Patient Care, Trauma

Call to Action: Snowmobile Trauma

Issue 4 and Volume 33. Editor’s Note: Grab a copy of the April 2008 issue of JEMS for Images B-E„from this incident.

On a snow-covered rural road, two men were attempting to fix a stationary snowmobile. While one held up the rear of the vehicle, the other revved the engine. Suddenly, one man slipped under the snowmobile, and the free-spinning track caught his left pant leg. His lower leg was quickly torn off, and he also sustained an injury to his left arm (Images A and B). Another friend, a veterinary assistant, witnessed the accident and immediately applied a belt as a tourniquet to control the exsanguinating hemorrhage from his leg. EMS was activated, and Dexter (Maine)„EMS was on scene in 11 minutes.„

The rapid trauma assessment revealed the amputation and an apparent open fracture of the left humerus. Both injuries were immediately stabilized and dressed. When LifeFlight of Maine arrived, the crew recognized the potential for life-threatening internal injuries, and the patient and the amputated limb were immediately flown to Eastern Maine Medical Center (EMMC).

On arrival at EMMC, it was clear from the amount of tissue loss and destruction that the patient was not a candidate for limb reimplantation. The focus changed to salvage and„to maximizing the patient_s function. In the relative calm of the trauma bay, it was noted that the bone protruding from the forearm was triangular (the humerus is round), the wound„margins were pushed in and pieces of the patient_s coat were lodged in the wound. These findings suggested that the bone protruding from the forearm was actually a portion of the patient_s tibia, and that the arm itself was not fractured.„

X-rays confirmed this suspicion (Image C), as well as the fact that the bone amputation in the leg was just below the level of the knee, much higher than initially suspected due to the large amount of remaining soft tissue (Image D). The patient was taken to the OR for management of both wounds. Approximately 18 cm of tibia was removed from the arm (Image E). The puncture wound was cleaned and closed, and healed very well.

Thanks to the quick and skillful action of bystanders, local EMS, the flight team and the trauma center, the patient recovered quickly from this potentially devastating injuries, and within two weeks, he was not only back home but was active in the community. He appreciates how lucky he is to have done so well with his leg amputation and “open fracture impaled in the arm.”