One day we were called to a job in a local factory. The factory produced, among other things, corrugated steel sheeting for roofing and other uses. One particular machine corrugated the steel sheets. A plain sheet of steel was fed into a slot on top of and the machine spat it out corrugated. Apparently the machine was prone to jamming and required frequent maintenance. This afternoon the machine had jammed and due to the pressure to get the current order out of the door, the operator had tried to help by climbing onto the machine and giving the stuck sheet a kick. It worked and the sheet flowed into the machine to be corrugated. Unfortunately the rollers also grabbed the lad’s boot and dragged his foot in too.
When we arrived the fire service had already arrived, the factory supervisor had rung them first since the lad, Rob, was trapped in the machine. I climbed up a set of step ladders and joined Rob and two fire fighters on the top of the machine. The fire fighters had dismantled part of the machine and just freed Rob’s foot. He was fully alert and while his foot was trapped had not really been in much pain, just his left leg felt numb. Now the leg was free the pain started. I started him off with some pain relieving gas, entonox. There was no sign of active bleeding so we carefully passed him down from the top of the machine to my mate Tony and a group of firemen at the base of the machine and they placed him on the ambulance stretcher Tony had prepared. Once on the ambulance we could have a closer look.
The skin on Rob’s foot had been stripped from above the ankle and was all bunched up around his toes. A single, thin and very stretched strand of skin joined this skin to the skin above the injury. The tendons and bones of Rob’s foot were exposed and it reminded me of one of the model feet you see in anatomy class (and also in art schools life art classes!) to show the students the underlying structure of the foot. The term for this injury is ‘degloved’ and applies to hand and feet injuries where the skin is fully or partially removed as in taking off a glove. The term applies to feet as well as hands, there’s no such term as far as I know as ‘desocked’.
The degloved tissue was very cold to touch, numb and pale which told us there was virtually no remaining blood supply – a time critical emergency as without quickly restoring the circulation Rob would lose the foot. Rob’s pain was increasing now and the entonox was not really helping. Tony checked his baseline observations and I quickly checked there were no other injuries. I gained IV access and gave some IV pain relief to back up the entonox. This was in the days before we were trusted with the controlled drug morphine, a very effective pain reliever and the best we had was called nubain – a synthetic opiate which was supposed to work in the same way but in my experience didn’t help people much, nowhere near as effective as the morphine we carry now.
This was also before we had trauma centres we could take serious injuries such as this one to where all the specialist staff are in one place, we had to take Rob to the local Emergency Department (ED) where he would be assessed by the ED doctors and then referred on to a specialist unit.
On the short ride to the local ED two things were worrying him: the first was that he played football for a pub team and was supposed to be playing the next weekend. I said he probably wouldn’t make the match, he jokingly asked if he’d be OK to play in goal. The second worry was that he was getting married in a few weeks. The thought of all the surgery he was faced with scared him less than the thought of his future wife’s reaction. I hope it went well for him!