# Impaled on an open femur fracture



## Manic_Wombat (Nov 28, 2009)

I am a member of a volunteer FD and was told this story of a call that we responded to a few years ago involving a quite uncommon emergency. Unfortunately the person telling me the story did not remember the treatment for the pts because a paramedic ambulance arrived on scene quickly, and I was curious what you all have to say since I am a new basic.

Around 2001, we responded to an "MVA with multiple injuries" dispatched in the early afternoon. The first EMTs and FFs on scene found the vehicle had driven off the road and collided with a light pole at an intersection. Upon further examination the driver of the vehicle was found on top of the person in the passenger's seat, with the majority of his abdomen touching the the top of the seated passenger's thigh. After removing the passenger's side door to access the patients, the responding EMTs and FFs found that the driver's RUQ and RLQ were impaled on the passenger's left thigh which had an open femur fracture. Both were conscious and alert, but obviously in extreme pain. After this the story gets fuzzy other than the fact that the FFs did a little disentanglement and the Paramedic ambulances transported both to the nearest trauma center.

I was curious what you people think the BLS actions could have been in this emergency, since conventionally we were taught not to remove impaled objects. I would assume that since it would be impossible to transport both attached to each other, the driver would have been collared and lifted off the passenger, then boarded and transported since he was almost prone on top of the passenger's lap. Meanwhile, I would guess that the passenger would have been collared and immobilized on a KED, lowered onto a longboard, and have a traction splint applied to the femur fracture (if they had time) and then transported.

I wish I had more details, but what do you guys think?


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## lightsandsirens5 (Nov 28, 2009)

Holy cow! I don't ever want to run across that in the field. When somones body parts are stuck inside another person............ (Ok, I know most will interpert that wrong. And no, I don't want to run across one of _those_ either!)

I will have to ask my SEI about this one.

As for the open femur fx. Definatly no traction. We never traction an open fx. because of contamination. And personally, I would consider the inside of someone elses abd a contaminated environment.


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## trevor1189 (Nov 28, 2009)

Well the impaled "object" would have to be removed in this case. Obviously because you can't transport both pts. Also, kind of hard to manage an airway if needed on a pt. in prone position as you described.

Also like lightsandsirens said, Open Fx is a contraindication for traction splinting. People always think broke femur gets tractioned. Not the case.


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## EMSLaw (Nov 28, 2009)

trevor1189 said:


> Well the impaled "object" would have to be removed in this case. Obviously because you can't transport both pts. Also, kind of hard to manage an airway if needed on a pt. in prone position as you described.
> 
> Also like lightsandsirens said, Open Fx is a contraindication for traction splinting. People always think broke femur gets tractioned. Not the case.



I have to agree.  You're not going to cut off patient 1's leg in order to transport the "impaled object" in situ, stabilized with bulky dressings.


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## Shishkabob (Nov 28, 2009)

EMSLaw said:


> I have to agree.  You're not going to cut off patient 1's leg in order to transport the "impaled object" in situ, stabilized with bulky dressings.



I would


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## lightsandsirens5 (Nov 28, 2009)

Linuss said:


> I would


 
So _that_ is why you are not an MPD!


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## Shishkabob (Nov 28, 2009)

Maryland Police Detective?


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## lightsandsirens5 (Nov 28, 2009)

Linuss said:


> Maryland Police Detective?


 
No! You are not that because you live in TX. ^_^

And no it is not multiple personality disorder.......or magneto-plasmadynamic thruster, or Myeloproliferative Disease, or...........

But I don't want to get booted for de-railing a thread.


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## Manic_Wombat (Nov 28, 2009)

Yeah, I was thinking about the airway issue and that's why I figured the prone patient would have to be moved. I wish I had more details though, since it was such an interesting story. Thanks for the input guys!


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