Saturday, 26 March 2011


It's 02:30. He's been trapped in the car now since 23:30 the day before. This man has spent the past three hours stuck in the wreckage of his brand new BMW, that hit a tree at high speed. I can't get him out. The fire crew can't get him out. He's cold and in pain. His right leg is embedded deep in the metalwork of the car, and, because the tree looks as though it has grown through the bonnet of his car, we are unable to do a dash roll to move the dash away and give us some more room.

I need my friend here, my mobile mechanic, to help decide what bit of the car is what. I peer at the leg, and pass my hand down slowly, to see where he is trapped, and by what. I cannot get my hand further than mid-calf - the rest of the leg and foot is completely buried. I have a chat to the fire crew, and suggest various bits of the car to cut off, knowing that this is going to take a long time. Fortunately for Timothy the foot injury seems to be the only problem he has. He is very chatty, telling me about his work as a Loss Adjuster for a local insurance firm.

Another half an hour goes by. I can now get my hand down to the top of his sock, but we are running out of options. The fire crew are cutting away down a deep hole, and it is proving increasingly harder for them to do anything without hurting Tim.

I regroup with the fire officer. I wonder whether we would be able to pull the car away from the tree. This is not something we would normally do because of the risk of injuring the patient, but in this case I can't see any alternative.

I decide to have one more look. Sometimes, if you clear some space behind the leg, this gives a small amount of manouevrebility, and the foot slips out. I run my hand down the back of the calf, and hit what I at first think is the leather seat cover. I look at the seats they are fabric. But this definitely feels more leathery. I ask for a torch, and peer down the hole, only to be greeted with the sight of his shoe. His shoe, toes pointing upwards, behind his leg. Pushing the shoe, prodding it with my gloved hand, I realise that his foot is still in the shoe, bent all the way back and up against the back of the leg. Furthermore, the sole of the shoe, and so the sole of the foot, is not the side of the foot that is resting against the back of the leg - it's the top of the foot. Try this yourself: take your shoe off. Now, keeping your shoe in the position it was when it was on your foot, bend it back all the way, until the sole of the shoe is against the back of your leg, with the toes pointing up towards the back of your knee. Now twist the shoe round, so that the laces are against the leg, rather than the sole, still with the toes pointing up to the back of your knee. Finally, imagine doing that with your foot still in the shoe! Well, that is the situation my patient is in...

Ok, so, although he has an obvious nasty fracture of his ankle, this will make extrication far easier, because the foot is not buried in the car - it is behind his leg. I decide to give Tim some STRONG pain-killers, and PULL him out. I am kneeling on the passenger seat (did I mention the roof and doors were removed ages ago?) and there are fire crews all around, to do the heavy lifting, while I pull the leg and foot out of the hole.

Nicely out of it on painkillers, Tim doesn't make a sound as I pull hard on the leg and foot. It still won't budge. I feel around again, confused, until I realise that his heel is getting stuck on the metalwork, and I cannot get it out. I call over my shoulder for a pair of scissors, and cut away at the shoe, until I can get his foot out of the shoe. It is very odd, seeing his toes right at the back of his leg, but at last he is beginning to move. It gets very dark, as the fire crew lean over and across me to grab a piece of the released passenger, and haul him up the waiting spinal board.

I glance at my watch - 04:30.


  1. I got as far as you firtling around and realising you could feel his foot, then had to skip to the end as I could feel the blood draining from my head! Glad you got him out though :D

  2. Did the foot survive? After 5 hours what had the blood supply been like? I thought I'd posted this question - or did you reject it? I'm having so many problems with blogger...

  3. Funnily enough, despite a particularly nasty open fracture dislocation, he has done very well indeed, and did not lose his foot.

  4. RapidResponseDoc,
    Do you have an email address I can contact you at?

  5. yes, send me yours via a comment, I won't publish it, then I can contact you.

  6. Pulling the car away from the tree doesn't happen often because that severity of collision is thankfully rare, but we in the States won't hesitate to do it if it speeds or eases extrication. I'd put it very near the top of our "Plan B" list of options. I think if it had happened here, we would have likely done that sooner rather than later.

    On the other hand, he wouldn't have gotten anywhere nears the pain management you were able to provide, so who's to say, really, that he would have been better off?

  7. Agree with you, Brendan. Slight problem here was the tree directly behind his car as well. Did I not mention that one? Yes, he had hit the tree in front, then swivelled round, so that he was essentially wedged between two trees. Oh, and did I mention he was on a steep hill as well?

  8. Well then, if you're going to survive a horrific crash, you might as well go all the way!

    If I had asked for all three of our ambulances be driven to the scene, I don't think I could have cobbled together enough narcotics to make that job doable. These people are lucky to have you!