxygen cylinder from the scene on the double.
Ariel reported on the radio: "one awake trauma pt , crash injury , critical condition"
"Awake" ?? - he was looking at us with that sunken look you all know....Whiter then the
snow , shallow fast breathing (if you can call it "breath"..)
The Seaport medic gave a brief description about the mechanism.
Jaw thrust , Oropharyngeal AW , BVM , assisting ventilation - No Oxygen.
Scoop board , onto the stretcher , into the MICU...... leaving track of blood behind us.
Pressure with his two hand on the what suppose to be the place of the Iliac Artery.
The remnants of his leg (there was nothing to take) were left on the scene.
Thready, at least 130/min carotid pulse ,no head trauma , unstable chest , poor but equal
air entrance bilaterally , and still severely bleeding from several places.
I told the trainee to be prepared to his first field intubation. He looked at me with widely
open eyes. "Yes - you !" I said.
"Ariel , on your left - a surgical set - open it, please" . I wiped the blood from the
abdomen with bunch of gauzes - to see what's going on .
For a moment I could see the full anatomy - the Great Saphenous Vein (at the junction
with the Femoral Vein , the Femoral Artery next to it , the External Iliac A &V , and even
the tip of the Internal Iliac Artery up to the Common Iliac Artery &Vein. I continued
pressing and the pt. still bleeding.
I wiped the blood again - clamped what I saw first - the External Iliac Artery and Vein , and
pressed next to it again. Much less but still bleeding....
Ariel was too quiet...
I raised my eyes towards him - he was pale almost like our pt...:
"if you are going to puke on me I'm going to tell it to all your friends in the station" I
said ..."Now - more gauzes please"..:"and the stitches threads too" I added ..
"Yes mam"...said Ariel (I knew it will work ! - his male ego won't let him puke !)
finally controlled the main bleeding.
With the angle of my eye , I watched my tranee intubating the pt.
The ETT was placed properly - Spread rales and crepitations were auscultating all over
lung's fields....no Pneumothorax >
"Good work " I said to the trainee...
On the way:
Transporting the pt. to the nearest hospital (relatively small , 17 minutes away , not
a trauma center) ...reporting .
I changed gloves for the third time
Carotid pulse - thready , about 140/min , regular
Missed the peripheral veins twice .
External Jugular , 14 G , ,,,and the first Ringer's Lactate was running. - I opened a 14 G IV
line on the other E. Jugular as well. (had no choice , dear colleagues)
Systolic BP was around 58-60 mmHg....... I connected the monitor - Sinus
Tachycardia of 145 , regular.
The trainee supported the pt.'s head with the Headivce while ventilating.
I called the Hospital: " 59 y/o trauma pt., crash injury and amputation ,in Hypovolemic
Shock , DIC stage. Asking for OR and surgeon"
"Okay" authorized the OR doc.
Covering the pt. with Aluminum blanket
and replacing the two empty infusion bags....
There was some blood from the ET Tube.....the trainee suctioned ......ventilating .......and
some more blood comming from the ETT again.
Unfortunately , it was expected.....
In the Hopital:
Although is was dark and rainy . a whole bunch of surgeons was waiting for us outside
the OR - at the back entrance.
The Senior Surgeon pulled the aluminum blanket off the pt. and immediately covered him
back.
"What happened exactly ?" he asked. "And where's his leg ?"
"A forklift carrying 25 tons container , run him over twice (forward and backward)
with the internal wheel on his right leg - nothing left from it - up to the lower abdomen .
From the pressure he have also broken ,unstable pelvis & ribs and crash of internal organs on his
right" > "Hypovolemic shock , DIC , 142/min HR ,Systolic BP of 68 mmHg after almost 3
litters of Ringer's Lactate...."
The pt. was operated for nearly 4 hours , got a lot of blood transfusions (mainly fresh -
because of the coagulants agents) and moved to the General (combined with the
Respiratory) Intensive Care Unit
Outcome:
He died 35 hours later , on his birthday , a year before retirement
Paramedic Neomi Zvi - May 2000
URGENT - The Israeli Emergency Medical Journal - Volum No 8
Some detailes were changed deliberately