One of our recent call-outs was to a Motocross accident where a patient had sustained a severe open fracture dislocation of his ankle. The accident happened in the Peak District and as one of our doctors was at home nearby at the time he was first on scene within a matter of minutes.
A member of the public had called 999 and helped transport the patient from the hill they were on to a local farm. When our doctor arrived the patient was in severe pain and still in the front seat of the passerby’s 4×4. Our doctor gained IV access and administered strong analgesia to make the patient more comfortable. The ankle was heavily contaminated with dirt, the surface of the joint was visible with large amounts of bone protruding through the skin so early IV antibiotics were also administered to prevent infection.
On the arrival of the EMAS ambulance the patient was assisted onto the ambulance trolley and our doctor thoroughly irrigated the wound, reduced the fracture and placed it in a splint for stability and protection. Early fracture dislocation reduction can be limb saving if the blood supply to the foot is compromised, however this is often incredibly painful. One of the advanced skills that our doctors have is sedation with strong medications such as Ketamine. This isn’t routinely available in NHS pre-hospital care and delivery of this means that the patient has a more efficient, comfortable management of their emergency. After receiving the advanced sedation the patient was then escorted to hospital by the EMICS doctor in the back of the ambulance.
As EMICS doctors respond in their own vehicles, kitted out with lights and sirens, when the patient needs escorting to hospital the doctor’s car often gets left at the scene to be retrieved later! It’s all worth it though. This patient was very grateful for the care he received and went on to make a good recovery.