"Bleeding is Controlled"

The call came in as a Code 3 (no lights or siren), "Elderly woman has fallen and cut her foot. Bleeding is controlled." When we arrived at the apartment building, my partner remarked, "Let's take everything. Knowing my luck, it's an amputation or something." We slog all the bags and the stretcher into the building and cram into the tiny elevator. I really wish they made elevators in stretcher size, sometimes I don't want to get that close to my partner or to 4 burly firemen. On the other hand...well, sometimes that can be a perk of the job! Ahem. Sidetracked.

Her frantic neighbours meet us in the hallway, and her daughter says, "I think she broke her leg! There's blood everywhere!" Oh, really? Hmm, this could be interesting after all.

She is wedged behind the door, and of course, the entrance hallway of her apartment is absolutely tiny. Luckily my partner is a skinny guy, and as it is his call, he manages to shimmy through the crack in the door, literally climbing over the patient's head to get in. Once in, he lets me know quickly that it is very serious without alarming the neighbours, the daughter, or the patient ("Red, this will be a CTAS 2 return."). All I can do is pass him equipment through the crack in the door, there is simply no room for me with her pressed against the door. Peering in, I can just make out the snow-white top of the patient's head and a trail of blood leading down the hallway. He tells me later that her foot was cold and pulseless, 180 degrees in the wrong direction with tibia and fibula shreds poking through the torn skin.

Once he has her leg splinted, he slides her back from the doorway and I am able to get in to help. Now I realize the full extent of the injury. She is pale and grey, tachycardic and hypotensive, her foot is a deathly white and her leg has already bled through the stacks of gauze that were just secured. The trail of blood down the hallway looks like somebody was murdered - that's what blood thinners will do. We lift her carefully and carry her to the stretcher, then shoot off to the hospital before she gets any closer to dead. I have to repeat my return code twice to dispatch - they don't seem to believe that the non-emergency call they sent us on is returning on a life-threatening priority. I hear her ask my partner, "Do you think it's broken, dear?".  I feel bad for the sweet old woman, she has no idea how bad it is.

The triage nurse wants to assess the injury, so we carefully cut part of the splint away. As we peel back the gauze, we can see the artery inside her leg pulsing. It hasn't been cut, but the muscle, bone and tissue around it has been shredded, so we can see every heartbeat throb inside her shin.  She tells us she stood up and her ankle buckled beneath her. She tried to walk on it and it just shattered - the razor sharp shards of broken bone shredding through her muscle and skin. She collapsed to the ground, out of reach of the phone, alone and bleeding profusely. She spent the next hour dragging herself to the front door, where she banged weakly until her neighbours came to investigate the noise. We find out two weeks later that she was still in ICU, 4 surgeries later, and still may lose her foot.