In the early morning hours, the Attack One crew receives a simple communication from dispatch: “Person injured, police on scene.”
The crew finds a young male patient in handcuffs in the backseat of a police cruiser. The police officer in the front simply says, “The guy hurt something.”
The patient, although a little disrespectful of the paramedic, reports that “Something is bad down there.” Since his hands are cuffed behind his back and the cruiser is small and dark, it is difficult to figure out what he’s referring to.
“Can we walk you to the ambulance and see what’s injured?” the paramedic asks.
“It hurts to walk,” the patient replies, “but it hurts worse to sit here.”
The officer just says OK to the idea of examining the patient in the ambulance.
The patient slides gently out of the cruiser, and the Attack One crew notes he’s dressed only in a t-shirt and a pair of red boxer shorts. He walks with his legs wide apart for the few steps to the ambulance, then sits straddling the stretcher. “It hurts bad down there,” is all he will say.
“Before we examine you, can you tell us what happened and where the rest of your clothes are?”
The patient will not reply. The police officer finally reports that the patient was driving a car trying to evade them, then got it stuck in mud on the country road. He ran from officers into a field and tried to climb over a barbed-wire fence. He got caught on the fence and started screaming in pain. He was lifted off the wire by a pair of police officers, and was handcuffed and walked to the cruiser. He complained of pain, so they activated EMS. The patient won’t discuss what caused the event, saying only that he hurts. He denies any other injuries.
The lead EMT turns the lights on bright, asks the patient to lie back on the stretcher, uses a sheet to maintain some modesty and cuts the patient’s shorts off using trauma scissors along the outside seams. There is some clotted blood attaching the shorts to the patient’s perineum, and as the EMT slowly tries to peel the shorts away, the patient howls in pain. With a promise to move very slowly, the EMT tries to finish the job. He finds more blood and clots, and finally realizes he cannot find the injury, separate the patient’s shorts from his perineum and keep the patient from screaming. He decides he will use some saline to clean the area, and hopefully make it easier to remove the shorts and find where the blood is coming from.
As they lift the patient to place some towels underneath him and start to pour some saline on the area, the patient shrieks again. “You guys are killing me! Stop, that hurts like crazy!” the patient wails. “That cold water makes it worse! Stop!”
His statements become increasingly descriptive, so the paramedic proposes a different plan: “Let’s have you stand up, and we’ll just let the shorts fall down.” The new plan works: As the patient stands up, the crew gently tugs on the back of his shorts, and they fall to the floor of the ambulance. The shorts have a large, jagged tear in the middle of the crotch and are filled with blood. The patient lies down on the stretcher, and it is now possible to examine him.
The paramedic finds the patient has a large laceration extending along his scrotum for about 10 centimeters. And although the paramedic has never seen them directly before, he notes that what appears to be both of the young man’s testicles are lying in the wound. There is no active bleeding, the man’s penis is not injured, and there are only a few other scratches in the area.
“OK, sir, we can now see you have a cut to your scrotum,” he tells the man. “The bleeding is controlled, but we can see why you were uncomfortable with the cold water. Your testicles are in the cut. Right now it does not appear they are injured, but I cannot tell for sure. Those are very sensitive to cold, so we will not use anything cold in the area.”