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Hip Fractures and ABCs

Posted Nov 16 2008 1:10pm

PC over at Street Watch: Notes of a Paramedic has a fascinating article on hip fractures

It’s a long and interesting article but what captured my attention was that PC found a manual on Emergency Medical Dispatch which states that a hip fracture is not a prehospital emergency. That seems counterintuitive to me. I’m not a paramedic or an orthopod, but it seems to me that a hip fracture is very much a prehospital emergency. A hip fracture is not immediately life-threatening, but it is an injury that requires expedient treatment and which can have a number of adverse effects. As PC mentions, the pain alone from a hip fracture makes it an emergency…I can’t imagine what it must feel like to break a hip. I fractured my radial head a few years back when I slipped on some ice and all 180 pounds of me landed on my wrist, and that hurt a hell of a lot, especially once the adrenaline wore off…I can not imagine what it must feel like to have a fractured hip.

 

As interesting as all that is, it reminds me of a story from back when I was training as an EMT-Basic. I had decided to take an EMT-B course to expand my knowledge of prehospital care and get an appreciation for what goes on In The Field. As part of that I was required to ride along with a local ambulance service.

It was early in the morning and we’d just completed our check of the truck. All the equipment was in place, the engine seemed to be running, the lights all worked, and everything appeared to be in order. The paramedic and I were shooting the breeze when the tone went off. we were dispatched lights and sirens to a fall from standing at a local apartment complex; details were sketchy. We zoomed off into the morning traffic, sirens blaring, cutting through the morning commute. We located the apartments and after circling the buildings four or five times we finally found the right one. The paramedic grabbed a bag of stuff and gave me a handful of triangular wedges.

“What are these for?”

“Never let a door close behind you. You don’t want to be trapped.” I nodded and we entered the apartment building, the medic in front, me behind, jamming doors open until we came to the proper apartment. We knocked on the door, and a young man from the local immigrant community opened it and beckoned us in. An elderly woman was reclined in a chair, staring at the ceiling and mumbling in a foreign language.

“What happened?” asked the medic.

“She…ah…she fall on ground. Try to stand and then…” he made a hand gesture indicating that she had tried to get out of her chair and had toppled forward. 

“Does she speak any English?”

“No, ah, no English for her. She say it hurt.” The paramedic moved to the woman in the chair and eyeballed her.

“Where does it hurt?” The young man shouted a mouthful of language at the old woman, who shouted another mouthful back at him.

“She…she tell me it hurt. She fall and now it hurt. In everywhere.” The medic sighed. Assessment is hard enough when you can communicate, but this posed a whole new set of challenges.

“Alright, let’s figure this out.” The medic and I talked to the old woman through her son and looked her over. No bleeding, no open fractures, nothing seriously wrong jumped out at us. I pressed on her hip bones as we had been instructed to do in class, and they felt normal to me; also the old woman didn’t scream in agony when I pressed her hips, which we had been told would be a good indicator that we had discovered a broken hip.

Unable to discern any obvious injuries, the medic instructed me to help him stand the old woman up. 

“Shouldn’t we get the stretcher for her?”

“She can walk. Remember the ABCs kid.”

“Airway Breathing Circulation?”

“No… Ambulate Before Carry.”

We walked the old woman to the ambulance outside and managed to maneuver her into the back and onto the stretcher. Her son rode in the front seat and translated for us through the window between cab and compartment. We took vitals, ran an EKG strip, pawed through the giant sack of meds her son had produced from the refrigerator at home. Nothing seemed out of place except “she say it hurt.” We patched through to the hospital, dropped her off, and returned to service. 

Later in the day we happened to stop by the hospital with another patient, and we asked the nurse what they’d found on our old lady.

“Oh, her? Turns out her hip was fractured in a couple places. She’s in surgery right now.” The medic and I both stopped in our tracks. A hip fracture? Really? We walked her to the truck! We checked and rechecked for fractures! How could we have possibly missed that? I looked at the medic and he looked at me. 

“Whoops,” he said.

      
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