Needle In a Racetrack

     It seemed the rain would never stop, but the sun finally came out, and the springtime Friday evening was an invitation to outdoor activities. The Attack One crew had eaten an early dinner, anticipating a busy evening. Almost on cue, the tones drop for a person injured at a popular local minicar racetrack, where amateurs try their driving skills against the clock.

     An excited staff member directs the arriving crew to the outside fence, where a car has driven off the track. A crowd has surrounded the injured young female driver, who is still in the car and partially wrapped in the chain-link fence surrounding the track. The miniature car lays on its side, leaking a small amount of fuel. The woman is still in her helmet, which resembles a football helmet without the facepiece. The muddy ground is soaking up the fuel, but makes working around the woman more difficult. One of the bystanders has placed a piece of towel on the young woman's face, which has bled.

     She can speak, and complains of right arm pain—there's an obvious forearm fracture—and pain around the right side of her face near her eye. She recalls that she lost control of the car, slid on mud and slammed into the fence. She never lost consciousness. Her seat belt system is still in place, and her chest, abdomen and lower body are uninjured. The helmet protected all of her head but her face. She has no neck pain.

     The Attack One crew and track staff agree it will be easiest to quickly cut through the lightweight fence, slide the patient out, upright the car and contain the small fuel spill. They will need to keep the patient calm, in her helmet and belted until the chain link can be cut and pulled away. It is easy to splint her injured forearm, and distal pulses and capillary refill, intact before, remain so after the splint is applied. The towel on her face is replaced with a large dressing pad. She has lacerations around her right eye and some dried blood, but there is no active bleeding.

     The fence is cut with simple tools and pulled away from the patient and vehicle. The restraint system is opened, and the patient is allowed to climb out. Several bystanders assist in moving the car to an upright position, and staff push it back toward the track. A fuel-absorbent material is placed on the spill. The patient is placed on a stretcher with her head upright and arm splinted. Under their cervical spine clearance protocol, there is no indication for the crew to perform spinal immobilization. The stretcher and patient are wheeled to the ambulance and loaded. It's a muddy mess, but the patient is comfortable with her arm splinted and in a sling, and it's now possible to clean up her face.

     The dressing pad is removed, and the crew prepares some saline-soaked 4 x 4 pads to clean the area. There is an extensive cut across the eyebrow, another below the eye on the right side, and another on that side of her nose. There is mud splashed into the area, and the mixture of mud and blood has caked firmly in some places around her face. As they clean the mess, the crew can examine her eye. And as the wet dressings remove more of the mixture, a problem becomes suddenly obvious: The entire upper eyelid is missing!

     The concern on the crew's faces is quickly apparent to the patient, and for the first time she realizes she can't blink or close her eye. Carefully and gently, the paramedic cleans the area around the eye and compresses the bleeding from the lacerations. The eye itself appears uninjured, and the patient says she can see fine out of it. Wondering what's wrong, she asks the paramedic why she can't get her eyelid to close. Gently and politely he reports that the upper eyelid is missing, and asks the patient if she knows where it might be.

     "It all happened too fast," she says. "I saw the fence coming at me and put my arm out. My face went into the fence and mud, and I was on my side. I knew my wrist hurt, but didn't think anything else was wrong."